What are the chances of miscarriage after 20 weeks
Understanding Second Trimester Loss | Obstetrics and Gynecology
Pregnancy loss in the second trimester can be the result of a very preterm delivery (like a spontaneous miscarriage in the second trimester) or death of the fetus (called a fetal demise). About 2-3% of pregnancies will be lost in the second trimester, a rate that is much lower than in the first trimester. Once a pregnancy gets to about 20 weeks gestation, less than 0.5% will end in a fetal demise.
A loss at this time in pregnancy is most often a hard and sad experience. Many friends and family already know you are pregnant. What do you do? What do you say? For most women and their partners, the process of grieving is no different than losing a person who has been in your life for some time. You often have hopes and dreams about your child before that child is born, and losing the pregnancy in the second or third trimester is certainly a loss for a family.
Why see a UC Davis Health specialist?
Our specialists can evaluate you quickly in an office setting. Any laboratory testing or ultrasound examinations that need to be done can be performed easily and conveniently. We perform our own ultrasound examination in the office and can share the results with you immediately. Treatment of a second trimester loss is very different than early miscarriage, and our specialists can provide all options to you and your family. We understand that losses at this time require both emotional and medical support. We are happy to review all treatment options but also know that you may need some time. It is also important for you to know that a fetal demise in the second trimester is not a medical emergency so treatment is not immediately indicated.
If you are having very heavy vaginal bleeding or are feeling very sick, you should go to the Emergency Room to see our physicians.
Symptoms of a second trimester loss
- Bleeding: Most commonly, bleeding is a sign of a problem with the placenta and does not indicate a fetal demise. But, bleeding can be a sign that the cervix is opening without labor (called cervical insufficiency).
With cervical insufficiency, the cervix begins to open early without contractions; as the cervix opens more, contractions then follow. - Cramping: Pregnancy losses in the second trimester can be due to early labor.
- Loss of fetal movement: This can indicate a fetal demise. Most women can feel the baby moving by the 20th week. If the baby has been moving and you no longer feel that same movement, it is important to contact the doctor’s office immediately to make sure the baby is fine. Decreased fetal movement is more commonly a sign that there is a problem with the pregnancy and only rarely does it mean the fetus has died.
Most women less than 20 weeks of pregnancy do not notice any symptoms of a fetal demise.
The test used to check for a fetal demise in the second trimester is an ultrasound examination to see if the baby is moving and growing. Fetal demise is diagnosed when the ultrasound examination shows no fetal heart activity.
What causes a second trimester loss?
The causes of a pregnancy loss in the second trimester are very different than early pregnancy loss.
There are medical conditions that increase the risk for cervical insufficiency or preterm labor before viability which include:
- Prior surgery to the cervix
- Use of illicit drugs, especially cocaine
- Fetal abnormalities (genetic or structural problems)
- Uterine infection (this is more common in developing countries and less common in the United States)
- Physical problems with the uterus, including fibroids or abnormalities in the shape of the uterus
There are also some medical conditions that are associated with fetal death in the second trimester which include:
- Fetal abnormalities (genetic or structural problems)
- Poorly controlled maternal cnoditions like thyroid disease, diabetes or hypertension
- Lupus (systemic lupus erythematosus)
- Autoimmune or genetic conditions that increase a woman’s risk of forming blood clots in her legs or her lungs (like antiphospholipid syndrome)
- Very early pre-eclampsia or eclampsia of pregnancy
- Trauma
The specialists at UC Davis Health will review with you what testing is indicated to help learn more about why a second trimester loss occurred.
Despite the testing that is available, about half of the time there is no identifiable reason for a second trimester loss. We can work with you to figure out what may be helpful with a next pregnancy or to learn more about medical issues that are important for your future.
Treatment of a second trimester loss
It is typically not safe for a woman to wait for the pregnancy to deliver on its own with a second trimester loss. There is a high chance of having significant bleeding when a pregnancy in the second trimester delivers on its own at home. In the case of fetal demise, a dead fetus that has been in the uterus for 4 weeks can cause changes in the body’s clotting system. These changes can put a woman at a much higher chance of significant bleeding if she waits for a long time after the fetal demise to deliver the pregnancy.
Our doctors are committed to providing all available treatment options. Testing to figure out the cause of the pregnancy loss can be performed regardless of the method a woman chooses for termination.
We understand that a second trimester loss is an emotional and stressful time and we want to ensure that the emotional needs of you and your family are met as well. We understand this is a time that you need support and we are sensitive to your wishes for remembrances and religious preferences. We will discuss these issues with you before any treatment.
When a diagnosis of fetal demise in the second or third trimester is made, options include:
- Surgical evacuation: This procedure, called a dilation and evacuation, can be performed in the second trimester, typically up to about 24 weeks. Surgical evacuation is the most common treatment women choose and involves removing the pregnancy through the cervix in the operating room while you are asleep. The cervix needs to be opened about 1-2 inches in diameter. The doctors can use different ways to open the cervix based on how far along the pregnancy is and your individual circumstance. The goal is to provide the safest care for each patient.
After a surgical evacuation, normal activity can typically be resumed the following day. Opening or preparing the cervix for surgical evacuation of the pregnancy may involve: - Medicines (tablets) that are put in the vagina a few hours to one day before the procedure.
- Medicine (tablets) that you hold between your cheek and gums for 30 minutes before swallowing. You would use this medicine a few hours before the procedure.
- Placing thin sticks in your cervix, called osmotic dilators, to absorb water from the cervix which causes the dilator sticks to swell slowly over 4-24 hours. Having the osmotic dilators placed is similar to getting a Pap test.
Labor induction: This treatment uses medicines to cause the uterus to go into labor. For women with pregnancies beyond 24 weeks, this is commonly the only option. If you choose this option, you will be in the Labor and Delivery Unit at UC Davis Medical Center and will have all of the same pain treatments available to you as a woman who is naturally in labor (like IV pain medications or an epidural).
The treatment typically starts with swallowing a pill to make the uterus more sensitive to the medications to induce labor. About 24 hours later, you are admitted to the Labor and Delivery Unit and will have medicine (tablets) put in the vagina every few hours to cause labor. Sometimes, women need medicine through an IV to also help get labor started. It may take 1-2 days for the uterus to go into labor and for the delivery to be complete. Up to 5% of women in the second trimester do not go into labor and need a surgical evacuation.
Your doctor will be able to explain more details about the pros and cons of each treatment.
After treatment of a second trimester loss
Bleeding may continue for several weeks after a labor induction but tends to be much lighter with a surgical evacuation. Any bleeding may change in color from bright red to pink or brown. Lower abdominal cramping in the few days after treatment is also common. You should contact a doctor right away if the bleeding gets heavier instead of lighter over time, if a fever develops, or if vaginal discharge or a strange or unpleasant vaginal odor occurs.
Avoid intercourse, douching, or using tampons for one week. Regular activities can be resumed right away, based on how you feel. Importantly, if you want to delay getting pregnant, it will be very important to start an effective method of contraception.
FAQs about second trimester loss
Q: What is cervical insufficiency?
A: This diagnosis is made when a woman has dilation of the cervix during the second trimester without having any contractions or signs of a uterine infection. Some studies suggest that some types of surgeries performed when women have advanced pre-cancerous changes in the cervix can increase the risk of cervical insufficiency. These surgeries include cervical conization (also known as a “cone biopsy”) or if a patient has had multiple LEEP procedures. With these surgeries, part of the cervix is removed to get rid of the pre-cancerous changes. Having these procedures increases the risk of having a second trimester loss by about 1%.
In women who have these types of procedures, the chance of having cervical insufficiency is about 1.5%.
Q: What treatments are available if one of the tests shows I have a medical problem that increased the chance of a second trimester loss?
A: Our specialists will work with you to maximize your health status before you try to get pregnant again. For some women, this may mean treatment of a thyroid condition, improved control of diabetes, or changing medications being used for chronic illnesses. Some conditions may require blood thinners like aspirin or injectable medications that should be started early in the next pregnancy (after a normal pregnancy is seen with an early ultrasound exam).
Q: In my last pregnancy, I didn’t get any genetic testing and had a second trimester demise related to a genetic abnormality. What genetic testing is available for my next pregnancy to help figure out if the pregnancy is normal so I can learn earlier if the pregnancy is genetically normal?
A: It will be important to meet with a genetic counselor, if possible, before your next pregnancy, who can also review the details of the available tests.
The counselor can also talk with you more about your history and your family history to make sure no genetic or familial medical problems are missed. There are a few different tests, all of which can be performed early in pregnancy, depending on what is right for you. Screening for some of the most common chromosomal abnormalities just from your blood (called NIPT or non-invasive prenatal testing). First trimester screening can be performed between 11 and 14 weeks which involves a blood test and an ultrasound examination. In some situations, chorionic villus sampling (a biopsy of the placenta) or expanded prenatal screening may be indicated. Our specialists and genetic counselors can work with you and your family to help you understand all of these tests and figure out what approach is right for you.
Q: After a second trimester loss, how long should I wait before I try to conceive again?
A: There is really no good information available to show the absolute right answer to that question.
First, it may take a month or two to have any testing completed to help figure out why you had a second trimester loss. We know that it takes some time for your uterus and your body to get back to normal. The specialists at UC Davis usually recommend waiting at least 3 months after a second trimester loss before trying again to get pregnant.
Miscarriage rates by week: Risks and statistics
Miscarriage rates by week vary from person to person. However, the chance of experiencing a miscarriage, or a pregnancy loss, starts to drop as the pregnancy progresses.
The risk figures for pregnancy loss are just averages, so each person’s chance may be higher or lower depending on a range of factors.
A pregnancy loss can occur before a person even knows that they are pregnant. After an ultrasound detects a healthy heartbeat, the chance of pregnancy loss is significantly lower. If a person knows about the pregnancy, the chance of loss is about 10–15%.
A pregnancy loss is the loss of a fetus that occurs before 20 weeks of gestation.
A stillbirth is a pregnancy loss that happens any time after 20 weeks.
In this article, learn more about average miscarriage rates by week. This article also covers signs of pregnancy loss.
Most pregnancy losses are due to factors that the person cannot control. Early in pregnancy, genetic issues are a major cause of miscarriage.
Around 80% of pregnancy losses occur during the first trimester, which is between 0 and 13 weeks.
Although the loss is often devastating, these genetic issues mean that the baby could not have survived outside the womb. Even if a person has this type of pregnancy loss, they are generally able to go on to have a healthy pregnancy in the future.
Fetuses are most vulnerable early in development, so other factors — such as exposure to alcohol — can have the most damaging effects at this time. This is why most miscarriages occur early in pregnancy.
As the fetus gets stronger, it may be less vulnerable to harm. Also, people may change any potentially damaging lifestyle habits they have once they know that they are pregnant.
A general estimate of miscarriage risk by week is as follows.
Weeks 3–4
Implantation usually occurs around 3 weeks after a person’s last period and about a week after ovulation. By week 4, they may be able to get a positive result on a home pregnancy test.
As many as 50–75% of pregnancies end before getting a positive result on a pregnancy test. Most people will never know that they were pregnant, though some may suspect that they were because of pregnancy loss symptoms.
Week 5
The rate of miscarriage at this point varies significantly. One 2013 study found that the overall chance of losing a pregnancy after week 5 is 21.3%.
Weeks 6–7
The same study suggested that after week 6, the rate of loss drops to 5%. In most cases, it is possible to detect a heartbeat on an ultrasound around week 6.
Weeks 8–13
In the second half of the first trimester, the rate of miscarriage seems to be 2–4%.
Weeks 14–20
Between weeks 14 and 20, the chance of experiencing a miscarriage is less than 1%.
By week 20, a pregnancy loss is known as a stillbirth, and this may cause a person to go into labor.
Stillbirth is relatively rare and is getting rarer because very young babies may be able to survive outside the womb thanks to modern technology.
According to a research group based in the United Kingdom, there is a minimal chance that a baby born at 22 weeks will survive. That chance increases each week.
Will I experience a pregnancy loss?
A 2012 study looked at the overall chance of pregnancy loss during the first and second trimesters and found it to be between 11–22% in weeks 5 through 20. Other research puts the percentage at around 10–15%.
These statistics suggest that the chance of pregnancy varies from person to person depending on a variety of factors, including their age and overall health.
Age is a major risk factor for pregnancy loss. This is because egg quality tends to decline over time.
The average chance of miscarriage by the age of the pregnant person is as follows:
- Under 35 years old: There is a 15% chance of pregnancy loss.
- Between 35 and 45 years old: There is a 20–35% chance of pregnancy loss.
- Over 45 years old: There is a roughly 50% chance of pregnancy loss.
It is essential to note that these are average figures and do not take any other factors into account.
The effects of lifestyle issues, such as smoking or having a sedentary lifestyle, can also accumulate with age. This may worsen underlying health issues and further increase the chance of pregnancy loss.
All that said, some people have healthy pregnancies in their 40s, and a few do so in their 50s.
Most people who experience a pregnancy loss go on to have healthy pregnancies in the future. Having a single miscarriage does not mean that a person will have difficulty getting or staying pregnant in the future.
In fact, one 2016 study found that people are more likely to get pregnant again immediately after experiencing a pregnancy loss.
Some people ask for genetic testing following one or more pregnancy losses.
Genetic testing may help a doctor understand the cause of pregnancy loss.
Some risk factors for pregnancy loss include:
- being older
- smoking
- using certain drugs, especially stimulant drugs such as cocaine or high amounts of caffeine
- having an uncontrolled chronic condition, such as diabetes or high blood pressure
- having a hormonal disorder that makes it difficult for the body to produce hormones to sustain the pregnancy
Most of the time, the earliest sign of a miscarriage is bleeding. However, not all bleeding is due to a pregnancy loss.
Some people experience spotting during pregnancy. Bleeding is more likely to indicate a miscarriage when it is heavy, gets heavier with time, or occurs with intense cramps.
A miscarriage can also happen without bleeding.
Some other symptoms of a pregnancy loss include:
- a sudden reduction in pregnancy symptoms, though symptoms can decrease even without a miscarriage due to fluctuating hormones
- a decrease in the fetus’s movements in the second trimester
- intense cramps
- passing blood clots
A person should speak with a doctor about any bleeding they experience during pregnancy.
If the bleeding is heavy or painful, it is best to go to the emergency room.
Some other symptoms to monitor for include:
- cramps
- a reduction in pregnancy symptoms
- not feeling the fetus move after regularly experiencing movement
Most pregnancies end with a healthy birth, even if the person has a previous history of or risk factors for a miscarriage.
There is no right or wrong way to react to a pregnancy loss. The experience can be emotional or spur doubts about future pregnancies. Conversely, some people are surprised that they do not have a strong reaction to a pregnancy loss.
A pregnancy loss is not anyone’s fault. Most people can have a healthy pregnancy following a miscarriage.
Receiving quality medical care, having support from one’s friends and family, and taking time to heal can help people manage the process.
Miscarriage, how to avoid - Planning and management of pregnancy in the gynecology of the Literary Fund polyclinic after a miscarriage
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A miscarriage is always associated with severe consequences for the whole body of a woman and for her reproductive organs in particular, it also affects the family situation, disrupts the woman's work schedule.
An unfavorable outcome of pregnancy requires great mental and physical costs on the part of parents. Therefore, contacting doctors to find out the causes of the problem is the very first and correct step towards the birth of a child.
Any competent gynecologist will tell you that the problem of miscarriage can be solved. With proper preparation for pregnancy and its management, the next time you will have a successful pregnancy. Most girls after a miscarriage go to extremes: they try to get pregnant again as soon as possible. And if this succeeds, then the miscarriage is very often repeated. And you need to give the body a rest for 2-3 months, then identify and eliminate the cause. And only then try.
Causes of miscarriage
Many are convinced that miscarriages are due to a fall, bruise, or some other physical shock. Any woman who has had a miscarriage can remember that not long before she either fell or lifted something heavy. And I am sure that she lost her unborn child precisely because of this.
However, those women whose pregnancy was normal also fall and lift heavy things. Most sudden miscarriages do not occur for this reason. The reason is in violations of the pregnancy itself. Approximately half of miscarriages are due to abnormal genetic development of the fetus, which can be hereditary or accidental. Merciful nature, following the principles of natural selection in everything, destroys the defective and unviable fetus. But you should not be afraid of this. The fact that there is a defect in one embryo does not mean at all that all the others will be the same.
The woman's body is almost always to blame for the other half of miscarriages. They are caused by various known and unknown factors, such as: acute infectious diseases suffered in the first trimester of pregnancy, poor environment or difficult working conditions, excessive psychological or physical stress, abnormal development of the uterus, radiation, alcohol, smoking and certain types of drugs.
The causes of early and late miscarriage may differ, although they may overlap.
The most important thing is to find out and eliminate or compensate for your own cause of miscarriage. Having discovered the cause, the gynecologist will tell you how to avoid another loss.
Miscarriage
Miscarriage statistics also include “missed pregnancy”. Sometimes it happens that the embryo dies and lingers in the uterine cavity. Most often, this fact is detected by ultrasound. The dead fetus may begin to decompose, and this, thereby, will lead to poisoning of the mother's body.
Doctors resort to surgical curettage, which is associated with a risk of inflammation and complications. With such a miscarriage, the next pregnancy is planned after the body is fully restored - not earlier than a year. During this year, you will have to find out the cause of the missed pregnancy and treat it.
Miscarriage up to 6 weeks
The main causes of miscarriage on this line are malformations of the embryo itself. Statistics say that from 70-90% of embryos had chromosomal abnormalities: they are random and will not occur in other pregnancies.
You may have been ill, taken medication, or were under the influence of other harmful factors. Fate saved you from a child with malformations.
The human body is perfect and finds a way to correct the situation by miscarriage. Today is a tragedy for you. The real tragedy would be the preservation and birth of a sick, non-viable child. So don’t cry and understand: everything is for the best, you won’t help grief with tears ... And after three months, try again - it will almost certainly turn out to be successful.
It should also be noted that the fact of a miscarriage does not mean that you have lost something. So for a period of 7-8 weeks, the absence of an embryo in the fetal egg is found - "anembryony". It is believed that in 80-90% of cases, miscarriages are undiagnosed non-developing pregnancies.
Miscarriage between 6 and 12 weeks
Miscarriage in this period is also considered early. Its most common causes are:
Endocrine disorders
Endocrine disorders, when the ovaries do not synthesize enough hormones to keep the fetus in the womb, or the amount of male sex hormones is increased, is one of the most common causes of miscarriage and miscarriage.
Imbalance of hormones in a woman's body is very likely to lead to an early termination of pregnancy. With a lack of the main hormone progesterone produced by the ovaries, this happens most often. Another hormonal problem is an increase in the tone of the uterus, which provokes the expulsion of the fetus.
Progesterone prepares the uterine mucosa for implantation and is the hormone for maintaining pregnancy in the first months. If conception occurs, the fetus cannot properly establish itself in the uterus. As a result, the fertilized egg is rejected. But pregnancy can be saved with the help of progesterone preparations if this problem is detected in time.
An excess of male sex hormones that suppress the production of estrogen and progesterone can also be the cause of an early miscarriage. Often, the cause of recurrent miscarriages are androgens that affect the formation and development of pregnancy; as well as thyroid and adrenal hormones. Therefore, a change in the function of these glands can lead to miscarriage.
Undertreated sexual infections
This problem must be solved before conception. Often the cause of miscarriage is sexually transmitted infections: syphilis, trichomoniasis, toxoplasmosis, chlamydia, cytomegalovirus and herpetic infections. Their effect on the fetus and the course of pregnancy is different for each woman and depends on the timing of infection, the activity of the microorganism, the degree of immune protection and the presence of other adverse factors. Depending on the situation, they can lead to the formation of fetal malformations, intrauterine infection, feto-placental insufficiency, early miscarriage or premature birth. Infection of the fetus and damage to the membrane of the fetus leads to miscarriage. To avoid this, infections should be treated before pregnancy. The use of therapy is possible during pregnancy as prescribed by a doctor.
Viral infections and other diseases
Any disease accompanied by intoxication and fever above 38 about C can lead to a miscarriage.
Rubella, influenza and viral hepatitis occupy a leading position in this list. At a period of 4-10 weeks for pregnancy, ordinary tonsillitis can also become tragic, pneumonia carries a more serious risk. Pyelonephritis and appendicitis can cause early labor. When planning a pregnancy, it is imperative to undergo a medical examination in order to identify and treat foci of infections.
Extremely dangerous during pregnancy rubella - it leads to severe fetal malformations, so infection during pregnancy is an indication for medical abortion.
Any disease during pregnancy can lead to non-viability of the fetus. And the body, through a miscarriage, insures you against unwanted offspring. With such a miscarriage, the next pregnancy has every chance of going well.
Immune causes of miscarriage
Sometimes antibodies that are hostile to the fetus are formed in the blood of a pregnant woman. This cause can be predicted and eliminated in advance.
Most often, the conflict occurs when the embryo inherits the positive Rh factor of the father, and the negative Rh factor, the mother's body rejects the embryonic tissues that are alien to it. Constant monitoring of antibody titer and the introduction of anti-Rhesus immunoglobulins allows you to maintain and maintain pregnancy. In case of an immune conflict, progesterone preparations are also used to prevent miscarriage, which in this case has an immunomodulatory effect.
Reduced immunity
Reduced immunity during pregnancy also refers to immune causes. The body is simply not able to grow a new life in itself. You need to take care of yourself and recover before the next conception.
Anatomical causes of miscarriage
Anatomical causes of miscarriage are the most intractable. Malformations of the uterus are a serious reason for miscarriage. Sometimes you just have to deal with it.
Miscarriage between 12 and 22 weeks
Such a miscarriage is considered late.
Its causes coincide with the causes of miscarriages in the early stages (anatomical, immune, infectious, endocrine).
At this time, miscarriage also occurs due to isthmic-cervical insufficiency - a weak cervix cannot hold the fetus and opens. For this reason, a miscarriage can occur in the 2nd or 3rd trimester. Isthmic-cervical insufficiency is observed in 15.0-42.7% of women suffering from miscarriage. Careful monitoring of the pregnant woman allows you to identify the problem in time and make surgical correction of the cervix before the onset of childbirth.
In isthmic-cervical insufficiency, there is only one method of treatment - mechanical narrowing of the cervical canal. To do this, the neck is either sewn up or a special ring is put on it. However, the latter method is less efficient, because the ring can easily slide off the neck, then it will no longer hold back the process of opening it.
After suturing, if necessary, it is possible to use antibiotics and drugs that normalize the microflora of the vagina.
The treatment of the vagina and the control of the state of the seams are carried out daily for 5 days. Stitches are removed at 37-38 weeks and with premature onset of labor.
Isthmic-cervical insufficiency may be primary (for no apparent reason), may be the result of abortion or hormonal disorders (increased levels of androgens - male sex hormones or their precursors).
Miscarriage after 22 weeks
Such a loss is hard to forget. Obstetricians talk about premature birth after the 28th week of pregnancy. Traditionally, a child born after this period is considered viable. But medicine knows many cases when it was possible to save the life of earlier children.
We recommend that you be carefully examined for miscarriage, check the above factors. In addition to them, the cause of a miscarriage can be antiphospholipid syndrome, while the woman's body perceives the child as something alien and rejects it. This disease, like the others listed, can be corrected; you have a very real chance of bearing a child.
Miscarriages due to hemostasis disorders
All of the above causes account for only 30-40%. Up to 70% of miscarriages are caused by disorders in the blood coagulation system (hemostasis).
Blood coagulation disorders leading to pregnancy loss can be divided into thrombophilic (increased clotting) and hemorrhagic (bleeding tendencies). Both of these extremes are dangerous to the fetus. Various disorders leading to the formation of small blood clots lead to the fact that the fetus loses sufficient blood supply, development is disturbed and the fetus is rejected.
The main hemorrhagic changes can appear even in childhood in the form of increased bleeding during cuts, tooth extractions, the onset of menstruation. But sometimes they declare themselves only during pregnancy and are the cause of a miscarriage. Bleeding in the early stages and detachment of the chorion is difficult to stop.
You may not guess, but incomprehensible headaches, weakness, fatigue, temporary loss of smell or hearing may be symptoms of disorders in the blood coagulation system.
When planning a pregnancy, a genetic examination should be carried out and, if necessary, treatment should be started.
It is advisable to be examined for hidden hemostasis defects even for those who consider themselves healthy. This will allow you to predict the occurrence of complications and prevent loss. Early therapy can prevent miscarriage at 98% of cases. If defects in hemostasis are already detected during pregnancy, it can be difficult to maintain it.
What to do after a miscarriage?
Find the cause! The ideal option is to be examined by future parents: it is much more reasonable to postpone conception and spend two or three months to identify the causes than to risk getting pregnant again, spend two months waiting, and then lose everything again and still go to the doctors.
Until you understand the reason, it will not evaporate. In most cases, the answers lie on the surface. Take care of your health and your future baby.
Sign up for a consultation with an obstetrician-gynecologist by phone +7 (495) 150-60-01
Tyan Oksana Alexandrovna
Head of the department, obstetrician-gynecologist Doctor of the highest category Work experience: 26 years
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Obstetrician-gynecologist, doctor of ultrasound diagnostics Doctor of the highest category Experience: 35 years
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Obstetrician-gynecologist, ultrasound specialist Work experience: 35 years
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Obstetrician-gynecologist, doctor of ultrasound diagnostics Doctor of the first category Work experience: 37 years
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The threat of miscarriage: how to recognize and prevent
Pregnancy is a period of life that is extremely important for any woman.
However, it is at this stage that the body loses most of its protective properties, becoming more vulnerable to adverse factors, especially in the case of existing health problems. According to disappointing statistics, about 15% of all clinically confirmed pregnancies end in the loss of the baby, and with a diagnosis of “ threatened miscarriage "Every second expectant mother is familiar firsthand.
What is a miscarriage?
Miscarriage is an involuntary termination of pregnancy that occurs before 20 weeks of gestation, when the weight of the fetus does not exceed 500 grams. More than 80% of miscarriages occur early up to 12 weeks. It is at this time that the initial laying of the organs of the fetus occurs, and therefore any impact can be negative. Often, the woman herself, not knowing about her pregnancy, perceives the bleeding that has arisen as the monthly onset of the menstrual cycle. This situation is dangerous and can cause serious complications in case of incomplete expulsion from the fetus.
If the threat of miscarriage occurs after 22 weeks, then we are talking about premature birth and born babies weighing more than 650 grams. can be successfully cared for thanks to the achievements of modern medicine and the experience of doctors.
Symptoms that must not be ignored
The fact that the pregnancy is at risk of miscarriage is indicated by the onset of vaginal bleeding. Whatever its intensity, duration and color saturation, this is a signal that you should immediately seek help from a specialist.
A no less alarming sign is a pulling pain that has appeared in the lower abdomen. Painful sensations radiating to the sacrum or inguinal region indicate the presence of uterine hypertonicity and an attempt by the body to get rid of the developing fetus.
The causes of bleeding and discomfort may be less serious, but these symptoms should definitely not be ignored. If the expectant mother is given a disappointing diagnosis, the task of the doctors is to do everything possible to keep the pregnancy until a safe period.
The main reasons causing the threat of abortion
The threat of miscarriage can be provoked by a number of reasons and not in every case it is possible to establish the true problem. And, nevertheless, every woman should be aware of the factors that can lead to termination of pregnancy:
- Any inflammatory and infectious diseases in which the body temperature rises above 38’C is a serious threat to pregnancy. The leaders who appear among the first on this list are rubella, chlamydia, hepatitis, taxoplasmosis, syphilis. Even the sore throat familiar to everyone at the initial stage can be fatal.
- Progesterone, a hormone produced initially by the yellow egg and later by the placenta, is essential for maintaining pregnancy and fetal development. A lack of progesterone can lead to the rejection of an already fertilized egg. An excess of male hormones is another reason for abortion, as it suppresses the production of female hormones.
- Severe stress, along with heavy physical labor and an unhealthy lifestyle, exhaust the expectant mother's body, making it unable to bear the fetus for the required period. In case of excessive emotional stress, the doctor decides on the need to prescribe sedatives.
- A variety of gynecological problems, such as the presence of sutures or abnormal development of the uterus, pose a serious threat to gestation. The non-standard shape (two-horned, saddle-shaped) does not allow the fertilized egg to gain a foothold and stay in the endometrium.
- Uncontrolled use of various medications during pregnancy can cause miscarriage. Even herbs that seem safe at first glance should be used only in advance, after consulting with an experienced doctor.
- Genetic anomalies in the development of the fetus - the main reason why there is a threat of miscarriage . Pathology is the result of a single mutation, in which the development of the embryo stops, which leads to its subsequent death.
The development of such pathologies is perhaps the only one of the factors listed above, in which medicine is powerless.
Who is at additional risk?
Not a single woman is insured against involuntary termination of pregnancy, and yet there are a number of factors that increase the risk and require more attention from the expectant mother and additional control from the attending physician:
- If the expectant mother's age exceeds 35 years, the risk of miscarriage increases significantly. After a series of studies, doctors say that the risk of abortion after 30 years increases by 2 times, after 40 years the probability of carrying a child decreases to 20%. Doctors attribute this problem to the aging of the eggs, which nature endows a woman at birth and lose their vitality as they get older. Past diseases, the accumulation of toxic substances adversely affect the ability of eggs to conceive.
- If a woman has chronic and endocrine diseases, it is necessary to inform the attending physician even before the onset of pregnancy.
Often such a problem as diabetes develops in parallel with the growth of the fetus. Being under the constant supervision of a specialist, a woman increases the chances of bringing a long-awaited child to a safe date. - A new pregnancy shortly after a recent birth is a serious factor that can lead to the inability of the body to bear the baby. According to doctors, you should beware of a new pregnancy for at least three months after giving birth.
- If a woman previously faced the problem of spontaneous abortion, the threat of miscarriage will be present during the subsequent conception. According to the observations of experts, in the case of two miscarriages following each other, almost every new pregnancy cannot be saved until the end, if the necessary examination has not been carried out beforehand and the appropriate treatment has not been received.
- Medicine knows many cases when the genetic incompatibility of the father and mother led to the rejection of the fetus.
At the highest risk are parents who do not match the Rh factor of the blood. If the mother has a negative and the father has a positive Rh factor, a situation may arise in which the female body, perceiving the developing fetus as a foreign body, tries by all means to get rid of it. - Modern women prefer to lead an active lifestyle and work until late. On the one hand, such activity can only be welcomed, since physical mobility helps the expectant mother to more easily endure the rather difficult process of the upcoming birth. However, if a woman has to constantly experience excessive loads, lift weights, then this is a serious reason to think about changing jobs or going on maternity leave as soon as possible.
What should I do if I suspect a threatened miscarriage?
Even with the slightest suspicion, a specialist should be contacted immediately. It is very important to maintain a sober mind and not panic. Your calmness and timely medical care in most cases help to keep the pregnancy.
If you notice bloody discharge, indicating a possible detachment of the chorion - the membranes of the embryo, with which it is held on the walls of the uterus, you should lie down and call an ambulance. Trying to get to a medical facility on your own in such a state is not worth it.
If a doctor suspects a threatened miscarriage , a number of tests and examinations will help clarify the situation and identify the degree of danger. First of all, the specialist will check the heartbeat of the developing fetus. Ultrasound examination will help to find out about the condition of the placenta and embryo, as well as show possible pathologies of the structure of the uterus. Examination by a gynecologist will determine the presence of tone.
Treatments
After a thorough examination and determination of the level of danger, the doctor will prescribe maintenance therapy. In the case when the risk of abortion is especially high, the expectant mother is left for treatment in a hospital until her condition stabilizes and the threat of miscarriage is eliminated.
If the condition does not cause serious concern, a woman can be treated at home, subject to the doctor's instructions and maintaining complete calm, for which she will be prescribed sedatives on a natural basis.
Treatment aimed at preserving pregnancy, includes the following stages:
1. Hormonal therapy
If The threat of miscarriage was caused by hormonal disorders, the pregnant woman will be prescribed by the main necessary by hormone - prognostron. Taking drugs (usually "Utrozhestan" or "Dufaston") is prescribed according to a special scheme and is used until a period of 16 weeks is reached. By this time, the mature placenta begins to produce the necessary hormones on its own.
There is no need to obtain hormones artificially, but it is very important to know that the abrupt cessation of progesterone use can cause spontaneous abortion. Cancellation of the drug should occur in stages, by reducing the dose entering the body weekly.
2. Decreased tone
Prescribing antispasmodics can reduce uterine tone and reduce pain. The most common drugs that can be used until the pain disappears completely are papaverine (candles) and drotaverine (tablets).
3. Vitamin support
The expectant mother will be required to take vitamins, which will not only strengthen the body as a whole, but also contribute to the fact that the threat of miscarriage will be minimized. The use of folic acid during the first trimester as a separate drug or as part of a vitamin complex will prevent the development of neural tube defects in the embryo.
How to avoid the threat of miscarriage: preventive measures
Considering the number of factors that affect the course of pregnancy, it is impossible to find a magic formula that will reduce the risk of miscarriage to zero. And yet, some preventive measures will help reduce the risk of complications to the minimum possible: Problems.
