Miscarriage (abortion, miscarriage) The term is commonly used for all forms of early pregnancy loss. The risk of miscarriage, which is one of the most common complications of pregnancy, is seen at an average rate of 5-15%. Spontaneous (spontaneous, natural) abortions occur with symptoms such as more or less vaginal bleeding and pain in the lower abdomen and groin. Spontaneous abortions are examined in four stages: Threat of miscarriage (threatened miscarriage), unstoppable low (inevitable miscarriage)discarding some parts (incomplete miscarriage), to fall completely (complete miscarriage)and stillbirth, which is a form of miscarriage with no symptoms or signs at the beginning but in which fetal heartbeat is not detected by ultrasonic examination (missed miscarriage)categorized as.
Chromosomal defects are common, especially in spontaneous abortions earlier than 10 weeks. 75% of miscarriages in the first trimester are due to chromosomal abnormalities. Chromosomal anomalies; It can occur from poor quality sperm and egg, abnormal cell division in the embryo, genetic abnormalities present in the mother and father. In addition to genetic factors in early pregnancy loss in the first trimester, infectious diseases such as chlamydia, cytomegalovirus, genital herpes, syphilis, toxoplasmosis, rubella, systemic diseases such as diabetes, severe hypertension, renal disease, systemic lupus erythematotus (SLE), untreated thyroid disease ( hypothyroidism, hyperthyroidism), immune system diseases such as antiphospholipid antibody syndrome, luteal phase insufficiency with low progesterone, other abnormal hormone levels, PCOS, smoking, drinking alcohol, excessive caffeine use, substance abuse such as cocaine, advanced maternal age, excessive diet Numerous factors also play a role, such as embryo implantation in the womb, exposure to dangerous environmental toxic substances such as benzene, arsenic or formaldehyde, radiation during or before pregnancy, exposure to NSAIDs and other drugs that have a toxic effect on the embryo. Although it is not common, the risk of miscarriage may occur in other pregnancy months for similar reasons. Abnormal uterine anatomy (septate uterus, unicornus uterus, T-shaped uterus, cervical insufficiency, adhesions in the uterus, fibroids) and environmental factors may be effective in second-trimester miscarriages.
The absence of factor XIII and the complete or partial absence of fibrinogen are mostly associated with recurrent spontaneous abortion (habitual abortion).
It is seen together with vaginal bleeding and pelvic pain in early pregnancy. Various degrees of vaginal bleeding are observed in the first six months in approximately one quarter of all pregnancies; On average, half of these cases end in miscarriage.
In the case of the threat of miscarriage, although pain and vaginal bleeding can be seen in various degrees, there is no opening in the internal canal in the cervix, the piece is not dropped, the gestational sac is clearly observed in the uterus in ultrasonic examination. Embryo and heartbeats are also monitored in pregnancies longer than five weeks. In some cases, bleeding foci (hematoma) can be seen behind the fetal membranes or placenta.
During pregnancy, it causes symptoms such as pain due to uterine contractions in the form of cramps in the groin, and active vaginal bleeding. During an average of two weeks of observation, both the size of the fetus does not change and the beta HCG level decreases. Then the cervical internal os opens and vaginal bleeding continues. Sometimes while the embryo is still alive, sometimes fetal heartbeats cannot be shown, and amniotic fluid may decrease. This situation will inevitably turn into an incomplete abortion after a while.
Incomplete abortion (incomplete miscarriage):
In case of incomplete abortion during pregnancy, painful cramp-like contractions occur. Cramp-like contractions in the uterus and pain in the groin gradually increase, the gestational sac deteriorates, the cervical canal opens, vaginal bleeding with excessive clots, containing fetal tissues, placenta and pieces of membranes is observed. If some parts are still in the uterus despite this bleeding, then incomplete abortion is mentioned. If these parts are not removed by abortion, there may be a risk of infection.
Complete abortion (complete miscarriage):
Patients express inguinal pain, vaginal bleeding and dropping a piece. If all parts of the pregnancy have fallen and the uterus is completely emptied in the ultrasonography, it means that a complete miscarriage has occurred. In this case, the patient’s bleeding gradually decreases, and pelvic pain and cramps disappear. There is no need for abortion.
Missed abortion (miscarriage):
Most of the time, pregnant women are not aware of this situation, but it can be revealed by examination. In the case of missed abortion, the embryo is dead, but the embryo is not thrown out. When the embryo dies, all pregnancy symptoms such as nausea, vomiting and fatigue disappear. In missed abortion, the cervical canal is closed on pelvic examination. The uterus is felt as soft and wide. Fetal heartbeat cannot be observed on ultrasound. This situation must be terminated with dilatation and curettage. In the case of missed abortion, in most cases, the placenta and membranes adhere to the uterine wall, the tissues are organized, and in this case, complications such as bleeding, fragmentation, and perforation of the uterus are more common since the contraction of the uterus will be difficult during the abortion procedure. Therefore, in such cases, abortion should be started after all precautions are taken. After the abortion, the inner wall of the uterus should be checked with ultrasound to see if there are any pieces left.
In the case of miscarriage, the aim of the treatment is to stop bleeding, prevent infection, and thus prevent adhesions in the uterus and clogging of the tubes.
When the risk of miscarriage occurs, if the bleeding is low, the cervix and cervical canal are closed, the gestational sac is smooth and the embryo development is normal in the follow-up according to the week, if the heartbeat is observed and if it is a desired pregnancy, it should be followed. After the necessary drugs are given, bed rest should be recommended to increase the blood flow to the uterus. Sexual life should be postponed until this intermediate bleeding stops.
If the bleeding does not stop, if the gestational sac breaks down, if the embryo’s heartbeat is not monitored, if the cervical canal is opened and the patient begins to drop pieces, abortion should be performed under sterile conditions, and the inside of the uterus should be cleaned and precautions should be taken against infection.
In case of a complete miscarriage, there is no need for abortion, as the placenta and fetal tissues in the uterus will fall completely. This should be proven by ultrasonography.
If the risk of miscarriage starts after the seventh or eighth gestational week, in case of Rh incompatibility, low-dose anti-Rh immunoglobulin injection should be administered to prevent sensitization of the pregnant woman.
Prevention of Miscarriage:
If it is due to low chromosomal anomalies, it is not possible to prevent it. Despite this, in order to prevent miscarriage due to other reasons, it is recommended to do some pre-pregnancy tests to rule out all preventable risks affecting the embryo and to get pregnant after normal conditions are met.
Not smoking, not drinking alcohol, limiting caffeine drinking, taking folic acid, staying at a certain weight within normal limits by being careful not to gain excessive weight, eating healthy, avoiding stress, environmental risks such as radiation, infectious diseases and x-rays, and many risks that can harm the body. Avoiding extreme sports activities is very beneficial in terms of preventing the risk of miscarriage.
Kiss. Dr. Kutlugul Yuksel
Gynecology and Obstetrics Specialist
Malake post date: 05.11.2011