miscarriage. Miscarriage: what it is and why it happens

 

Miscarriage: what it is and why it happens






What is a spontaneous abortion?
A miscarriage (or miscarriage) is the loss of a baby in the first 20 weeks of pregnancy. About 10 to 20% of the pregnancies detected end in a miscarriage and more than 80% of these losses occur before 12 weeks.

This does not include situations in which you lose a fertilized egg before the pregnancy is consolidated. Studies have shown that between 30 and 50 percent of fertilized eggs are lost before or during the implantation process. Often this happens so early in the pregnancy that the woman will have her period more or less on the expected date.
What are the symptoms of a miscarriage?
If you have the following symptoms of spontaneous abortion, call your doctor or midwife right away so you can determine if you have a problem that requires urgent attention:

    Bleeding or vaginal bleeding. This is usually the first symptom of a miscarriage. Keep in mind that one in four pregnant women loses some blood or finds stains on their underwear or toilet paper early in pregnancy, and most of these pregnancies do not end in abortion.

    Abdominal pain. As a rule, the pain starts after you have bled a little. It can be in the form of cramps or be persistent, soft or strong, and feel like a pain in the lower back or pressure in the pelvis.

If you have both abdominal bleeding and pain at the same time, the chances of your pregnancy continuing are much lower.

It is very important to take into account that vaginal bleeding, blood spots and pain at the beginning of pregnancy can also be a sign of an ectopic or molar pregnancy.

If you have these symptoms, call your doctor or midwife right away so you can determine if you need emergency treatment.

Also, if your blood is Rh negative, you may need an immunoglobulin injection two or three days after you notice the first bleeding, unless the baby's father also has Rh negative blood.

Some spontaneous abortions are detected at routine prenatal visits, when the doctor or midwife can not hear the baby's heartbeat or notes that the uterus is not growing as it should. Often the embryo or fetus stopped its development a few weeks before you had symptoms such as bleeding or cramping.

If your doctor thinks you have had an abortion, he will request an ultrasound to check it. Maybe he will also ask for a blood test.
What can cause a miscarriage?
50 to 70% of spontaneous abortions that occur during the first trimester are the result of chromosomal abnormalities in the fertilized egg. Most of the time, this means that the ovum or sperm has the wrong number of chromosomes, and as a result, the fertilized egg can not develop normally.

Sometimes an abortion is a consequence of problems that occur during the delicate process of early development. This includes an ovule that is not implanted properly in the uterus or an embryo that has structural defects that prevent it from developing.

Since most doctors do not do a complete analysis of a healthy woman after she has suffered a first miscarriage, it is often impossible to know with certainty what caused the loss of pregnancy. Even when a detailed evaluation is made (for example, after a patient has had two or three miscarriages in a row), half the time the cause is not found.

When the fertilized ovum presents chromosomal problems, there is a possibility that an anembryonic ovum or anembryonic pregnancy may occur. In this case, the fertilized egg is implanted in the uterus, and the placenta and the gestational sac begin to form, but the embryo interrupts its development very early or does not form at all.

As the placenta begins to secrete hormones, the pregnancy test is positive and you may even have some pregnancy symptoms, but an ultrasound will show that the gestational sac is empty.

In other cases, the embryo develops, but only for a very short time because it has anomalies that make its survival impossible, and the development is interrupted before the heart begins to beat.

However, once the baby's heart starts beating, which can usually be seen by ultrasound around 6 weeks of pregnancy, and you do not have symptoms such as bleeding or cramping similar to menstrual pain, chances of having a miscarriage drop significantly and continue to decrease with each passing week.
What factors increase the risk of having a miscarriage?
Although any woman can have a miscarriage, some are more likely to lose a pregnancy than others. Here is a list of risk factors:

    Age. Older women are more likely to conceive a baby with chromosomal abnormality, and this type of pregnancy is more easily lost. In fact, women in their 40s are twice as likely to suffer an abortion as women in their 20s. Your risk of abortion also increases with each child you expect.

    A history of abortions. Women who have had two or more miscarriages in a row are more likely to have an abortion than other women.

    Diseases and chronic conditions. Some of the conditions that may increase the risk of miscarriage are poorly controlled diabetes, inherited conditions that cause problems with blood clotting, diseases of the immune system (such as antiphospholipid syndrome or lupus) and hormonal conditions (such as polycystic ovary syndrome). ).

    Uterine or cervical problems. Having certain congenital malformations of the uterus, severe uterine adhesions (scar tissue), or a weak cervix (cervical insufficiency) increases the chances of abortion. The relationship between uterine fibroids (a benign tumor) and spontaneous abortion is controversial, but most fibroids do not cause problems.

    A history of birth defects or genetic problems. If you, your partner, or members of your family have a genetic abnormality, have been diagnosed with one in a previous pregnancy, or have had a child with a birth defect, you have a higher risk of miscarriage.

    Infections Research has shown a higher risk of miscarriage if you have listeria, mumps, rubella, measles, cytomegalovirus, parvovirus, gonorrhea, HIV and some other infections.

    Smoking, drinking and using drugs Smoking, consuming alcohol, and using drugs such as cocaine and ecstasy during pregnancy can increase the risk of having an abortion. Some studies show a relationship between high caffeine intake and an increased risk of miscarriage.

    Medicines. It has been shown that some medications increase the risk of miscarriage. That's why it's important to always ask your doctor if the medicines you take are safe, even when you're still trying to get pregnant. This applies to both prescription and over-the-counter medications, including anti-inflammatories such as ibuprofen and aspirin.

    Toxins of the environment. The environmental factors that can increase your risk include: lead, arsenic, some chemical substances such as formaldehyde, benzine and ethylene oxide, as well as high doses of radiation or anesthetic gases.

    Paternal factors. Little is known about how the condition of the father affects the risk of abortion, although it is known that the risk increases with the age of the father. Researchers are studying the extent to which toxins in the environment can damage sperm. Some studies have observed a higher risk when the father has been exposed to mercury, lead and some industrial chemicals and pesticides.

    Obesity. Some studies have shown a relationship between obesity and miscarriage.

    Diagnostic procedures There is a small increase in the risk of miscarriage after an analysis of chorionic villi and an amniocentesis, which are performed to give a genetic diagnosis of the fetus.

Your risk of having an abortion is also higher if you become pregnant three months after giving birth.
What should I do if I think I am having an abortion?
Call your doctor or midwife immediately if you notice unusual symptoms during pregnancy, such as bleeding or cramping. Your doctor will examine you to see if the blood comes from the cervix and to check your uterus. I may also ask you for a blood test to look at the hCG pregnancy hormone level, and repeat it two or three days later to see if the level is going up as it should.

If you have bleeding and pain and your doctor has the slightest suspicion that there could be an ectopic pregnancy, they will do an ultrasound immediately. If there are no signs of any problem but you still have blood loss, they will do another ultrasound at 7 weeks.

At this time, if the technician doing the ultrasound sees an embryo with a normal heartbeat, you have a viable pregnancy and your risk of having an abortion is much lower, but they will have to do another ultrasound if you continue to bleed. If the technician determines that the size of the embryo is appropriate but does not see the heartbeat, it means that the embryo has not survived.

If the gestational sac or the embryo is smaller than expected, the absence of the heartbeat may mean that you are pregnant for fewer weeks than you thought. Depending on the circumstances, you may need to repeat an ultrasound in one or two weeks and a blood test before your doctor can give you a firm diagnosis.

If you are already in the second trimester and an ultrasound shows that the cervix (also called cervix) is shortening or opening, perhaps your doctor will perform a procedure called uterine or cervical cerclage.

The cerclage consists of closing the cervix with stitches to try to prevent an abortion or premature delivery. The cerclage is only done if the baby seems normal on an ultrasound and you have no signs of an intrauterine infection. The cerclage has its risks and not everyone agrees on when you are a good candidate for this procedure.

If you show symptoms of a possible miscarriage, such as bleeding, the doctor may suggest bed rest in the hope of reducing the risk of miscarriage. However, there is no evidence that rest helps. It may also suggest that you refrain from having sex while you are bleeding or in pain. Sex does not cause an abortion, but it is a good idea to abstain if you have these symptoms.

You can have blood loss and abdominal pain for a few weeks. You can take sanitary towels, but not tampons during this period. You can also take acetaminophen (paracetamol) for pain.

If you are having an abortion, the bleeding and pain will probably get worse until you remove the placenta and the embryonic or fetal tissue. This tissue will be grayish and may include blood clots.

If you can, store the tissue in a clean container. Perhaps your doctor wants to examine it or send it to a laboratory for analysis and so try to find out why you have had an abortion. In any case, the doctor will want to see you again, so call to let him know what happened.
What should I do if my doctor tells me that I have lost the pregnancy, but I have not yet expelled the tissue?
You can face this situation in different ways and it is a good idea to talk about all the options with your doctor. You can choose to wait for the tissue to be expelled naturally, if this does not pose a risk to your health. More than half of women have a miscarriage about a week after finding out that their pregnancy is not viable.

You can also decide to wait a period of time to see what happens before undergoing the procedure to remove the tissue.

In some cases you can use medication to speed up the process, but it can cause side effects such as nausea, vomiting, and diarrhea. If you choose to wait or take medication to speed up the process, there is a chance that you still need a surgical procedure to remove fetal or embryonic tissue.

On the other hand, if you feel that waiting for a miscarriage to occur is too difficult emotionally or physically painful, you can opt for an operation to remove it. This is done by a curettage by suction or a dilation and scraping.

If you have a major hemorrhage, signs of an infection, or any other problem, you will have to undergo the operation immediately because waiting for a miscarriage would not be safe. And your doctor can recommend this procedure if this is your second or third miscarriage in a row, in order to analyze the tissue and see if there is a genetic cause.
How is a curettage or scraping?
The procedure is usually ambulatory (there is no need to spend a night in the hospital), unless complications arise. As with any surgery, you have to get to the hospital on an empty stomach: you can not eat or drink anything since the night before.

Most obstetricians prefer to use suction curettage because it is a little faster and safer than traditional dilation and scraping. Some doctors will use a combination of both.

For any of these procedures, the doctor will insert a speculum into your vagina, clean your cervix and vagina with an antiseptic solution and dilate the cervix with thin metal rods (unless the cervix is ​​already dilated) for having passed fetal tissue).

In most cases, they will sedate you through an intravenous line and give you a local anesthetic to numb the cervix.

In the case of a curettage by suction, the doctor will pass a hollow plastic tube through your cervix and suction the tissue that is in your uterus. In the case of traditional dilation and scraping, you will use a spoon-shaped instrument to gently scrape the tissue on the walls of your uterus. The procedure lasts between 15 and 20 minutes, although the extraction of the tissue itself lasts less than 10 minutes.

If you have Rh negative factor you will get an injection of immunoglobulin, unless the father of the baby also has Rh negative factor.
What happens after a miscarriage?
Regardless of whether you naturally abort or have removed the tissue, you will then feel mild pain like menstrual cramps for about a day and you will have some bleeding for one or two weeks.

Use compresses instead of tampons and take ibuprofen or acetaminophen (paracetamol) for pain. Avoid having sex, swimming, giving douching and using medication in the vagina for at least a week or two, until the bleeding stops.

In case you start to bleed intensely (that is, you saturate a compress in an hour), have any symptoms of infection (such as fever, discomfort or vaginal discharge with an unpleasant odor), or a very strong pain, immediately call your doctor or go to the emergency room.

If the bleeding is intense and you begin to feel weak, dizzy or dazed, you may be entering into a state of shock. In this case, call the local emergency service immediately (911 if you live in the United States or Mexico). Do not wait to talk to the doctor, and do not drive yourself to the emergency room.
Does having an abortion mean I have more chances of losing other pregnancies?
It is normal to worry about losing another pregnancy, but fertility experts do not consider that a single miscarriage early in pregnancy indicates that you or your partner have a problem.

Some doctors request genetic tests and special blood tests to try to find out what causes abortions if you have more than two followed, especially if you are over 35 or if you have certain diseases. Others wait until you have lost three pregnancies.

In some circumstances, they can send you to a specialist in high-risk pregnancies after a first abortion, to follow your next pregnancy with special care. This will happen, for example, if you had an abortion during the second trimester or a premature delivery at the beginning of the third trimester caused by an incompetent cervix.
When can I try to get pregnant again?
Maybe you'll have to wait a bit. Whether you have a miscarriage, with the help of medication, or if you remove the tissue, you will have your period again after four to six weeks.


Some doctors say that you can try to conceive again after this period, but others recommend waiting until you have had a complete second menstrual cycle, so that you have more time to recover physically and emotionally.

During this period you will have to choose a contraceptive method, since you can ovulate as soon as two weeks after having the abortion.
How to overcome pregnancy loss
Even if you are physically recovered and ready to conceive again, you may not feel emotionally prepared. Some women cope better with their pain if they focus their attention on trying a new pregnancy as soon as possible (although the doctor will ask them to wait at least four to six weeks).

To others it happens that months or even more time elapse before regaining interest in trying to conceive. Take the time you need to analyze your feelings and decide with your partner what the next step will be. Read our article on how to cope with this loss.

It may help to talk about your emotions with someone you trust. Or you can ask your doctor where to get guidance or find support groups, if you think they will be of use to you. If you feel very overwhelmed and sad, your doctor may also recommend a therapist to help you cope with the loss.

And do not forget to seek support in our forum about the loss of a baby in which you can talk with other moms who are going through or have been through your same situation.

If you have other children and you do not know how to tell them that you lost the baby you were expecting, read our article with suggestions from experts on this topic.