Symptoms of miscarriage in the second trimester. Late spontaneous abortion in the second trimester - treatment

Spontaneous miscarriage is the natural death of an embryo or fetus during pregnancy caused by pathological or traumatic factors. The pathology often occurs in early pregnancy and, according to experts, occurs in 15-25% of cases of successful conception of a child. To the most common symptoms spontaneous miscarriage include periodic pain in the lower abdomen caused by contractile activity of the uterus and spotting.

Causes of miscarriage

There are many reasons why spontaneous miscarriage can occur, and not all of them can be identified. Experts attribute some reasons to genetic or hormonal disorders, problems with implantation of a fertilized egg, genital tract infections and isthmic-cervical insufficiency.

First trimester

The risk of miscarriage is highest during the first 13 weeks of pregnancy, and the woman may not even know she is pregnant. Initially, there is a nagging pain in the lower abdomen, which is eventually joined by bloody discharge. At this moment, under the influence of hemorrhage in the basal decidua and tissue necrosis, the contractile activity of the uterus increases, which pushes the embryo out. If you experience any such symptoms, you should immediately consult a doctor.

Genetic abnormalities occur in more than half of embryos after miscarriage in early pregnancy. Most of them happen by chance and are unlikely to happen again. A small proportion of genetic problems are permanent and related to the parents' genes. The likelihood of such a fact can be identified in the case of repeated miscarriages or the presence of birth defects in a previously born child.

Some experts note that the cause of miscarriage may be a deficiency of the pregnancy hormone progesterone. However, to date, no studies have shown that taking progesterone supplements in the first trimester reduces the risk of miscarriage.

Second trimester

In the second trimester of pregnancy, miscarriage can be caused by a malformation of the uterus, neoplasms in the uterine cavity and isthmic-cervical insufficiency. These reasons can also increase the risk of premature birth.

In 2006, a study was published in the journal "Children's and Age-related Pathology" according to which in 19% of cases, miscarriage in the second trimester of pregnancy was caused by a narrowing of the diameter of the umbilical cord.

Other causes of miscarriage:

• Myomas: benign formations in the uterine cavity (not cancerous), which increase its contractile activity. About 20% of women suffer from fibroids.
• Spikes: connective tissue formations that prevent embryo implantation into the uterine wall.
• Uterine mucous polyps: growths of the lining of the uterus that can block the uterine cavity and cause spontaneous miscarriages.
• : a disease in which in a woman's body tissue similar to the endometrium grows and develops outside the lining of the uterus. The disease can lead to miscarriage or even infertility.
• Open cervix during pregnancy: may be associated with a congenital disease or pathology of the uterus.
• Infectious diseases: some infectious diseases are transferred into the bloodstream through the placenta, causing the death of the embryo or fetus.
• Serious illnesses: diabetes mellitus, liver disease, high blood pressure, hormonal disorders.

Signs and symptoms of miscarriage

The most common symptom of a miscarriage is spotting. They may be pale red or dark brown in color and last for one day or several days. However, spotting is relatively common during the first trimester of pregnancy and does not necessarily indicate a miscarriage. Other symptoms often include lower back pain, pain in the lower abdomen, and discharge in the form of large blood clots.

Diagnostics

If you notice signs of a miscarriage, you should immediately contact a gynecologist. The doctor will conduct a blood test for the presence of the hormone hCG (low levels of the hormone is a bad sign in case of pregnancy) and a transvaginal ultrasound, which will help determine the presence of an embryo in the womb.

If a spontaneous miscarriage is confirmed, the gynecologist examines the uterus for any remaining fetal tissue that could cause bleeding or spread of infection. Absence components fertilized egg in the uterine cavity indicates a complete miscarriage.

If a case of a frozen pregnancy, an empty sac or an incomplete miscarriage is confirmed, treatment is prescribed:

1. Regular visits to the gynecologist for 2-6 weeks, during which spontaneous miscarriage occurs in 70% of cases. This type of treatment avoids possible side effects and complications associated with use medicines or surgical interventions, but increases the risk of spotting and incomplete miscarriage.
2. Medical treatment usually involves the use of misoprostol and helps complete the miscarriage.
3. Surgical intervention consists in using a special vacuum suction in case of vacuum aspiration or a curette for curettage. In both cases, the contractile activity of the uterus is restored and bleeding is reduced.

The recovery period for the body after a miscarriage takes about a month.

Risk factors

Intercurrent diseases. Some intercurrent diseases in early pregnancy increase the risk of miscarriage: polycystic ovary syndrome, hypothyroidism, diabetes mellitus, infectious and autoimmune diseases. The quality of research on polycystic ovary syndrome and its impact on miscarriage is still questionable. However, some experts still recommend the use of medications in the presence of the syndrome. In particular, the drug Metformin is widely used.

The risk of miscarriage increases in patients with poorly controlled insulin diabetes mellitus, but no significant increase in risk was found in women with well-controlled diabetes.

Diseases passed through the placenta to the fetus, such as rubella or chlamydia, may also increase the risk of miscarriage. Mycoplasmosis increases the risk of premature birth and miscarriage.

Smoking. Expectant parents should stop smoking when planning, during and after pregnancy. Otherwise there is increased risk miscarriage, low birth weight and other serious complications.

Age. A woman's age is a significant risk factor. At the age of 35 or more, the risk of miscarriage can be 45%.
Antidepressants. Some studies suggest there is a slight increase in the risk of miscarriage for women taking antidepressants.

Recovery after miscarriage

The recovery period after a spontaneous miscarriage takes some time: after four weeks the normal menstrual cycle returns, followed by the onset of menstruation two weeks later.

Despite the fact that the body is physically recovering sufficiently short terms, many women experience emotional turmoil for a long time. Very often there are feelings of sadness and guilt, states of shock and depression; headaches, problems with sleep or concentration, and loss of appetite occur. Ailments are normal in this situation.

After a miscarriage, a woman needs rest, plenty of fluids, and adequate intake of minerals and vitamins.

Most women who have a miscarriage can successfully become pregnant and raise healthy child. At the same time, the chance of a successful pregnancy is more than 85%.

Answers to questions

When does your period start after a miscarriage? After a spontaneous miscarriage, your period comes in about 4 weeks. Is it possible to get pregnant after a miscarriage? Yes, if most of the reasons preventing pregnancy are eliminated. How many days after a miscarriage can you get pregnant? Experts recommend waiting for the normal flow to return. menstrual cycle, and then start planning your pregnancy. How long does it take to bleed after a miscarriage? The duration of bleeding should not exceed 5-10 days. If bleeding continues for more than 14 days, you should contact a gynecologist.

According to statistics, out of 100 pregnancies, 15–20 end in miscarriages. Most often this happens when the woman does not yet know about her situation. But if expectant mother is already aware that conception has occurred, then a miscarriage becomes a terrible loss for her. Therefore, information regarding miscarriage will be useful both to those who are at the planning stage and to women already expecting a baby. Knowing the causes and symptoms of spontaneous abortion in early stages, you can prevent the threat of losing a child, as well as avoid unpleasant consequences.

What is spontaneous abortion

Miscarriage (spontaneous or spontaneous abortion) is the rejection of the fetus by the mother’s body for reasons beyond her control for up to 28 weeks.

Statistics of pregnancy rates among women in Russia

There are three types of spontaneous abortion (depending on the period at which the miscarriage occurred).

1. Termination of biochemical pregnancy (up to 3 weeks). For unknown reasons, the embryo detaches from the walls of the uterus and comes out along with blood clots. Bleeding at these times is in most cases perceived as the beginning of menstruation, since the woman does not yet know about her pregnancy.
2. Early miscarriage, or spontaneous abortion. Termination of pregnancy occurs before the third trimester.
3. Premature birth or miscarriage later. The reasons may be various pathologies of the fetus, circulatory disorders, gestosis in the mother, etc. In most cases, with a miscarriage in the later stages, the child can be saved.

In each period of pregnancy, there are periods during which the threat of miscarriage is most likely. The highest risk of losing a baby occurs in the first month after conception, especially from 14 to 21 days.

In addition, you need to be extremely careful during the following periods: 8–12, 16–20, 28–32 weeks. During these periods, a woman should rest more, avoid stress, listen to her feelings and visit a doctor in a timely manner.

If signs of an incipient miscarriage are detected, a woman should immediately seek qualified medical advice. medical care. Timely measures taken increase the chances of maintaining the pregnancy and a successful delivery on time.

Threat of miscarriage - how to maintain pregnancy (video)

Types

Miscarriages are divided into several types:

1. Inevitable (incomplete). He is accompanied by severe pain, covering the lower back and lower abdomen. Accompanied by cervical dilatation and uterine bleeding. A miscarriage is considered inevitable when a rupture of the membranes forms and the internal os of the uterus opens. Continuous pain and discharge are signs of an incomplete miscarriage.
2. Complete - spontaneous termination of pregnancy, in which the embryo or fetus is completely expelled from the uterine cavity. After complete cleansing organ pain, spasms and bleeding disappear. Surgery is rarely required.
3. Failed miscarriage or frozen pregnancy. The dead fetus remains in the uterus; at first, no symptoms are observed. Most often it is diagnosed at a routine appointment with a gynecologist or by ultrasound. Surgery is mandatory.
4. Repeated miscarriage. Happens in about one in a hundred couples. When a woman has three pregnancies in a row end in arbitrary termination in the early stages.
5. Anembryony. Fertilization and attachment of the egg occurs, upon examination, an enlargement of the uterus is observed, a fertilized egg is formed, and other symptoms of pregnancy are also present. But the fetus either does not develop or dies at the initial stage.
6. Chorioadenoma. Develops due to genetic disorders. In place of the amniotic sac, just a piece of tissue is formed, which gradually increases in size.

With early diagnosis of these conditions, a woman in mandatory An abortion is performed for medical reasons.

Features in the early stages

In most cases, complete or incomplete miscarriages occur in the early stages of pregnancy.

1. With a complete miscarriage, the uterus rejects the fetus completely, along with the waters and amniotic sac.
2. In the case of an incomplete miscarriage, most often only the embryo is rejected, and the amniotic membranes remain in the uterine cavity. The embryo can come out either completely or partially.

To avoid the serious consequences of an incomplete miscarriage, the woman is cleaned and also prescribed hemostatic, hormonal, antibacterial medications that cause uterine contractions.

After cleaning, it is imperative to perform an ultrasound to make sure that there are no blood clots or fetal tissue left, and that the uterine lining is being restored.

Reasons

Most often, the causes of miscarriage are genetic abnormalities and fetal malformations that are incompatible with life. This is why some doctors prefer not to continue pregnancy until 12 weeks, arguing that this is natural selection. In some cases, abortion is offered for medical reasons.

If a woman is hospitalized for preservation, then in most cases doctors are able to prevent a miscarriage. In this case, if possible, a complete examination of the fetus is carried out for the presence of genetic abnormalities. And only then is a decision made on further tactics for managing the pregnancy or a referral to terminate it is issued.

The main causes of early miscarriage:

1. Genetic defects:
   • anatomical (congenital and acquired malformations);
   • infectious (chronic endometritis);
   • genetic (structural or quantitative change in chromosomes);
   • endocrine;
   • thrombophilic;
   • immunological (autoimmune and alloimmune).
2. Violation of hormone levels and thyroid function.
3. Diseases of the reproductive system, sexually transmitted infections.
4. Viral and infectious diseases (flu, tonsillitis, rubella, chickenpox, toxoplasmosis).
5. Impaired blood flow between mother and child;
6. Severe pathologies internal organs fetus
7. Bad habits of the mother (smoking, alcohol, drugs).
8. Stress, nervous tension.
9. Physical activity, heavy lifting, injuries.
10. History of abortion, scars on the uterus and abdominal cavity.
11. Taking medications contraindicated during pregnancy.
12. X-ray radiation.

The causes of early fetal rejection can also be attributed to a later period, although in the second and third trimesters, miscarriage is most often provoked by inflammatory processes in the uterine cavity or placenta.

Signs in the early stages

The following symptoms indicate a threat of miscarriage:

• pain in the lower abdomen;
• vaginal bleeding (scarlet or brown discharge, spotting or heavy);
• convulsions.

In the early stages, it is not always known about pregnancy, so the symptoms of a miscarriage can easily be mistaken for the beginning of a new menstruation. It is worth noting that there are also secondary signs of spontaneous abortion that distinguish it from menstrual periods, in particular:

• vomiting and frequent loose stools;
• pain in the form of spasms;
• weight loss;
• bleeding alternating with mucus;
• aching pain in the lumbar region.

If you know you are pregnant and even minor bleeding begins, you should urgently seek medical help.

There is such a thing as a frozen pregnancy, or a failed miscarriage. This is the cessation of fetal development and its death for up to 28 weeks. Signs of this condition:

• absence of toxicosis;
• decrease basal temperature;
• weakness.

In addition, the symptoms of a miscarriage may vary depending on the stage of its progress.

Symptoms depending on the stage of miscarriage (table)

Stage	Clinical picture
State of threatened miscarriage	This stage is accompanied by aching pain in the lower abdomen and lumbar region. In some cases, spotting and spotting appears.
	During the second stage of miscarriage, the pain becomes cramping, there is general weakness and dizziness. With every movement, the bleeding increases, and there are clots in the discharge.
Miscarriage in progress (or in progress)	Symptoms of miscarriage are a sharp pain that spreads throughout the abdomen and lower back, significant blood loss and the release of the fertilized egg from the uterus. In some cases, a woman may see a small bubble in the discharge gray, most often this happens if the fetus died a few days before the development of the main symptoms.
Completed miscarriage (completed abortion)	The bleeding gradually becomes less intense, but spotting may continue for several days.

Timely diagnosed threat of miscarriage and the onset of spontaneous abortion (first and second stages) with adequate treatment leave a chance of saving the child. The next stages are irreversible and lead to termination of pregnancy.

Stages of spontaneous miscarriage (gallery)

Bleeding after spontaneous abortion can last from 4 to 10 days Some time later, the fertilized egg and placenta are expelled from the uterus Clinical picture of a miscarriage: bleeding, accompanied by spasm and pain in the lower abdomen, pain in the lumbar region

Spontaneous abortion or menstruation?

It is possible to determine that a termination of pregnancy has occurred, and that another menstruation has not occurred, using monitoring hCG level in the blood and measuring basal body temperature.

Basal temperature is the most low temperature body, which is measured immediately after sleep, without getting out of bed.

Prevention

Even a completely healthy woman is not immune from spontaneous miscarriage. It is not always possible to detect genetic mutations, hereditary or chronic diseases, which often manifest themselves during pregnancy.

But you can follow simple rules that will allow you to conceive a healthy child and increase the chances of a successful pregnancy. Among them:

• moderate and healthy eating, weight control;
• complete cessation of alcohol and cigarettes;
• taking multivitamins;
• elimination of stress and overload;
• frequent and long walks in the fresh air;
• gymnastics or physical education classes;
• complete rest;
• routine examinations with a doctor.

After an early miscarriage, a woman should undergo a full examination, treatment, and only with the doctor’s permission begin planning a new pregnancy.

According to statistics, 2 out of 10 pregnancies end in spontaneous miscarriage. Therefore, it is necessary to carefully monitor your well-being while carrying a child. If specific symptoms occur, seek medical help immediately. Timely diagnosis and treatment will preserve your pregnancy and minimize the risks of its termination.

A miscarriage is the spontaneous termination of pregnancy before 20 weeks. The words “miscarriage” and “abortion” in gynecology are synonymous, so spontaneous abortion or miscarriage mean the same condition.

Depending on the period at which the termination of pregnancy occurred, miscarriages are divided into early (up to 12 weeks) and late (from 13 to 20 weeks). In the vast majority of cases, pregnancy is terminated in the early stages of pregnancy.

According to statistics, up to 20% desired pregnancies end in miscarriages. If a woman has already had several miscarriages in the past, then she is diagnosed with “miscarriage”.

Causes of miscarriage

There are many reasons for termination of pregnancy, ranging from banal stress to serious endocrine disorders. In some cases, the cause of the miscarriage cannot be determined.

The main causes of miscarriages include:

Genetic (chromosomal) abnormalities of fetal development that are incompatible with life. As a result, the non-viable fetus dies and a miscarriage occurs;
- hormonal disorders: lack of the hormone progesterone, hyperandrogenism, hyperprolactinemia, thyroid disease and diabetes;
- sexually transmitted infections (chlamydia, trichomoniasis, ureaplasmosis, mycoplasmosis, HPV, HSV, CMV) and TORCH infections (rubella, herpes, toxoplasmosis, cytomegalovirus infection);
- anatomical anomalies: malformations of the uterus (unicornuate, bicornuate and saddle uterus, the presence of an intrauterine septum); uterine fibroids with submucosal localization of the node, intrauterine synechiae;
- isthmic-cervical insufficiency (insufficiency of the muscular layer of the cervix, leading to its dilatation);
- Rh conflict between mother and fetus.

Other factors that can also trigger a miscarriage include: previous abortions, smoking, drinking alcohol, using drugs, stress, acute respiratory diseases, taking analgesics and hormonal contraceptives.

How to recognize the symptoms of an incipient miscarriage?

As a rule, a miscarriage begins with nagging pain in the lower abdomen. These pains feel like the first day of menstruation. This condition indicates an increase in uterine contractility, that is, a threat of miscarriage. The fetus does not suffer.

As the process progresses, the pain becomes cramping in nature and blood discharge from the genital tract appears. The discharge may be spotty or moderate. This indicates that a miscarriage has begun.

When the fertilized egg is detached from the wall of the uterus, a “complete” or “incomplete miscarriage” occurs. In both cases, the pregnancy cannot be maintained. With a complete miscarriage, bleeding from the genital tract increases - the discharge becomes profuse with clots. The fertilized egg comes out of the uterine cavity on its own. After which the uterus contracts on its own and the bleeding stops.

With an incomplete miscarriage due to the fact that the fetus does not completely leave the uterine cavity, bleeding can be very long and heavy.

All of the above symptoms at any stage of pregnancy require immediate contact with a gynecologist.

Diagnosis of threatened miscarriage

Diagnosing spontaneous abortion is not difficult. During an examination on the chair, the gynecologist checks whether the size of the uterus corresponds to the expected period of pregnancy, checks whether there is any tone of the uterus, whether or not the cervix is ​​open, determines the nature of the discharge - mucous, bloody, with or without the remains of the fertilized egg.

To assess the condition of the fetus, an ultrasound of the pelvic organs and fetus is performed. At the same time, they determine the location of the fertilized egg (if present) and look to see if there is a detachment. Using an ultrasound, you can determine the hypertonicity of the uterus, that is, its excessive tension, which is a sign of a threat of miscarriage.

Based on examination and ultrasound, the management tactics for the pregnant woman are determined. All pregnant women with a threat of miscarriage are subject to hospitalization in a hospital.

Treatment of pregnant women with threatened miscarriage

Treatment tactics are determined depending on ultrasound data, examination and clinical manifestations.

In case of threatened abortion or incipient miscarriage, therapy is carried out aimed at prolonging pregnancy, provided that there is no detachment of the ovum. In case of partial detachment of the fertilized egg, if the bleeding is not very profuse, as happens when a miscarriage begins, treatment is also carried out aimed at preserving the pregnancy.

But if the fertilized egg has already detached and the bleeding is profuse, then the treatment is no longer effective. In this case, the uterine cavity is curetted to remove the remaining fertilized egg. The resulting scraping is sent for cytogenetic research.

In late abortions, after removal of the remaining fetal egg, drugs to contract the uterus (Oxytocin) are prescribed intravenously. After curettage, antibiotics are prescribed.

For women with a negative blood group, anti-Rhesus immunoglobulin is administered after curettage to prevent Rh conflict.

For better contraction of the uterus and to reduce blood loss, after curettage, apply a bubble with cold water or ice to the abdomen.

Upon discharge from the hospital, a woman is recommended to undergo an outpatient examination by a gynecologist to determine the cause of the miscarriage, which includes: ultrasound of the pelvic organs, examination for urogenital infections and TORCH infections, blood test for hormones (DHEA, prolactin, 17-OH progesterone, progesterone, estradiol, LH, FSH, cortisol, testosterone); study of thyroid hormones (TSH, free T3, free T4); coagulogram, hemostasiogram; cytogenetic study of the remains of the fetal egg.

This is the main checklist. At the initiative of the doctor, it can be expanded. In addition, for 6 months a woman is recommended to protect herself from pregnancy with hormonal contraceptives to regulate hormonal levels.

If everything is normal with the fetus, then the following groups of drugs are used to prolong pregnancy:

Progestins (Duphaston or Utrozhestan) to correct progesterone deficiency. They are prescribed up to 16 weeks of pregnancy;
- glucocorticoids (Dexamethasone, Metipred) are prescribed to correct hyperandrogenism;
- sedatives (tinctures of Motherwort or Valerian);
- antispasmodics (No-shpa, Papaverine, Baralgin) to relax the muscles of the uterus;
- vitamins and microelements (Magne B6, folic acid, vitamin E).

If the pregnancy has been maintained, then upon discharge the pregnant woman is recommended to continue taking the medications prescribed in the hospital. This is especially true for gestagens and glucocorticoids, which should be used continuously. If you suddenly stop using the medications, the risk of miscarriage may arise again.

In addition, a pregnant woman needs physical and emotional rest and sexual abstinence.

To reduce the risk of miscarriage in the future, it is recommended to increase the consumption of complex carbohydrates (bread, pasta); fiber-rich fruits and vegetables; dairy products, fish, meat, vegetable oil and legumes.

Complications of miscarriage:

Spontaneous abortion that cannot be treated;
- excessive uterine bleeding, which can lead to hemorrhagic shock;
- infectious complications, sepsis.

Prevention of spontaneous abortions:

Healthy lifestyle;
- timely examination and treatment of gynecological and endocrine diseases;
- refusal of abortion.

Consultation with an obstetrician-gynecologist on the topic of miscarriage:

1. Is it possible to get pregnant after a miscarriage?
Yes.

2. Does a doctor have the right to perform curettage without a preliminary ultrasound?
In emergency situations, if a woman is admitted to the hospital with heavy bleeding, then maintaining the pregnancy is out of the question and curettage is performed on an emergency basis without an ultrasound. In other cases, an ultrasound is required.

3. I had a miscarriage and the discharge stopped. Tell me, is it necessary to do curettage? Can fetal remains remain in the uterus?
If there is no discharge, then most likely everything has already come out and there is no need for scraping.

4. After a missed period, I began to experience heavy bleeding with clots. What is this? A miscarriage? The pregnancy test is negative.
By clinical picture very similar to a miscarriage. Pregnancy tests sometimes give false results. Go to the gynecologist for an ultrasound.

5. Can sex cause miscarriage?
If the pregnancy is progressing normally and there are no other reasons causing a miscarriage, then sexual intercourse is safe.

6. After a miscarriage at 20 weeks, I began to experience light yellow discharge from my nipples. Is this normal or does treatment need to be done?
This is the norm. The discharge will go away on its own after menstrual function is restored.

7. Can you use tampons if you have a miscarriage?
You can’t, they can contribute to infection of the genital tract. Use gaskets.

8. I have lower back pain. Could this indicate a threat of miscarriage?
Lower back pain can occur when there is a threat of miscarriage. But even under normal conditions, lower back pain is also possible due to the growth of the uterus. For an objective assessment of the condition, you need to contact a gynecologist.

9. What can be done at home if heavy bleeding from the genital tract suddenly appears during pregnancy?
Call an ambulance immediately and place an ice pack on your stomach.

10. How long should you use protection after a miscarriage??
At least 6 months.

Obstetrician-gynecologist, PhD Christina Frambos

Found an interesting article about leakage amniotic fluid and how it is treated. Maybe it will be useful to someone too.
Don’t pay attention to the scary title of the article – there is a lot of useful and interesting information there.

Late spontaneous abortion (13-21 weeks) is a common pathology. There are many reasons leading to spontaneous abortion in the second trimester. A number of them (chromosomal abnormalities) cannot be corrected, and if they are detected, it is advisable to perform an induced abortion. A number of other causes (isthmic-cervical insufficiency, placental insufficiency) require corrective treatment.

Termination of pregnancy at 22 weeks or later is considered premature birth. After 22 weeks, the newborn is potentially viable.

A threatened abortion is accompanied by an increase in tone, periodic contractions of the uterus, shortening of the cervix and a slight opening of the cervical canal (internal os of the cervix).

Late spontaneous abortion in the second trimester - causes

1) chromosomal abnormalities of the fetus;

2) the impact of adverse external factors(smoking, alcohol abuse, substance abuse);

3) isthmic-cervical insufficiency;

4) hormonal disorders (hyperandrogenism);

5) genital tract infections and fetal IUI, etc.

Further normal development of pregnancy can be hampered by malformations of the uterus (bicornuate, saddle-shaped), the presence of large myomatous nodes with centripetal growth and submucosal localization, as well as a low location of the intermuscular myomatous node (in the area of ​​the uterine isthmus). Overstretching of the uterus is important in case of multiple pregnancy or acute polyhydramnios. The role of autoantibodies (antiphospholipid, anti-cardiolipin) in the pathogenesis of late abortion is discussed.

Fetal defects

Fetal chromosomal abnormalities:

Pathology of autosomal chromosomes:

Trisomy on chromosome 21 (Down syndrome);

Trisomy on chromosome 18 (Edwards syndrome, which consists of a single umbilical artery, flexion deformation of the fingers, crossing of the index and little fingers, shortening of the first toe). Less than 10% of these newborns survive to 1 year of age;

Trisomy on chromosome 13 (Patau syndrome: cleft lip and palate, eye abnormalities, polydactyly. Less than 3% of newborns survive to 3 years of age);

Short arm deletion syndrome of chromosome 5 (cry-the-cat syndrome, mental retardation, moon face).

Pathology of sex chromosomes:

Klinefelter syndrome (chromosome set 47XXY). The phenotype is male, but the distribution of subcutaneous fat tissue and the development of mammary glands female type. Lack of facial hair. Infertility;

Turner syndrome (chromosome set 45X0). Small stature, wing-shaped skin folds on the neck, amenorrhea, kidney anomalies, malformations of the cardiovascular system (coarctation of the aorta). Infertility;

Chromosome set 47XYY. Tall. Male genotype and phenotype, intellectual impairment. Poorly trained. Infertile.

Children with Down syndrome are more often born to women of late age (40 years and older). A triple screening test can detect up to 80% of cases of this syndrome in utero, before birth. False-positive results are noted in no more than 5% of cases. They study the concentration of AFP (detection rate 20-25%), the concentration of hCG in the blood serum and use ultrasound (sensitivity 65-75%). The final diagnosis is made by examining the karyotype.

Detection of fetal pathologies using ultrasound

We present ultrasound data on identifying signs of Down, Patau, Edwards syndromes, as well as hormone studies (AFP, hCG, E3).

Ultrasound signs of trisomy 21 (Down syndrome):

Thickening of the skin fold;

Short femurs;

Enlargement of the renal pelvis;

Heart defect;

Duodenal atresia;

Echogenic intestine;

Echogenic focus in the heart.

The examination should be carried out at 18-22 weeks of pregnancy.

Ultrasound signs of trisomy 13 (Patau syndrome):

Encephalopathy;

Heart defect;

Omphalocele;

Polycystic kidney;

Fetal IUGR;

Polydactyly;

"cleft lip"

Ultrasound signs of trisomy 18 (Edwards syndrome):

Polyhydramnios;

Fetal IUGR;

Micrognathia;

Deformation of fingers;

Cysts of the choroid plexus of the ventricles of the brain;

Omphalocele;

Foot deformity;

Hydronephrosis.

Late spontaneous abortion in the second trimester - signs

Clinical signs of spontaneous abortion. Spontaneous abortion in the second trimester can be manifested by pain in the lower abdomen, lower back, and unusual discharge from the genital tract (mucous, watery, bloody). You should pay attention to symptoms such as a constant increase in uterine tone and abdominal pain, changes or absence of fetal heartbeat, weakness, pallor skin, tachycardia, decreased blood pressure (partial placental abruption is possible, in which there may be no external bleeding).

It is necessary to clarify the gestational age according to the anamnesis, examination, ultrasound, and find out the condition of the fetus (alive, asphyxia, intrauterine death). Pay attention to signs of fetal IUI, urinary tract infections, pathology gastrointestinal tract. Careful palpation of all parts of the abdomen will determine the hypertonicity of the uterus or the presence of regular contractions. Until 24 weeks of pregnancy, parts of the fetus are not palpable through the anterior abdominal wall, so you should not try to identify them. It is necessary to listen to the fetal heartbeat, including using a Doppler sensor.

At vaginal examination It is necessary to carry out an inspection using mirrors. Take a swab from the lower vagina. Take a smear to determine the leakage of amniotic fluid.

Express tests include blood and urine tests, and establishing the sensitivity of microbial flora to antibiotics. It is also necessary to conduct an ultrasound to determine the condition and size of the fetus and the location of the placenta.

The situation may vary. If there is a threat of late miscarriage, they adhere to expectant tactics aimed at maintaining the pregnancy.

When amniotic fluid leaks, the situation becomes more complicated. Typically, labor develops with chorioamnionitis, when the pregnancy should be terminated. When diagnosing gross malformations of the fetus or an unpromising pregnancy, the woman should be advised to terminate it. But in all cases, it is necessary to take into account and support the woman’s desire until she is threatened with life-threatening complications.

Late spontaneous abortion in the second trimester - treatment

To maintain pregnancy when there is leakage of amniotic fluid, there are no signs of infection, and the fetus is in normal condition, acute tocolysis is used by intravenous administration of tocolytics. Change sterile diapers every 2-3 hours. Pregnancy is maintained until 34 weeks, then the obstetric situation is left to its natural course. The amniotic membranes may stick together and the leakage of water may stop. There is little harm from conservative tactics if they are based on careful monitoring of symptoms of infection and prevention or treatment.

Empirical antibacterial therapy (erythromycin, metronidazole) is indicated.

Management of spontaneous abortion (basic provisions). If it is impossible to maintain the pregnancy (cervical opening more than 3 cm) or impractical (fetal malformations), premature termination of pregnancy is carried out through the natural birth canal, even with a transverse position of the fetus, since its size is quite small. The exception is observations with complete placenta previa.

The main provisions are as follows.

They provide the woman with maximum psychological support and attention.

Provide adequate pain relief.

After a spontaneous abortion, curettage of the uterus with a large, blunt (Winter) curette is required, since there are almost always remnants of placental tissue in the uterine cavity.

When the pregnancy is 22 weeks or more, the presence of a pediatrician is necessary to assess the viability of the fetus.

Pregnancy is wonderful. But sometimes it happens that the body itself decides to get rid of the emerging new life, and then a miscarriage occurs. In most cases, this happens in the early stages of pregnancy, in the first 12 weeks.

Statistics say that every fifth woman loses a child before even knowing that she is pregnant. From a gynecological point of view, a miscarriage is considered to be a spontaneous termination of pregnancy before 22 weeks, since children born prematurely - after 22 weeks and weighing 500 grams - can be saved by today's medicine. But, if the weight is below 500 grams, then the possibilities are zero.

As we have already said, in most cases it happens that the woman does not even suspect that she is pregnant and nothing bothers her. While waiting for her period to come, she simply registers that she is late, and a few days later her period begins, but it comes more heavily than usual and with pain.

Sometimes, an early miscarriage is characterized by only moderate pain in the lower abdomen and heavy bleeding, then the woman does not even go to the doctor if the bleeding stops soon. If bleeding occurs profusely for several days, then a visit to the doctor cannot be avoided.

In some cases, such delayed periods are very painful, and one day a blood clot comes out. Then we can definitely say about spontaneous miscarriage at an early stage. Usually this clot resembles a burst blood blister. This phenomenon always frightens those who encounter it for the first time. After the release of a blood clot, you must definitely consult a doctor: firstly, to undergo an examination and determine exactly what it was; secondly, to check if cleaning is needed.

A miscarriage is a phenomenon that makes both the body and soul suffer. Many people know that there is such a danger as spontaneous abortion, but not everyone knows about its causes and how it can be prevented.

If we talk about early miscarriage up to 12 weeks, then basically it is a test and warning for parents. A miscarriage at this stage of development indicates that either the mother’s body is not yet ready for the normal development of the baby inside it, or something is wrong with the health of both parents, and it needs to be strengthened so that the baby develops healthy in the future, and the body from unhealthy and in the future it will get rid of itself.

Early miscarriage: causes

The reasons for miscarriage in the early stages of pregnancy can be very different - from hormonal imbalance to an emotional state. To avoid consequences, it is important to establish why spontaneous abortion occurred.

Genetic disorder in the fetus

In the first weeks of pregnancy, special attention is paid to the healthy formation of all organs of the future person, which requires equal 23 chromosomes from mom and dad. And if one of them suddenly contains a mutating element, then it is recognized as incompetent, and a miscarriage occurs in the early stages.

The presence of such elements is influenced by the environment, viruses, and occupational hazards. It is very difficult to avoid these factors; you can only reduce the risk of their influence on the body by going on vacation: to fresh air and for a long time. By carrying out a miscarriage, the body thus produces natural selection, characteristic of all life on earth.

Hormonal disorders

It is known that hormones are responsible for the good functioning of a woman’s body, so their incorrect balance in the body can lead to early miscarriage. Also, a lack of the hormone progesterone or an excess of the male hormone causes this phenomenon. If such a problem is diagnosed in a woman in advance, then before planning a pregnancy she is prescribed hormonal therapy, which helps avoid miscarriage.

Rhesus conflict

It is not for nothing that when planning a pregnancy, they are required to take a blood test to determine the group of both the mother and the father (if the mother turns out to have a negative Rh factor). In this case, the father’s Rh is important, since its opposite indicator can lead to the development of an Rh conflict, when the embryo inherits the father’s positive Rh, and the mother’s body identifies its tissues as foreign and rejects them, saving itself, as it seems.

If the father also has a negative Rh factor, then such a problem does not arise. With timely diagnosis of such a pathology, the hormone progesterone is used, which plays a protective role for the embryo and eliminates this cause of spontaneous miscarriage in the early stages.

Infections

Infection is bad in any case. If you know that you or your partner have a sexually transmitted infection, you need to get rid of it before conception. When a pregnancy occurs with this diagnosis, the fetus becomes infected and, again, the body gets rid of the embryo at an early stage.

Diseases of internal organs

Any increase in temperature up to 38 degrees, caused by a disease of the internal organs, can cause early miscarriage. Typically, such a temperature is accompanied by intoxication of the entire body, and therefore it is unable to hold the embryo. This is why it is so important to undergo a complete examination when planning a pregnancy in order to detect and treat all chronic diseases and get vaccinated if necessary.

Abortion

As you know, this is an interference in ordinary life. female body. If an abortion has ever taken place, it can lead either to habitual spontaneous miscarriages in the early stages or to infertility.

Medicines

In the first trimester, the use of any medications is not recommended at all, as this can lead to defects in fetal development. There are also herbs that are contraindicated in early pregnancy: parsley, nettle, cornflower, St. John's wort, tansy. Their use can cause early miscarriage.

Bad mood

Severe stress, grief, and prolonged mental stress can negatively affect the birth of a new life and lead to miscarriage in the early stages of pregnancy. In this case, with the recommendation of a doctor, it is possible to take some sedatives.

Lifestyle

You need to change your lifestyle when planning a pregnancy. Getting rid of bad habits, balanced and good nutrition- the first conditions for the development of a healthy child, but the opposite can lead to early miscarriage.

Physical impact

Unsuccessful falls and heavy lifting can cause early miscarriage. If the woman is healthy, then this effect must be very strong to cause termination of pregnancy.

Early miscarriage: symptoms

The most common signs of early miscarriage are pain in the lower abdomen and bleeding. Also, unpleasant sensations from the lower abdomen can spread to the lower back. This pain is periodic. Vaginal discharge indicates a threat of early miscarriage. If they have a reddish or even brownish tint, you should consult a doctor to avoid miscarriage.

Often the cause of miscarriage is the tone of the uterus, but only in cases where it is accompanied by discomfort for the mother and pain. If it is not accompanied by anything, then doctors’ recommendations stop at reducing physical activity and reducing stressful situations.

In some cases, even after the above symptoms, pregnancy proceeds normally, only under more careful medical supervision, then they talk about the threat of miscarriage.

The symptoms of spontaneous miscarriage at any stage of pregnancy are relatively similar. They may only be accompanied by stronger pain and copious discharge.

Symptoms of miscarriage in the second trimester:

• damage to the amniotic fluid sac is indicated by fluid dripping from the vagina, in which case contacting a doctor should be immediate;
• vaginal bleeding is a sign of miscarriage in any trimester of pregnancy;
• blood clots appear during urination, accompanied by pain;
• internal bleeding, which can be indicated by very severe pain in the shoulder or in the stomach area.

How is threatened miscarriage diagnosed?

If your pregnancy is planned, and you have gone through all the necessary preparation procedures that the doctor told you about, taken all the tests and treated all the detected diseases, then the possibility of a miscarriage is reduced to a minimum. If any contraindications were discovered in advance, then attention is paid to them already when the baby is conceived. In this case, the diagnosis of the threat of miscarriage takes place at the planning stage, and treatment is prescribed in advance.

If pregnancy occurs spontaneously, without preliminary treatment and examination, then any gynecologist can diagnose a miscarriage or its threat during a routine examination. When examining a woman who comes in with a delay problem, the doctor determines the expected duration of pregnancy.

• checks the size of the uterus for the given period;
• checks for uterine tone;
• determines whether the cervix is ​​closed;
• pays attention to the nature of the discharge (bloody or mucous).

Most reliable way diagnose a miscarriage or premature birth already at a later stage - transvaginal ultrasound, which is performed by an experienced doctor. Using this method, the length of the cervix and the condition of the internal os are checked.

Treatment of threatened miscarriage in the early stages

The most basic and first thing that the doctor advises if there is a threat of miscarriage at any stage of pregnancy is to adhere to bed rest. In some cases, in order to maintain the pregnancy, the woman is even forbidden to get out of bed.

It is also recommended to reduce the level of anxiety, bad news and thoughts. Already from the first weeks of existence, the nascent life feels you from the inside; any of your excitement can negatively affect its condition. And disturbances in the condition can lead to its rejection by your body. To avoid these nervous tensions, your doctor may prescribe valerian or motherwort.

You yourself can use relaxation therapy: sit comfortably on a sofa or chair and think about something good. The most appropriate in this case may be dreams about the future baby, choosing a name, mentally drawing his portrait. But all this is after consultation with a doctor.

If the threat of miscarriage is more serious and just good thoughts are not enough, then the first thing the doctor does is determine the cause. After determining the cause of the threat of miscarriage in the first weeks of pregnancy, hormonal drugs are prescribed, which are designed to maintain a good pregnancy.

You may be prescribed progesterone (it is part of Utrozhestan, Duphaston), you may be prescribed drugs for hyperandrogenism (with a large amount of male hormones), as well as drugs if there is a threat of Rh conflict.

If the doctor deems it necessary, they may conduct an additional intrauterine ultrasound examination. If insufficiency is detected with this diagnostic method, then sutures are placed on the cervix, which stop the fertilized egg inside the uterus. This operation is performed in a hospital and under anesthesia, while relaxing drugs are injected into the uterus.

Most cases of threatened miscarriage in early pregnancy are treated in a hospital; sometimes women have to remain under the supervision of doctors until the very end of pregnancy, that is, until childbirth. In some cases, treatment begins in a hospital, and then proceeds to home conditions while observing bed rest. Sometimes, having undergone treatment for a threatened miscarriage in the early stages, a woman does not return to it until the birth.

Prevention

In most cases, it is possible to avoid early miscarriage. If a couple approaches their decision carefully and responsibly, then they will be examined by a doctor in time, which will reveal all sorts of deviations and inconsistencies in the bodies of the man and woman. A preliminary examination will allow you to cure all kinds of infectious and hormonal diseases that can cause a miscarriage later.

Another six months before the planned conception, the couple’s lifestyle should be changed. Getting rid of bad habits will help reduce the risk of miscarriage.

Consequences after early miscarriage

From a medical point of view, serious consequences after spontaneous miscarriage in the early stages are extremely rare. Big problems can happen if this miscarriage is caused independently with the help of medications or folk remedies, or if parts of the fetus remain in the uterus, which most often happens at a later stage during miscarriages.

It is in order to avoid such problems in the early stages that gynecologists prefer to do preventive cleaning of the uterus after a miscarriage. If a woman goes to see a doctor, she always undergoes a control ultrasound.

Many people believe that the consequence after one miscarriage is subsequent spontaneous termination of pregnancy. But in reality this is not the case. Subsequent miscarriages occur after the first only if the cause has not been identified or if it has not been eliminated.

A miscarriage in early pregnancy does not have serious consequences only if you consult a doctor in a timely manner. If this fact is neglected, severe uterine bleeding may occur, that is, large loss of blood, which can be fatal.

If your next period doesn’t go as usual (heavier or with severe pain), it’s better to consult a doctor, in case you were pregnant and didn’t notice it. The answer to the question of what to do if you have an early miscarriage is to consult a doctor, if it’s very bad, then even call an ambulance.