miscarriage

Miscarriage: description

In a miscarriage (medical: abortion), a pregnancy ends before the child is viable. A child is considered medically viable after the twenty-third week of gestation and over four hundred grams of birthweight. If the pregnancy ends after this time, it is called premature birth if the child is born alive. In this case, special measures are taken to keep the child alive. These include drugs for lung maturation and intensive care treatment. However, if the child already died in the womb, it is stillbirth.

Abortions are also subdivided over time. An early abortion is a miscarriage before the 13th week of pregnancy. Between the 14th and 24th week of pregnancy is called the late abortion.

If the miscarriage results from natural causes, the doctor speaks of the spontaneous abortion. On the other hand, there are so-called artificial, ie artificially induced abortions through medical or chemical measures. An example of this would be abortion.

frequency

About 15 percent of medically diagnosed pregnancies end in miscarriage. There are also pregnancies that can only be detected in the laboratory. This shows the increase of a certain value (ß-hCG), but clinically there are still no signs. If these pregnancies are included, the frequency of abortion is around 50 to 70 percent. It is also observed that miscarriage risk increases with each loss suffered. The age of the mother plays an additional role; As a rule, the likelihood of abortion increases with age.

Miscarriage: symptoms

The signs of miscarriage depend on the various forms of abortion. Read all important about it in the post miscarriage: signs and symptoms.

Miscarriage: causes and risk factors

Video: Miscarriage: signs and causes

If it comes to a miscarriage, this can have different causes. Frequently several factors come together at the same time.

Risk factors of the mother

A distinction is made between risk factors that affect the female genital organ and those that derive from the rest of the maternal body. Miscarriage triggers that affect the genitals are:

reason	explanation
Malformations of the uterus	In some cases, the uterus (uterus) is duplicated or has only one fallopian tube. According to a University of Washington study, the greatest risk of miscarriage is when the uterine cavity is divided by a muscle or fiber wall. In addition, lack of space in the uterus can cause late abortions.
Tumors of the uterus	If the uterus is changed by a tumor, the child may not be properly cared for and there will be an abortion. Sometimes the fertilized egg can not nest properly in the mucous membrane.
cervical weakness	If the cervix opens too soon due to weakness of the musculature, a miscarriage is imminent. He no longer holds the fruit in the uterine cavity. In addition, germs can rise so easily, which promotes a miscarriage. This insufficient closing and holding function is above all a risk for late abortions.
infections	Pathogens can, for example, infect the cervix or uterine lining. The resulting inflammation causes a loss of function and a miscarriage can follow. In addition, the pathogens can pass to the child. If the mother cake (placenta) is affected, the fetus can no longer be properly treated.
hormonal disorder	With regard to the miscarriage risk is primarily the luteal weakness (medical: corpus luteum insufficiency) of importance. The yellow body arises after ovulation in the ovary. He usually produces hormones, the progestins. In pregnancy, they prevent the bleeding of the endometrium (= menstrual bleeding). If the luteal function is disturbed, it can no longer fulfill its function and miscarriage occurs. The miscarriage cycle should be observed, especially in the case of irregularities.
Age	Generally, the likelihood of miscarriage increases with age. According to a recent Danish study, the risk of abortion in women is already elevated when they are over 30 years old.
frequent pregnancy	With each pregnancy, the risk increases that the next one ends in a miscarriage. One of the most important factors for this is the cervix, as a result of many vaginal deliveries.

Other maternal causes of miscarriage include:

Anemia	The most common anemia is iron deficiency. This can lead to undersupply of the child with oxygen. In addition, the mother cake is then often too small, which can also lead to a deficiency supply of the fetus.
infections	Febrile infections can stimulate the uterine musculature, triggering contractile contractions. In addition, bacterial toxins are transmitted through the blood to the fetus and can damage it.
hormonal disorders	Diabetes (diabetes) or hyperthyroidism increases the risk of abortion. These diseases affect, for example, the luteal function, or the cakes can not develop properly by vascular damage. If the parathyroid glands work insufficiently, the calcium content of the blood falls. This can lead to excessive cramping of the uterus, causing miscarriage.

Risk factors of the father

Not only the mother but also the father can deliver risk factors for a miscarriage. Defective sperm can increase the risk of abortion. In case of increased abortions, a spermiogram may provide information. The appearance, number and flexibility are assessed. Studies have shown that the likelihood of altered sperm increases with age.

Risk factor immune system

There are disorders in the immune system of the mother, which favor a miscarriage. In the most important, the body’s defense attacks the fertilized egg. The implantation usually does not occur first. If it does, it is defective and ends in the early abortion.

Risk factors of the fetus

The most common miscarriage causes are genetic changes in the fetus. The genome information lies on the chromosomes in the cell nucleus. One half comes from the mother, the other from the father. If deviations in number or form of these chromosomes occur, this leads to erroneous systems in the embryo. As a result, viability is limited or absent. The fetus dies and there is a miscarriage.

Risk factor doctor

Even medical actions can lead to a miscarriage. Radiation as in computed tomography, for example, can damage the genome of the fetus to the point of abortion. In addition, medications or many vaccinations increase the miscarriage probability. Surgeries should also be avoided during pregnancy as the procedure and possible anesthesia may increase the risk of miscarriage. Also methods for the detection of malformations of the child such as an examination of the amniotic fluid (amniocentesis) or the mother cake (chorionic villus sampling) increase the risk of abortion.

Risk factors smoking, alcohol and drugs

Studies show that if mothers smoke during pregnancy, drink alcohol or take drugs, this leads to severe developmental disorders or malformations of the embryo or fetus. Excessive alcohol consumption is considered the most common cause of premature birth.

Risk factor stress

Mental stress increases the risk of miscarriage. That at least shows a study of the Berlin Charité. An imbalance in the immune system and hormone balance disturbs the pregnancy. On the one hand, decreased hormone levels are observed (especially progesterone), which sustain the pregnancy. On the other hand, immune cells are increased, which can cause a miscarriage. Other psychological components also play a role.

Already in the 90s, a connection between fear and increased abortion rate was discovered. Above all, fears of the course of pregnancy and birth influence the miscarriage probability. Whether a miscarriage is favored by stress, is difficult to say because of the variety of other possible influences on the risk of miscarriage. For example, night work has to be considered as risky as, for example, underweighting pregnant women. It goes without saying that accidents or similarly serious traumatic events can cause a miscarriage.

Miscarriage: examination and diagnosis

As soon as a pregnant woman notices typical signs of miscarriage, she should consult her gynecologist as soon as possible. This will first scan the abdomen thoroughly to determine if there is still labor or pain in the abdomen. In an infected miscarriage, the uterus, for example, is painful to the touch.

The doctor then examines the vagina and cervix. Particular attention is paid to the cervix. The doctor assesses whether it is closed or hurts. He also looks for causes of unnatural bleeding. It is also important to find the place of the bleeding. In case of an incomplete miscarriage, parts of the abortive tissue may still be present in the uterus or cervix.

ultrasound

In threatened prematurity, the cervix is ​​closed. In contrast, the muted abortion is a miscarriage without bleeding or contractions. Examination with the ultrasound is therefore essential in the case of a miscarriage suspicion. This determines whether the child lives in the mother’s womb. From about the sixth to seventh week of pregnancy heartbeats should be detectable. In the case of imminent abortion, one can find a bruise behind the placenta with the help of ultrasound.

laboratory tests

If the ultrasound does not provide clear indications, the pregnancy hormone ß-hCG is determined at regular intervals. In this case, a lack of increase or decrease in the value can be determined. In addition, laboratory controls provide evidence of an increased miscarriage risk. A blood picture, for example, shows not only typical signs of infection but also anemia.

Miscarriage: treatment

The treatment of a woman after a miscarriage depends essentially on the form of the abortion. The therapy depends on how far the abortion has progressed or whether the pregnancy may still be maintained.

bed rest

In case of imminent miscarriage there are no special treatment options. The patient should rest in bed. An examination of the vagina should be omitted. In addition, the unborn, still living child must be monitored. This happens among other things with the help of the ultrasound. In the case of a threatened late-onset mortality, in which labor has already begun, painkillers (tocolytics) are administered.

A luteal insufficiency is a risk for early miscarriage. This can be reduced by the administration of hormone preparations, the progestogens in the first few weeks. Mending is expected when the bleeding stops.

Miscarriage-curettage

In the other miscarriages usually a shaving (curettage) is necessary. In the case of incomplete abortion, the parts of the pregnancy remaining in the uterus (placenta, etc.) are thereby removed. Otherwise there would be a risk of prolonged bleeding or severe infections or life-threatening blood poisoning (sepsis). A miscarriage without scraping is possible after a complete abortion from the 24th pregnancy week. It is only necessary if there are doubts that actually all pregnancy shares have gone off. Even if the bleeding does not stop after the abortion or the uterus does not regress afterwards, an intervention is necessary. This is to avoid complications after a miscarriage.

Medicines instead of scraping

In the so-called wind egg, ie a pregnancy, in which no child develops, and the restrained early abortion until the twelfth week of pregnancy, a Ausschabung is required. At a later date, drugs are first administered. These are intended to loosen and dilate the cervix and stimulate the uterine muscles. So the dead fetus can be ejected. The same drugs are also given before an operational clearance. This is intended to protect the maternal organs from injury from surgical instruments.

Miscarriage: disease course and prognosis

If a pregnant woman loses her baby due to a miscarriage, the doctor should act very carefully but also consistently. He must stop bleeding quickly, but at the same time make sure that later pregnancies are not endangered or impossible. For example, if the miscarriage is carelessly eradicated, the uterine lining could be permanently damaged.

It is particularly important to find the cause of the abortion in order to reduce the risk of similar complications in later pregnancy. Basically, after a miscarriage but a new pregnancy is possible.

Pregnant after miscarriage

After experiencing abortion, many women worry about another pregnancy. Read here everything important about pregnancy after miscarriage.

“Dead fetus syndrome”

The “dead fetus syndrome” is a rare complication of miscarriage. Since obvious symptoms are missing, the dead fruit sometimes stays in the uterus for a long time. The biological decomposition of the fetus releases harmful substances. These can eventually pass into the mother’s bloodstream and lead to severe sepsis with life-threatening blood clotting disorders.

infection

Especially after a miscarriage dangerous germs can rise through the cervix in the uterine cavity. There they colonize the uterine lining. Affected women get fever between 38 and 39 Celsius. In some cases, bleeding and pain are added. An infection mainly occurs after improper removal of miscarriage. Treatment is with antibiotics. With this so-called infected abortion a transmission into the blood must necessarily be prevented, since otherwise life-threatening blood poisoning and coagulation disturbances threaten. Therefore, the uterus is examined only when the patient is again fever-free.

In addition to the medical aspects of miscarriage, the medical staff as well as the personal environment should always pay attention to the mental state of those affected. The fear of a miscarriage is great anyway with expectant mothers. However, she goes much further after an abortion. Therefore, a doctor should always be aware of the possible miscarriage causes and risks. With useful tips, the pregnant one miscarriage prevent.