Miscarriage: causes, treatment and prevention. Recurrent miscarriage: causes, risks, prevention and what to do

Miscarriage is a serious problem that happens to be faced by about 15-25% of couples expecting a baby. Why are some pregnancies doomed to such a sad outcome, and is it possible to deal with this problem, our article will tell.

They talk about miscarriage when, in the period from the moment of conception to 37 weeks, all the hopes of the expectant mother collapse due to spontaneous miscarriage. It acquires the status of a “familiar” phenomenon when misfortune befalls a pregnant woman 2-3 or more times in a row. Statistics say that habitual miscarriage competes with infertility for the right to be called the most common problem of procreation.

Classification of cases of miscarriage

Depending on the term of termination of pregnancy, there are:

Spontaneous abortions. If the miscarriage occurred before 11 weeks, the abortion is considered early. If the misfortune happened between 11 and 21 weeks of gestation, the abortion is late. The interrupt occurs regardless of whether the child is alive or dead.
premature birth. Pregnancy is terminated at 22 - 27 weeks, when the child's body weight fluctuates in the range of 0.5 - 1 kg.

There are several stages of abortion, based on which they distinguish the following types this state:

threatened abortion;
abortion in progress;
incomplete abortion;
complete abortion.

In addition, speaking of abortion in general, they mean that it can be failed and infected.

Causes of miscarriage

A great many factors have been found to cause this pathology. Stimulates miscarriage is often not one, but several reasons. Let's list them all.

Reasons depending on future mother:

endocrine diseases (for example, pathologies related to the health of the ovaries or adrenal glands);
anatomical features of the female body (for example, an infantile uterus or serious anomalies in its development);
pathological incompatibility of a woman and a child. It's about about the phenomenon when, on immunological or genetic grounds, the mother organism rejects the embryo/fetus as a potential threat.

Complications that occur during pregnancy:

preeclampsia, which entails various disorders of cerebral circulation;
placenta previa or its premature detachment;
violation of the integrity of the membranes earlier than expected;
polyhydramnios;
the presence in the uterus of 2 or more embryos;
pathological location of the fetus.

Factors not related to gestation:

acute and chronic infectious diseases;
pathology of the heart and blood vessels;
disorders of the functionality of the genitourinary system;
thrombophilic diseases;
diseases of the abdominal organs.

Adverse environmental impact:

bad ecology;
harmfulness in production related to the profession of a woman;
physical or mental trauma of the expectant mother;
bad habits.

It should also be noted that the causes of 27.5 - 63.5% of cases of miscarriage remain unexplained. Pregnant women and the physicians leading them find themselves in such a difficult situation so often that the phenomenon has even been identified as idiopathic (not to be explained) abortion. Drug treatment in these cases is ineffective, and the psychological support of a woman comes to the fore, helping her to endure the pain of loss.

The mechanism of development of pathology

At the heart of self-interruption prenatal development of the fetus, a pathological destruction of the connection between cortical and cortico-subcortical factors is hidden, which occurs under the influence of many prerequisites. The prerequisites mean the most complex reflex relationships between mother and child, as well as factors that can affect the nuances and strength of the reflex.

Today, 4 options for the development of pathology have been identified:

Termination of pregnancy is possible on the basis of pathological changes in the immune and hormonal balance of the fetoplacental complex. In this case, miscarriage occurs early dates(up to 12 weeks).
Gestation is interrupted due to active uterine contractions: the fetus is rejected as if it had begun generic activity. This happens mainly closer to the 3rd trimester of the “interesting” position, when the uterus has already undergone morphological and functional metamorphoses.
The death and rejection of the fetus occurs under the influence of mutations or genetic disorders.
Miscarriage occurs on the basis of isthmic-cervical insufficiency (pathology of the isthmus and cervix) in the middle and at the end of gestation.

Scientists have combined all types of childbearing losses into fetal loss syndrome. The general concept means:

One or more miscarriages in a row during a pregnancy of 10 weeks or more.
The birth of a dead child in the history of the disease.
Neonatal (infant) death.
3 or more self-abortions during the pre-embryonic or early embryonic stage.

Diagnosis of pathology

Due to the fact that miscarriage is considered the result of a combination of the interaction of a number of unfavorable causes, the examination of affected patients is complex. It involves clinical, instrumental and laboratory methods diagnostics, during which the doctor must not only detect the "weak link" during pregnancy, but also examine the state of the patient's reproductive system in order to prevent a recurrence of the misfortune.

Features of the examination before conception

Analyzing the medical history of a woman who has experienced habitual miscarriage, the specialist will pay attention to the hereditary factor, oncological diseases and neuroendocrine disorders. It also remains to be determined whether the patient suffered from genital inflammatory diseases and viral infections in the past, whether she underwent surgery during childbirth, intentional or spontaneous abortions.

Clinical examination is represented by the following procedures:

examination of a woman by a gynecologist;
assessment of the patient's skin condition;
determination of the amount of excess weight according to BMI;
assessment of the state of the "thyroid gland";
determination of the frequency of ovulation and the functional viability of the ovaries based on data from rectal temperature and the monthly calendar.

In laboratory and instrumental diagnostics, the following methods are used:

Hysterosalpingography. The procedure is relevant in the period from 17 to 23 days of the monthly cycle. With its help, you can examine the body of a woman for the presence of defects and anomalies in the development of internal genital organs, intrauterine synechia, etc.
ultrasound. During the procedure, the ovaries are examined, the uterus is checked for the presence of cysts, adenomyosis and polyps.
infectious screening. The method involves the examination under a microscope of biological material taken from the urethra, vagina and uterus.
Hormonal analysis. Allows you to clarify the level of prolactin, testosterone, cortisol, luteinizing, follicle-stimulating hormones and other important active substances in the patient's blood.

The potential father also undergoes an examination, during which his detailed spermogram is analyzed, the presence of immune and inflammatory factors and specific somatic diseases is clarified.

Features of the examination after conception

If there is a risk of miscarriage in a patient who is in position, she is observed with particular care. The conduct of such a pregnancy is necessarily accompanied by the following research methods:

regular blood sampling to determine the level of hCG;
a blood test for DHEA / DHEA sulfate (this is the main steroid hormone in a woman's body, with the participation of which the glands of the endocrine system produce another 27 hormones);
periodic consultations with a psychologist.

Symptoms and treatment of miscarriage

Discharge of some blood from the vagina and painful discomfort in the lower abdomen is considered to be the main signs spontaneous abortion. However, it should be borne in mind that each stage of miscarriage has its own specific manifestations, which means that it requires a special approach to treatment.

Threatened abortion

A woman in position is disturbed by pulling pains in the lower abdomen and in the lower back. If anxiety symptoms are noted in the middle of pregnancy, the pain, as a rule, resembles contractions. There is a slight discharge of blood. The uterus develops well, its volume corresponds to the gestational age, but there is hypertonicity.

The ultrasound procedure reveals such symptoms of a threatened abortion as a fuzzy contour gestational sac or detachment of the chorion / placenta in a certain area.

Before prescribing maintenance therapy to a pregnant woman with a threat of miscarriage, the doctor will certainly pay attention to the presence of such concomitant factors as:

cases of self-abortion in the past;
age over 34;
bradycardia;
the absence of a heartbeat in an embryo with KTR;
slow growth or its absence in the fetal egg within 10 days;
an empty fetal egg measuring 15 mm for a gestation period of 7 weeks and 21 mm for a period of 8 weeks;
the size of the embryo is significantly inferior to the size of the fetal egg;
reduced levels of hCG;
low levels of progesterone.

Despite having all warning signs threatened abortion, targeted treatment helps to maintain the pregnancy. Maintenance therapy in this case is complex: drugs are prescribed at a minimum in scanty doses, mainly focusing on safe procedures in the form of electroanalgesia, acupuncture, electrorelaxation of the uterus and phytoaromatherapy.

Abortion on the go

At this stage of miscarriage, the embryo exfoliates from the uterine endometrium and leaves the uterus through the dilated cervical canal. The pregnant woman feels cramping pain in the abdomen, she develops profuse bleeding. Vaginal examination reveals an open cervix with parts of the ovum in it. At 12 weeks gestation, ultrasound shows complete detachment of the egg or partial detachment placenta.

tactics further action choose according to the gestational age. So, for a gestation period of up to 16 weeks, the uterus is scraped as a matter of urgency, followed by a laboratory analysis of the torn tissue. With a period of 16 weeks, spontaneous complete rejection of biological material is expected, and only then vacuum cleaning or curettage of the uterus is carried out.

In case of severe bleeding, which can threaten the life of the patient, they act promptly: the embryo is removed from the uterus, without waiting for its rejection, and hemodynamics are stabilized. If an immediate operation to curettage the uterus for some reason is not possible, with severe bleeding, the pregnancy is terminated abdominally.

incomplete abortion

The embryo leaves the uterus, but some of its parts remain there. Outwardly, this is manifested by pain of a cramping nature and the release of blood from the vagina, and these symptoms can be of varying degrees of intensity. On examination, the sick doctor determines that the cervix is shortened, and the pharynx is open. There is no uterine tone - the organ is soft and does not correspond to the gestation period. On ultrasound in the cavity of the muscular organ, unclear outlines of heterogeneous tissues are found.

In case of incomplete abortion, the uterine cavity is cleaned, removing rejected tissues from there, followed by a laboratory study. They resort to a surgical or medical method of ridding the uterus of parts of the embryo.

Choice in favor surgical operation do in case:

intensive spotting;
the uterine cavity is open by more than 50 mm;
body temperature is about 38 0 С.

With a satisfactory condition of the patient and a gestational age of 70 days from the first day of the last menstruation, preference is given to the medical method of cleaning. In case of incomplete abortion, large doses of prostaglandin (from 800 to 1200 mg) are used. Most often they stop at the drug Misoprostol. After 4-6 hours after intravaginal administration, the uterus begins to contract and completely expels the fetal egg. The main advantage of this method is the low percentage of cases of pelvic infection.

Complete abortion

Under the influence of strong uterine contractions the fertilized egg is rejected by the uterine cavity. External signs either absent completely, or expressed by scanty bleeding and pulling pains in the lower abdomen. Vaginal examination reveals a firm uterus with an open external os. If the patient's condition is satisfactory, then an instrumental examination of the walls of the uterine cavity is not performed.

Missed abortion

In this case, the embryo stops developing, but does not leave the uterus. The patient at this time may increase body temperature and appear ichorus. Subjective sensations"interesting" positions disappear. Ultrasound shows that the size of the embryo lags behind the gestation period. In addition, there are no heartbeats and movements of the embryo. If the diagnosis of a failed abortion is confirmed, an emergency operation is necessary to remove the embryonic or fetal material by surgical or medical means.

Forecast and measures to prevent recurrent miscarriage

The prognosis for the development of pregnancy in the future in a patient whose medical history contains a mark on self-abortion depends on how the previous pregnancy ended. The most favorable prognosis is in women whose pregnancy was terminated due to organic uterine pathology, endocrine or immune factors.

With all the complexity and unpredictability of the phenomenon of habitual miscarriage, you can try to avoid it. After a detailed study of the patient's history, the doctor prescribes a comprehensive treatment, consisting of the use of medications and the implementation of the recommendations of a specialist. An approximate therapeutic complex for the treatment of recurrent miscarriage looks like this:

Bed rest and strict diet.
The use of sedatives (Sanosan, Diazepam, Phenazepam, herbal tinctures).
The use of hormonal drugs. Treatment is effective from the 5th week of gestation until the 28th week inclusive. The most popular drugs are progesterone, gonadotropin, Duphaston and Ethinylestradiol.
Use of antibiotics to prevent infection.
Tocolytic treatment aimed at suppressing the contractile activity of the uterus.
Work to improve the metabolism of the fetoplacenary complex, for which the patient is prescribed multivitamin complexes, preparations of ascorbic acid and tocopherol acetate.
Operative surgical intervention (in case of urgent need) - a circular suture is applied to the uterus until the 38th week of gestation.

Prevention of miscarriage

Unfortunately, nature cannot be outwitted, and with all the desire of expectant mothers and their attending physicians, cases of habitual miscarriage still occur. The search for methods of getting rid of this pathology continues to this day and indicates that the methods of treatment already found cannot be called 100% effective. However, you can’t give up - a woman must use all the opportunities and chances to become a mother. Therefore, planning pregnancy after the previous one ended in spontaneous abortion is of no small importance.

The patient should consult a doctor for a thorough examination of the state of the body for the presence of diseases in which the course of pregnancy can be complicated, tests to analyze the hormonal background and bacteriological examination of the microflora of the internal genital organs, determine the blood type and Rh factor. In addition, the future father must also undergo a thorough examination.

With an unclear etiology of the causes of miscarriage, a woman can be sent to a specialized hospital for a rigorous analysis of the state of her endocrine and immune systems.

How to deal with the problem. Video

Miscarriage is not only a physical trauma for a woman, but also a moral one. It is for this reason that the article below has collected the maximum amount of information about the diagnosis, causes, symptoms, treatment, and prevention of spontaneous miscarriage.

Early miscarriage is a very sad and, unfortunately, quite common occurrence. According to statistics, every eighth woman's pregnancy is terminated in the first twelve weeks. Most of them experience a miscarriage without knowing they were pregnant. And some are already told about the possibility of losing the fetus at the first consultations and are advised to lie down for preservation.

It is considered the least affecting the reproductive function and health of women. It is very important not to miss the deadline.

Termination of pregnancy may not be noticed by a woman in the early stages. The delay in menstruation is simply written off as a delay, and then heavy bleeding begins, which is accompanied by a feeling of pain. When the fetus comes out completely, bleeding and pain stop, while the woman may not know that she was pregnant.

If the fetus does not come out completely, which is the cause of prolonged bleeding, women, as a rule, turn to a specialist who ascertains miscarriage. Most doctors, in order to restore the female body, after such an incident, prescribe a course of medical therapy.

Causes

Reasons for miscarriage may include:

Hormonal disbalance.
genetic abnormalities.
Infectious diseases.
Rh factor.
Medications.
Injuries.
abortion in the past.

The threat of termination of pregnancy in the second trimester is markedly reduced. According to statistics, in the second trimester, a miscarriage occurs only in every fiftieth woman.

So, let's consider in more detail the reasons for miscarriage listed above.

Hormonal disbalance

In the female body, hormones and their correct balance are necessary condition For normal course pregnancy process. In some cases, a failure in the hormonal background can result in a breakdown. Specialists secrete progesterone as a very important hormone that is required to maintain pregnancy. If its deficiency was detected in a timely manner, the woman is prescribed this hormone in the form of medicines, as a result, the fetus can be saved.

In addition, the balance of androgens affects the safety of the fetus. With their excess in the body of a pregnant woman, the production of estrogen and progesterone is inhibited, and this is also a threat of miscarriage.

Infectious diseases

In preparation for pregnancy, a woman should take up the therapy of all available chronic diseases. In addition, it is recommended to avoid infectious diseases. After all, when a pathogen enters the female body, the temperature can rise sharply, which will also provoke miscarriage.

A separate threat to the fetus are diseases that are sexually transmitted. Therefore, future parents in preparation for pregnancy should be examined and tested for these diseases. Due to the fact that this type of infection enters the fetus through the blood, in most cases, in the presence of pathology, miscarriage is diagnosed.

genetic abnormalities

The lion's share of all miscarriages occurs precisely for this reason. Doctors call the figure 73% of their total number. IN modern world this factor plays a huge role. Poor-quality products, radiation contamination, polluted ecology - all this affects the female body every day.

Today, preparing for pregnancy, many women try to leave the polluted noisy city and spend that time in the most appropriate environment. Although these factors are not easily eliminated, the mutations associated with them are not considered hereditary, next pregnancy can become successful.

Rh factor

This factor almost always provokes abortion in the early stages. For this reason, if a woman and a man are positive, this state of affairs can provoke a Rh conflict and, as a result, miscarriage.

To date, medicine has learned to cope with this problem by introducing progesterone into the female body. Thus, the fetus is protected from the aggressive female immune system. However, in this case, the problem of miscarriage may arise.

Medications

Experts recommend during this period to avoid taking medical preparations, especially in the early stages. It is very important to exclude all analgesics and hormonal drugs. It is also undesirable to use folk recipes, in which St. John's wort, nettle, cornflowers and parsley are present as ingredients.

Stress factors

Sudden grief, quarrels in the family or stress at work are all causes of early miscarriage. These factors should be minimized or, if possible, avoided. An important role in creating a calm environment for a woman belongs to a man. If it is not possible to avoid the action of stress factors, then doctors in this case prescribe light sedatives.

Bad habits

Even before conception, it is necessary to stop drinking alcohol and quit smoking. Smoking can adversely affect the fetal cardiovascular system. It is recommended to build a consistent system healthy eating, with a set essential minerals and vitamins. It is also necessary to adjust the daily routine.

Injuries

Along with the factors listed above, miscarriage in the early stages can provoke a strong blow, falling or lifting heavy objects. Therefore, you should be as careful as possible.

Abortions in the past

This is not only an argument used to intimidate young women, but also a real problem factor in the future. In some cases, abortion can lead to infertility and provoke chronic miscarriage.

Diagnosis

Miscarriage is a multifactorial disease, in which in many patients it is combined with several pathogens at the same time. For this reason, the examination of patients should be carried out comprehensively and include all modern laboratory, instrumental and clinical methods.

During the examination, not only the causes of spontaneous miscarriage are established, but the condition is also assessed for the subsequent prevention of the occurrence of such a condition.

Examination before pregnancy

The anamnesis includes clarification of the presence of somatic, oncological, hereditary diseases and neuroendocrine pathology. Gynecological history allows you to find out the presence of a viral infection, inflammatory diseases of the genitals, features of reproductive and menstrual functions (spontaneous miscarriages, childbirth, abortions), methods of therapy and others surgical interventions, gynecological diseases.

In the course of a clinical examination, an examination is performed, an assessment of the condition skin, thyroid gland and the degree of obesity in accordance with the body mass index. According to the hirsute number, the degree of hirsutism is determined, the condition of the internal organs is assessed, as well as the gynecological status. The absence or presence of ovulation, ovaries are analyzed according to the menstrual calendar and rectal temperature.

Laboratory and instrumental research methods

Diagnosis of miscarriage consists of the following studies:

Hysterosalpinography - carried out after the menstrual cycle on days 17-13, allows you to exclude intrauterine synechia, uterine malformations, ICI.
Ultrasound - determines the presence of adenomyosis, cysts, uterine fibroids, assesses the condition of the ovaries. Clarifies the state of the endometrium: endometrial hyperplasia, polyps, chronic endometritis.
Infection screening - includes microscopic examination smears of the vagina, urethra, cervical canal and bacteriological examination of the contents of the cervical canal, PCR diagnostics, testing for virus carriers.
Hormonal research. It is carried out on the 5th or 7th day of the cycle, subject to regular menstruation, in patients with oligo- and amenorrhea - on any day. The content of 17-hydroxyprogesterone, DHEA sulfate, cortisol, testosterone, FGS, LH, prolactin is determined. Progesterone can be determined only in patients with a regular cycle: in the first phase of the cycle on days 5-7, in the second phase of the cycle - on days 6-7 of the rise in rectal temperature. In women with adrenal hyperandrogenism, a small test with dexamethasone is performed to determine the optimal therapeutic dose.
To determine the risk of miscarriage, it is necessary to determine the presence of anticardiolipin antibodies, anti-CHG and analyze the features of the hemostasis system.
If you suspect the presence and / or intrauterine pathology under the control of hysteroscopy is carried out
If you suspect the presence of adhesive stress in the pelvis, tube pathology, genital endometriosis, with scleropolycystic ovaries and uterine myoma, operative laparoscopy is indicated.
Examination of a man includes the determination of a hereditary history, analysis of a detailed spermogram, the presence of neuroendocrine and somatic diseases, as well as clarification of inflammatory and immune factors.

After the causes causing habitual miscarriage of pregnancy are determined, a set of therapeutic measures is prescribed.

Examination during pregnancy

Observation during pregnancy should begin immediately after its onset, and it consists of the following research methods:

Prevention

According to statistics, the frequency of spontaneous miscarriage is 1 in 300 pregnancies. Despite the fact that the probability of miscarriage decreases with an increase in the term, in the last trimester this indicator is about 30%. It also often happens that premature birth and miscarriage in a woman occur repeatedly. As a result, a diagnosis is established - habitual miscarriage (treatment will be discussed below).

Causes this disease are diverse, in most cases, a whole complex of them leads to premature birth or miscarriage. Moreover, their action can be both sequential and simultaneous. A woman who has a tedious job, combined with nervous and physical overload, or a low socio-economic status, automatically falls into the risk group.

In addition, factors that increase the likelihood of pathology should include diabetes, kidney disease, bronchial asthma, vascular and heart diseases, regular intoxication with narcotic substances, alcohol, tobacco smoke. If a woman has pregnancy complications, or an obstetric history is burdened, then this also applies to risk factors for spontaneous miscarriage or termination of pregnancy. It is important to remember that in the short term, spontaneous abortion can be a biological mechanism of natural selection, for this reason a miscarriage is not yet a harbinger of a subsequent unsuccessful pregnancy.

In fact, the prevention of miscarriage comes down to two main points:

Timely examination of the body of a woman and a man.
Healthy lifestyle.

It is very important to determine the presence of hereditary diseases, infections in a man, conduct a semen analysis and complete the treatment of all existing problems.

Women face a more difficult task. It should be clarified whether there were somatic, neuroendocrine, oncological diseases, how things are with hereditary pathologies.

Also, within the framework of prevention, the features of reproductive and menstrual functions are studied, the presence of obesity and its degree are ascertained, the condition of the skin is assessed.

It is advisable to apply for Quite informative is hysterosalpingography, which is carried out in the second half of the menstrual cycle. As a result, it is possible to find out if the patient has intrauterine pathologies. The results of ultrasound of the pelvic organs allow diagnosing the presence of endometriosis, fibroids, cysts, as well as assessing the condition of the ovaries.

It is important to examine smears from the urethra, cervical canal and vagina. Hormonal research is desirable to perform in the first half of the menstrual cycle. In addition, it is necessary to think about a blood test, which will include clotting indicators. This will determine the presence of antibodies such as anti-CHG, anticardiolipin and lupus.

Treatment

Treatment for miscarriage occurs in next sequence: identification and subsequent elimination of the cause.

One of the reasons is the infection of the fetus, which occurs as a result of infection of the amniotic fluid or penetration of pathogens through the placenta. In this case, spontaneous abortion occurs after the contractile activity of the uterus, triggered as a result of acute intoxication or premature outflow of amniotic fluid, which is due to a change in the structure of the fetal membranes under the influence of infectious agents. Treatment in such a situation can be successful, since the child's ability to withstand negative factors increases with increasing gestational age.

In measures to prevent this disease, it is necessary to include consultations with an endocrinologist, since hormonal deficiency can lead to pathological restructuring of the endometrium and its depletion, which is also considered a prerequisite for miscarriage. Hyperandrogenism (a pathological condition) is also characterized by a hormonal nature and can be the cause of spontaneous interruption.

Acquired or congenital organic pathology of the organs of the reproductive system is also the cause of miscarriage. In addition, the causes of this disease should include psychological overload, stress, the effects of certain drugs, diseases different nature, intimate life during pregnancy.

Even when habitual miscarriage is diagnosed, the possibility of its spontaneous termination can be significantly reduced under the condition of constant monitoring by specialists and comprehensive prevention.

What is miscarriage, of course, it is better not to know anyone. However, cases of threatened abortion still happen and therefore you need to be prepared for anything. What are the causes of a miscarriage, and how to avoid its possible recurrence, we will describe in the article.

Miscarriage is the spontaneous termination of pregnancy before 37 weeks. That is, the body rejects the fetus even before all its organs and systems have had time to form for a full life. Termination of pregnancy occurs in 15-25% of cases and this figure does not decrease over the years. How to understand that something is wrong? What should be of concern?

If you feel during pregnancy:

persistent discomfort in the lower abdomen;
cramping pains;
see bleeding.

All this should be a serious cause for concern, as there is a danger of abortion.

When the expectant mother ignores these signs, the threat of miscarriage increases. After all, with urgent medical care, the loss of a child can often be avoided. But even if the pregnancy was saved, after such a diagnosis, the girl should be under close medical supervision until the end of the term.

Three reasons for miscarriage

A large percentage of abortions indicates a poor condition of the mother's body. Perhaps some unfavorable processes are taking place in it. Let's consider three main reasons for such deviations.

Endocrine causes of miscarriage

Often the loss of an embryo occurs due to severe developmental pathologies, which is called natural selection. It is possible to detect such a defect if you make genetic research both partners by examining the family history.

If this is the reason for the miscarriage, then in subsequent attempts, you can turn to in vitro fertilization (IVF). When applying the IVF method, only healthy eggs are isolated, and artificial insemination is carried out.

Also, the cause of miscarriage can be diabetes, problems with the thyroid gland, sex hormones and other malfunctions of the endocrine system.

Diabetes mellitus greatly complicates the course of pregnancy and requires constant monitoring of insulin.

Thyroid dysfunction is an insufficient amount of iodine-containing hormones (thyroiditis), which are necessary for a normal pregnancy.

A decrease in the hormone progesterone (the steroid hormone of the ovarian corpus luteum, necessary for all stages of pregnancy) leads to the fact that the fetal egg cannot stay in the uterus and attach to its walls.

Anatomical causes of miscarriage

Such pathologies are considered to be an incorrect congenital structure of the uterus or a change in the organs of childbearing during life. This problem can be solved by surgeons. If a pregnant woman has a shortening of the cervix, then after the first trimester, her premature opening may occur. This situation is very dangerous. Therefore, before pregnancy, it is necessary to do plastic surgery to correct this anomaly. If the mother finds out about this problem when the baby is already in her womb, then an operation is performed to suture the cervix.

Infectious diseases

About 40% of miscarriages are due to infections and viruses. Therefore, all infections must be checked before conception. If you did not do this and still fell ill, the doctor will prescribe treatment taking into account your term. Antibiotics are prescribed only after 12 weeks. Before this time, such drugs can cause serious harm to the child.

Classification of miscarriages

An early miscarriage is a spontaneous abortion before the end of the first trimester. From 12 to 22 weeks is late miscarriage. In the period from 23 to 37 weeks, termination of pregnancy is called premature birth and a premature baby. A baby born after 37 weeks is considered term born.

Often a woman may not even know that she was pregnant. The term for termination of pregnancy is so short that it can only be judged by special tests (hCG - definitions in the blood of the "hormone of pregnancy" - chorionic gonadotropin). Outwardly, such a miscarriage can only manifest itself as a delay in menstruation or its more severe course.

Today, modern medicine saves even babies weighing 500-600 grams. This is approximately 22-23 weeks of pregnancy. And seven month old baby has many chances for a full life, even despite the fact that the first months will be under the constant supervision of doctors.

If we talk about the problem of miscarriage in early pregnancy, then there is a high probability of malformation of the fetus. In order to try to find the root cause, you will need to undergo an ultrasound examination (ultrasound). According to its results, doctors will be able to see the state of the fetus (the presence of a heartbeat and heart rate), see if there is an increased tone of the uterus or early opening of the cervix. It is also recommended to donate blood for progesterone and estrogen levels, a general urine test and tests for infections.

After all the procedures, the doctor prescribes therapy. Treatment can be done at home. In more complex cases, with bleeding, the pregnant woman is sent to the hospital for preservation.

After an unsuccessful pregnancy, it is very important to properly tune in psychologically, enlist the support of loved ones and not be afraid to keep trying. As a rule, the positive attitude of the expectant mother greatly affects the result.

How to avoid re-abortion of pregnancy

What to do after a miscarriage:

Wait with re-pregnancy for six months. Otherwise, the probability of miscarriage almost doubles.
Control the choice and use of contraceptives for the period of treatment and recovery. Let the doctor who is aware of the current situation prescribe these funds for you.
Choose the right therapy with your doctor.

Now there are many clinics that are focused on reproduction. There you can get all the options for research and subsequent treatment. You should not let everything take its course, as there is a chance to miss a serious illness.

Miscarriage is the rejection of the fetus from the endometrium. Doctors say that 2 out of 10 clinically established pregnancies end with the development of spontaneous abortion. Why this happens and for what reasons, we will consider in more detail.

Why there is a threat of miscarriage in the early stages

The causes of miscarriage are varied and numerous:

Genetic pathology in the embryo, incompatible with life. Most often, it is these disorders that affect the occurrence of miscarriage in the early stages. Spontaneous mutations in male and female germ cells due to medication, alcoholic beverages, the actions of viruses lead to pathology.
endocrine disorders. They arise as a result of insufficient synthesis of progesterone, which is required for the maintenance and development of the fetus in the uterus. Other factors for the onset of spontaneous miscarriage are considered to be an increased content of androgens and an imbalance of thyroid and adrenal hormones.
Infectious diseases in a pregnant woman. Influenza, pyelonephritis, tonsillitis, sexually transmitted diseases increase the risk of spontaneous abortion.
Rhesus conflict. There is a rejection by the body of the Rh (-) woman of the Rh (+) fetus.
Folic acid deficiency. With a deficiency of the substance, the pathology of the fetal karyotype develops. Termination of pregnancy for this reason occurs most often for a period of 6-12 weeks.
Previous gynecological interventions and inflammation of the uterus. Previous curettage and endometritis in a pregnant woman often leads to spontaneous abortion.
Wrong way of life. Alcohol abuse, drug addiction, smoking, a large number of caffeine, stress provoke the onset of spontaneous abortion.
Excessive physical activity, sex, falls or blows to the stomach contribute to the development of miscarriage.

What are the types of pathology

A pregnant woman may experience various gestational disorders, due to which spontaneous rejection of the fetus from the uterine wall occurs. According to the international classification of diseases, doctors encode the disease as "Threatened abortion", the ICD-10 code for the disease is O20.

Anembryony

According to statistics, about 15% of pregnant women experience this pathology at an early stage. Anembryony is a disorder in which there is no embryo in the fertilized egg. The egg is fertilized and then implanted in the endometrium. The embryo stops developing, and the fertilized egg continues to grow. To confirm the disease, the doctor performs an ultrasound scan at 5-7 weeks of the gestation period and a blood and urine test for hCG, the content of which is insufficient at the appropriate time.

chorionadenoma

Approximately 1 out of 1000 women who consider themselves pregnant are faced with a pathology. It is an abnormal formation of the placenta, arising exclusively from a set of 3 paternal chromosomes. Maternal chromosomes are completely absent in it. The disease is characterized by the development of early stages pregnancy, when conception occurs without maternal information, and are copied male chromosomes. Or 1 normal female reproductive cell is fertilized immediately by 2 spermatozoa.

The formation of the embryo does not occur, despite the presence of intrauterine growth, while classic symptoms of pregnancy appear.

Doctors distinguish 2 types of choreoadenoma:

Complete: a drift is formed in the uterus instead of the placenta and the fetus.
Incomplete: there is an abnormal development of the placenta, which turns into an intrauterine growth. If formations of fetal tissue appear, with such a pathology they have severe defects.

threatened miscarriage

Threatened abortion is a condition in which there is a risk of rejection of the embryo from the endometrium of the uterus. A pregnant woman complains about the occurrence of pulling pains in the lower abdomen, increased uterine tone and scanty spotting. With illness internal os not open, and on ultrasound, the doctor registers the baby's heartbeat.

If at this stage the pregnant woman receives timely medical care, it is possible to prevent the development of spontaneous abortion.

Started miscarriage

This is a violation characterized by partial rejection of the embryonic egg from the endometrium with uterine hypertonicity. The manifestations of an abortion that has begun are fully consistent with threatened miscarriage, differing only in the severity of pain and spotting, as well as the opening of the cervical canal.

At this stage, the disease is reversible, so the immediate help of a doctor and the rest of the pregnant woman are required.

Complete miscarriage

There is a complete detachment of the fetal egg, followed by exit from the uterine cavity. More common on later dates gestation. A complete abortion is manifested by severe bleeding and pulling, severe pain in the lower abdomen. When performing an ultrasound, the doctor determines the closed uterine cavity and complete absence embryo.

Incomplete miscarriage

The disease is characterized by spontaneous rejection of the fetal egg from the endometrium and its exit from the uterus, but particles of the embryo remain in the cavity. A pregnant woman complains of severe bleeding from the genital tract. Pathology is confirmed by ultrasound, where fetal pieces are visualized. The doctor performs a curettage after incomplete abortion to clean the uterus in order to avoid the development of the inflammatory process in it.

Missed miscarriage

This is an early pathology, when the embryonic egg stops its further development due to the action of uncertain reasons, but does not exfoliate, but undergoes resorption.

A failed abortion goes through 3 stages:

Stage of hemorrhage.
Stage of fleshy skid.
Stage of rock drift.

Doctors say that the cause of such an anomaly is sexually transmitted diseases (gonorrhea, chlamydia, mycoplasmosis, ureaplasmosis), genetic disorders, due to which the fetus becomes unviable. The diagnosis is confirmed by ultrasound diagnostics, where there is no fetal heartbeat. After that, the doctor removes the frozen embryo from the uterine cavity.

What symptoms to look out for

There are the first manifestations of the threat of miscarriage in the early stages, by which any pregnant woman will be able to recognize the anomaly:

Feeling of heaviness and pulling pains in the lower abdomen and lower back, which become more pronounced over time. Please note that the development of pain at 9-20 weeks in the groin or lateral sections of the abdomen during physical activity may be associated with an increased load on the ligamentous apparatus of the enlarging uterus. Doctors say that they do not carry any threat of spontaneous abortion in the early stages.
Pathological discharge: at first they are bloody, bloody. With the development of the disease, the discharge from the genital tract becomes bright scarlet and abundant due to the exfoliation of the embryonic egg from the uterine wall and damage blood vessels with hematoma formation.
Uterine hypertonicity: a pregnant woman complains of a feeling of tension in the abdomen, the occurrence of cramping pains.

What not to do with the threat of an early miscarriage

If you are experiencing an illness and have symptoms of impending miscarriage, try not to panic.

None physical activity, especially weight lifting, jumping. Instead, you need bed rest and peace.
Beware of making sudden movements: this can provoke the development of embryonic detachment.
Do not worry: try to keep calm, in such a difficult time, stress can harm your condition.
Refrain from taking a bath and going to the sauna: hot temperature causes increased bleeding and detachment of the embryo.
Limit sexual intercourse: if threatened, sex provokes miscarriage.
Give up bad habits and consumption of coffee and chocolate.
Do not self-medicate: taking drugs without medical prescriptions, you aggravate the situation.

Who to contact for treatment of the disease

When the first symptoms appear, it is necessary to seek medical help from a gynecologist who will determine whether the fetus can be saved. The faster qualified therapy is, the higher the chances that the risk of spontaneous abortion will disappear.

If you notice that the discharge has become profuse, call an ambulance to save the desired pregnancy.

How to prevent the threat of miscarriage - ways to treat pathology

When a woman shows signs of spontaneous abortion, she is admitted to a hospital where she is under observation. How many lie in the hospital with an illness depends on the elimination of symptoms and the normalization of the condition.

The specialist prescribes bed rest with complete rest. The doctor takes a smear for the threat of miscarriage to determine the existing endocrine disorders or sexually transmitted diseases. Specialists study the microflora and calculate the karyopyknotic index (KPI), which shows the saturation of the body of a pregnant woman with estrogens. With a decrease in the CPI, one can judge the threat of spontaneous abortion at an early stage.

Medical

The main task of treatment is to relieve tension in the uterus, stop bleeding and prolong pregnancy, provided that the fetus is viable. The faster they provide medical assistance, the greater the likelihood of maintaining gestation.

The following medicines are used:

Hormonal drugs: are necessary to ensure the normal course of pregnancy at an early stage. Means based on progesterone are used - tablets Duphaston, Utrozhestan.
Hemostatic drugs: pregnant women are given droppers with drugs (Tranexam, Dicinon). They are dripped to stop bleeding.
Antispasmodics: Drotaverine injections with a further transition to tablets (No-shpa), Papaverine suppositories, droppers with magnesia. They are used to relieve symptoms of the disease - increased uterine tone and severe pain.
Tocopherol: the instructions for use say that vitamin E is necessary for the normal functioning of the ovaries, strengthening the vascular walls and preventing thrombosis.
Sedative medications: motherwort, valerian tincture. They are used for excessive nervousness of a pregnant woman.
Glucocorticosteroids: Dexamethasone, Metipred. They are prescribed in the presence of immune disorders that cause a threat of miscarriage in the early stages.

If necessary, install the unloading ring. The procedure is performed in the second trimester after the 20th week of gestation. The device is removed no earlier than 38 weeks. It is placed to maintain the correct position of the uterus and prevent premature birth.

ethnoscience

You can use "grandmother's" recipes only after the permission of the attending physician. Alternative medicine can sometimes be unsafe for the development of the fetus.

With the threat of spontaneous abortion, doctors allow the pregnant woman to use the following recipes:

Dandelion decoction. Take 5 g of the plant, pour 1 glass of water. Put on the stove, bring to a boil, cooking the medicine for another 5 minutes. Take the prepared remedy ¼ cup three times a day.
Viburnum bark. Prepare 1 teaspoon of crushed ingredient and pour 1 cup of boiling water. Place on the stove and cook for about 5 minutes. Drink the medicine for 2 tbsp. l. three times a day.
Viburnum flowers. Take 30 g of the component and pour 1.5 liters of boiling water. Let it brew for about 2 hours, strain and drink ¼ cup three times a day.
Infusion of St. John's wort with calendula flowers. You will need to take both ingredients in the same proportions and pour 200 ml of boiling water over them. Let it brew for about half an hour. Strain the remedy and take 2 glasses throughout the day. If desired, you can add 1 tsp. honey.

If there is a threat of miscarriage, read a prayer: according to believers, it helps even in the most difficult cases. To save the fetus, try reading these prayers:

To the Most Holy Theotokos;
To the Lord God;
Akathists to the icons of the Mother of God "Help in childbirth", "Unexpected joy", "Kazan";
Pray to the holy and righteous Joachim and Anna.

Traditional medicine cannot be used as the main treatment for the threat of spontaneous abortion. "Grandmother's" recipes are used in combination with drug therapy.

Prevention of threatened miscarriage

The threat of miscarriage becomes a real test for a woman. There are many factors due to which there is a threat of spontaneous abortion at an early stage, so it is extremely difficult to prevent the onset of the disease. But this does not mean at all that you need to sit idly by.

The main measure for preventing abortion is planning a child: during this period, future mothers and fathers are examined. It is imperative to do tests for the genetic compatibility of parents, especially when their age is over 35 years old, and determine the Rh factor. If a pregnant woman suffers infectious diseases, they need to be treated before the onset of gestation. Doctors prescribe folic acid to both parents before conception of the fetus at a dosage of 1 tablet per day to reduce the likelihood of intrauterine development pathologies and illness in the fetus.

If the pregnancy turned out to be unplanned, reconsider your lifestyle, stop smoking and drinking alcohol, drugs. Try to get registered in a timely manner and come to an appointment with your doctor. Stick to the full balanced nutrition and spend a lot of time on fresh air. Try to avoid stressful situations and take medications with extreme caution.

Tips from a practitioner in the video below:

Conclusion

Termination of pregnancy can be a real tragedy for a pregnant woman. According to statistics, spontaneous miscarriage is the most frequent complication gestation, so you need to prepare in advance for bearing the fetus.

The threat of miscarriage at an early stage is manifested by the occurrence pulling pain in the lower abdomen and lower back with a feeling of tension in the projection of the uterus, the appearance of bloody discharge from the genital tract. The earlier medical care is provided to a woman, the greater the chances for a favorable course of pregnancy.

According to statistics, miscarriage is recorded in 10-25% of pregnant women.

The cause of miscarriage can be various diseases that are difficult to treat or have become chronic. However, these diseases do not apply to the sexual sphere. An important feature this kind of pathology is the unpredictability of the process, since for each specific pregnancy it is difficult to determine the true cause of abortion. Indeed, at the same time, the body of a pregnant woman is influenced by many different factors that can act covertly or explicitly. The outcome of pregnancy in case of habitual miscarriage is largely determined by the ongoing therapy. With three or more spontaneous miscarriages at gestational ages up to 20 weeks of gestation, an obstetrician-gynecologist diagnoses habitual miscarriage. This pathology occurs in 1% of all pregnant women.

After the fertilized ovum is “located” in the uterine cavity, the complex process of its engraftment there begins - implantation. future baby first develops from a fetal egg, then becomes an embryo, then it is called a fetus that grows and develops during pregnancy. Unfortunately, at any stage of bearing a child, a woman may encounter such pathology of pregnancy as her miscarriage.

Miscarriage is the termination of pregnancy between the time of conception and the 37th week.

Risk of primary miscarriage

Doctors note a certain pattern: the risk of miscarriage after two failures increases by 24%, after three - 30%, after four - 40%.

In case of miscarriage, a complete or incomplete (the fetal egg exfoliated from the uterine wall, but remained in its cavity and did not come out) miscarriage occurs in the period up to 22 weeks. At a later date, in the period of 22-37 weeks, spontaneous abortion is called premature birth, and an immature but viable baby is born. Its mass ranges from 500 to 2500 g. Premature, prematurely born children are immature. Their death is often noted. In surviving children, malformations are often recorded. The concept of prematurity, in addition to the short term of pregnancy, includes low birth weight of the fetus, on average from 500 to 2500 g, as well as signs of physical immaturity in the fetus. Only by a combination of these three signs can a newborn be considered premature.

With the development of miscarriage, certain risk factors are indicated.

Modern achievements in medicine and new technologies, timeliness and quality of medical care allow avoiding severe complications and prevent premature termination of pregnancy.

A woman with a first trimester miscarriage should undergo a long-term examination before the expected pregnancy and during pregnancy to identify true reason miscarriage. Very a difficult situation develops with spontaneous miscarriage against the background of the normal course of pregnancy. In such cases, the woman and her doctor can do nothing to prevent such a course of events.

The most common factor in the development of premature termination of pregnancy are fetal chromosomal abnormalities. Chromosomes are microscopic elongated structures located in the internal structure of cells. Chromosomes contain genetic material that defines all the properties that are characteristic of each “person: eye color, hair, height, weight parameters, etc. There are 23 pairs of chromosomes in the structure of the human genetic code, 46 in total, with one part inherited from the mother organism, and the second - from the father. Two chromosomes in each set are called sex chromosomes and determine the sex of a person (XX chromosomes determine the female sex, XY chromosomes determine the male sex), while the other chromosomes carry the rest of the genetic information about the whole organism and are called somatic.

It has been established that about 70% of all miscarriages in early pregnancy are due to abnormalities of somatic chromosomes in the fetus, while most chromosomal abnormalities developing fetus occurred as a result of the participation in the process of fertilization of a defective egg or sperm. This is due to the biological process of division, when the egg and sperm in the process of their preliminary maturation divide in order to form mature germ cells in which the set of chromosomes is 23. In other cases, eggs or spermatozoa are formed with an insufficient (22) or excessive (24) set chromosomes. In such cases, the formed embryo will develop with a chromosomal abnormality, leading to a miscarriage.

The most common chromosomal defect can be considered trisomy, while the embryo is formed by the fusion of the germ cell with chromosome set 24, as a result of which the set of fetal chromosomes is not 46 (23 + 23), as it should be, but 47 (24 + 23) chromosomes . Most trisomies involving somatic chromosomes lead to the development of a fetus with malformations that are incompatible with life, which is why spontaneous miscarriage occurs in early pregnancy. In rare cases, a fetus with a similar developmental anomaly lives to a long time.

An example of the most well-known developmental anomaly caused by trisomy is Down's disease (represented by trisomy on chromosome 21).

A woman's age plays an important role in the occurrence of chromosomal disorders. And recent studies show that the age of the father plays an equally important role, the risk of genetic abnormalities increases with the age of the father over 40 years.
As a solution to this problem, couples where at least one partner is diagnosed with congenital genetic diseases are offered mandatory counseling by a geneticist. In certain cases, it is proposed to carry out IVF (in vitro fertilization - artificial insemination in vitro) with a donor egg or sperm, which directly depends on which of the partners revealed such chromosomal disorders.

Causes of primary miscarriage

There can be many reasons for such violations. The process of conceiving and carrying a baby is complex and fragile, it involves a large number of interrelated factors, one of which is endocrine (hormonal). The female body maintains a certain hormonal background so that the baby can develop correctly at each stage of its intrauterine development. If for some reason the body of the expectant mother begins to produce hormones incorrectly, then hormonal imbalances cause a threat of abortion.

Never take hormones on your own. Their intake can seriously disrupt the reproductive function.

The following congenital or life-acquired lesions of the uterus can threaten the course of pregnancy.

Anatomical malformations of the uterus - duplication of the uterus, saddle uterus, bicornuate uterus, unicornuate uterus, partial or complete uterine septum in the cavity - are congenital. Most often, they prevent the fetal egg from successfully implanting (for example, the egg "sits" on the septum, which is not able to perform the functions of the inner layer of the uterus), which is why a miscarriage occurs.
Chronic endometritis - inflammation of the mucous layer of the uterus - the endometrium. As you remember from the section that provides information on the anatomy and physiology of a woman, the endometrium has an important reproductive function, but only as long as it is “healthy”. Prolonged inflammation changes the nature of the mucous layer and disrupts its functionality. It will not be easy for a fetal egg to attach and grow and develop normally on such an endometrium, which can lead to pregnancy loss.
Polyps and hyperplasia of the endometrium - the growth of the mucous membrane of the uterine cavity - the endometrium. This pathology can also prevent the implantation of the embryo.
Intrauterine synechia - adhesions between the walls in the uterine cavity, which do not allow the fertilized egg to move, implant and develop. Synechia most often occurs as a result of mechanical trauma to the uterine cavity or inflammatory diseases.
Uterine fibroids are benign tumor processes that occur in the muscular layer of the uterus - myometrium. Fibroids can cause miscarriage if the fetal egg is implanted next to the myoma node, which has broken the tissue of the internal cavity of the uterus, “takes over” the blood flow and can grow towards the fetal egg.
Isthmic-cervical insufficiency. She is considered the most common cause perinatal losses of the II trimester of pregnancy (13-20%). The cervix shortens with subsequent dilatation, which leads to pregnancy loss. Typically, isthmic-cervical insufficiency occurs in women whose cervix has been damaged earlier (abortion, rupture in childbirth, etc.), has a congenital malformation or cannot cope with increased stress during pregnancy (large fetus, polyhydramnios, multiple pregnancy, etc.). P.).

Some women have a congenital predisposition to thrombosis (blood clotting, the formation of blood clots in the vessels), which makes it difficult for the implantation of the fetal egg and prevents normal blood flow between the placenta, baby and mother.

The expectant mother often does not know at all about her pathology before pregnancy, since her hemostasis system coped well with its functions before pregnancy, that is, without the “double” load that appears with the task of bearing a baby.

There are other causes of miscarriage that need to be diagnosed for timely prevention and treatment. Methods of correction will depend on the identified cause.

The cause of habitual miscarriage can also be normal chromosomes, which do not give problems in the development of both partners, but carry a hidden carriage of chromosomal disorders, which affect the developmental anomalies of the fetus. In such a situation, both parents should have their blood tested for a karyotype in order to identify such chromosomal abnormalities (carriage of non-manifesting chromosomal abnormalities). During this examination, based on the results of karyotyping, a probable assessment of the course of a subsequent pregnancy is determined, and the examination cannot give a 100% guarantee of possible anomalies.

Chromosomal abnormalities are diverse, they can also be the cause non-developing pregnancy. In this case, only fetal membranes are formed, while the fetus itself may not be. It is noted that the fetal egg is either formed initially, or it stopped its further development in the early stages. For this, in the early stages, the cessation of the characteristic symptoms of pregnancy is characteristic, at the same time, dark brown discharge from the vagina often appears. Ultrasound can reliably determine the absence of a fetal egg.

Miscarriage in the second trimester of pregnancy is mainly due to abnormalities in the structure of the uterus (such as an irregular shape of the uterus, an additional uterine horn, its saddle shape, the presence of a septum, or weakening of the cervix's retentive capacity, the opening of which leads to preterm labor). Wherein possible reasons miscarriage in the later stages can be infection of the mother (inflammatory diseases of the appendages and uterus) or chromosomal abnormalities of the fetus. According to statistics, chromosomal abnormalities are the cause of miscarriage in the second trimester of pregnancy in 20% of cases.

Symptoms and signs of primary miscarriage

A characteristic symptom of miscarriage is bleeding. Bloody discharge from the vagina with spontaneous miscarriage usually begins suddenly. In some cases, a miscarriage is preceded by pulling pain in the lower abdomen, which resembles pain before menstruation. Together with the release of blood from the genital tract, with the onset of spontaneous miscarriage, the following symptoms are often observed: general weakness, malaise, fever, a decrease in nausea that was present before, emotional tension.

But not all cases of spotting in early pregnancy end in spontaneous miscarriage. In case of bleeding from the vagina, a woman should consult a doctor. Only a doctor will be able to conduct a proper examination, determine the condition of the fetus, find out if the cervix is dilated and select the right treatment aimed at maintaining pregnancy.

If bloody discharge from the genital tract is detected in the hospital, a vaginal examination is performed first. If the miscarriage is the first and occurred in the first trimester of pregnancy, then the study is carried out shallowly. In the event of a miscarriage in the second trimester or two or more spontaneous abortions in the first trimester of pregnancy, a complete examination becomes necessary.

In this case, the course of a complete examination includes a certain set of examinations:

blood tests for chromosomal abnormalities in both parents (clarification of the karyotype) and the determination of hormonal and immunological changes in the blood of the mother;
testing for chromosomal abnormalities of aborted tissues (it is possible to determine if these tissues are available - either the woman herself saved them, or they were removed after curettage of the uterus in a hospital);
ultrasound examination of the uterus and hysteroscopy (examination of the uterine cavity using a video camera that is inserted through the cervix and displays a picture on the screen);
hysterosalpingography (X-ray examination of the uterus;
biopsy of the endometrium (inner layer) of the uterus. This manipulation involves taking a small piece of the uterine mucosa, after which a hormonal examination of the tissue is performed.

Treatment and prevention of primary miscarriage

If pregnancy is threatened by endocrine disorders in a woman, then after laboratory tests, the doctor prescribes hormone therapy. In order to prevent unwanted surges in hormones, medications can be prescribed even before pregnancy, with subsequent adjustment of the dosage and drugs already during pregnancy. In the case of hormone therapy, the condition of the expectant mother is always monitored and appropriate laboratory tests (analyzes) are performed.

If miscarriage is due to uterine factors, then appropriate treatment is carried out a few months before the conception of the baby, as it requires surgical intervention. During the operation, synechiae are dissected, polyps of the uterine cavity are removed, fibroids that interfere with the course of pregnancy are removed. Medications before pregnancy treat infections that contribute to the development of endometritis. Isthmic-cervical insufficiency during pregnancy is corrected surgically. Most often, the doctor prescribes suturing the cervix (for a period of 13-27 weeks) in the event of its insufficiency - the cervix begins to shorten, become softer, the internal or external pharynx opens. The stitches are removed at 37 weeks of gestation. A woman with a sutured cervix is shown a sparing physical regimen, the absence of psychological stress, since even on a sutured cervix, amniotic fluid may leak.

In addition to suturing the cervix, a less traumatic intervention is used - putting a Meyer ring on the cervix ( obstetric pessary), also protecting the neck from further disclosure.

The doctor will suggest the most suitable method for each specific situation.

Do not forget that not only ultrasound data is important, but also information obtained during a vaginal examination, since the neck can be not only shortened, but also softened.

For the prevention and treatment of problems associated with the hemostasis system of the expectant mother, the doctor will prescribe laboratory blood tests (mutations of the hemostasis system, coagulogram, D-dimer, etc.). Based on the results of the examination, drug treatment (tablets, injections) can be applied to improve blood flow. Expectant mothers with impaired venous blood flow are recommended to wear therapeutic compression stockings.

There can be many reasons for miscarriage. We did not mention severe extragenital pathologies (diseases that are not related to the genital area), in which it is difficult to bear a child. It is possible that for a particular woman, not one reason “works” for her condition, but several factors at once, which, overlapping each other, give such a pathology.

It is very important that a woman with a miscarriage (history of three or more losses) be examined and medical preparation BEFORE upcoming pregnancy to avoid this complication.

Treatment of such a pathology is extremely difficult and requires a strictly individual approach.

Most women do not need treatment as such immediately after a spontaneous miscarriage in the early stages. The uterus is gradually and completely self-cleansing, as it happens during menstruation. However, in some cases incomplete miscarriage(partially the remains of the fetal egg remain in the uterine cavity) and when the cervix is bent, it becomes necessary to scrape the uterine cavity. Such manipulation is also required in case of intense and non-stop bleeding, as well as in cases of a threat of the development of an infectious process, or if, according to ultrasound, remnants of the membranes are found in the uterus.

Anomalies in the structure of the uterus is one of the main causes of habitual miscarriage (the cause is in 10-15% of cases of repeated miscarriage in both the first and second trimesters of pregnancy). These structural anomalies include: irregular shape uterus, the presence of a septum in the uterine cavity, deforming the uterine cavity benign neoplasms(myomas, fibromas, fibromyomas) or scars from previous surgical interventions(caesarean section, removal of fibromatous nodes). As a result of such violations, problems arise for the growth and development of the fetus. The solution in such cases is to eliminate possible structural disturbances and very close observation during pregnancy.

A certain weakness of the muscular ring of the cervix plays an equally important role in habitual miscarriage, while the most typical term for termination of pregnancy for this reason is 16-18 weeks of pregnancy. Initially, the weakness of the muscular ring of the cervix can be congenital, and can also be the result of medical interventions - traumatic injuries of the muscular ring of the cervix (as a result of abortions, purges, ruptures of the cervix during childbirth) or a certain kind of hormonal disorders (in particular, an increase in the level of male sex hormones). The problem can be solved by applying a special suture around the cervix at the beginning of a subsequent pregnancy. The procedure is called "cervical seclage".

A significant cause of recurrent miscarriage is hormonal imbalance. Thus, studies have shown that low level progesterone is extremely important in maintaining early pregnancy. It is the deficiency of this hormone that is the cause in 40% of cases. early interruption pregnancy. The modern pharmaceutical market has been significantly replenished with drugs similar to the hormone progesterone. They are called progestins. The molecules of such synthetic substances are very similar to progesterone, but they also have a number of differences due to modification. Such drugs are used in hormone replacement therapy in cases of corpus luteum insufficiency, although each of them has a certain range of disadvantages and side effects. Currently, there is only one drug that is completely identical to natural progesterone - utrogestan. The drug is very convenient to use - it can be taken orally and injected into the vagina. Moreover, the vaginal route of administration has a large number of advantages, since, being absorbed into the vagina, progesterone immediately enters uterine blood flow therefore mimics progesterone secretion corpus luteum. To maintain the luteal phase, micronized progesterone is prescribed at a dose of 2-3 capsules per day. If, against the background of the use of utrozhestan, pregnancy develops safely, then it is continued, and the dose is increased to 10 capsules (which is determined by the gynecologist). With the course of pregnancy, the dosage of the drug is gradually reduced. The drug is reasonably used until the 20th week of pregnancy.

A pronounced hormonal disorder may be the result of polycystic altered ovaries, resulting in multiple cystic formations in the body of the ovaries. The reasons for recurrent non-violence in such cases are not well understood. Habitual miscarriage is often the result of immune disorders in the body of the mother and fetus. This is due to the specific feature of the body to produce antibodies to fight penetrating infections. However, the body can also produce antibodies against the body's own cells (autoantibodies), which can attack the body's own tissues, causing health problems and premature termination of pregnancy. These autoimmune disorders are responsible for 3-15% of cases of recurrent miscarriage. In such a situation, it is first necessary to measure the existing level of antibodies with the help of special blood tests. Treatment involves the use of small doses of aspirin and drugs that thin the blood (heparin), which leads to the possibility of carrying a healthy baby.

Modern medicine draws attention to a new genetic anomaly - a Leiden mutation of factor V, which affects blood clotting. This genetic trait may also play an important role in recurrent miscarriage. Treatment of this kind of disorders is currently not fully developed.

A special place among the causes of habitual miscarriage is occupied by asymptomatic infectious processes in the genitals. It is possible to prevent premature termination of pregnancy by routine testing of partners for infections, including women, before a planned pregnancy. The main pathogens that cause habitual miscarriage are mycoplasmas and ureaplasmas. Antibiotics are used to treat such infections: ofloxin, vibromycin, doxycycline. The treatment provided must be performed by both partners. A control examination for the presence of these pathogens is performed one month after the end of antibiotic therapy. In this case, a combination of local and general treatment is extremely necessary. Locally, it is better to use broad-spectrum drugs that act on several pathogens at the same time.

In the event that the causes of recurrent miscarriage even after comprehensive examination cannot be discovered, spouses should not lose hope. It has been statistically established that in 65% of cases after miscarriage, spouses have a successful subsequent pregnancy. To do this, it is important to strictly follow the prescriptions of doctors, namely, to take a proper break between pregnancies. For a complete physiological recovery after a spontaneous miscarriage, it takes from several weeks to a month, depending on how long the pregnancy was terminated. For example, certain pregnancy hormones remain in the blood for one or two months after a miscarriage, and menstruation in most cases begins 4-6 weeks after the termination of pregnancy. But psycho-emotional recovery often takes much longer.

It should be remembered that the observation of a pregnant woman with habitual miscarriage should be carried out weekly, and if necessary, more often, for which hospitalization is carried out. After establishing the fact of pregnancy, an ultrasound examination should be performed to confirm the uterine form, and then every two weeks until the period at which the interruption occurred previous pregnancy. If, according to ultrasound data, fetal cardiac activity is not recorded, it is recommended to take fetal tissues for karyotyping.

Once fetal heart activity is detected, additional blood tests are no longer needed. However, in later pregnancy, an assessment of the level of α-fetoprotein is desirable in addition to ultrasound. An increase in its level may indicate malformations of the neural tube, and low values - chromosomal disorders. An increase in the concentration of α-fetoprotein without obvious reasons at a period of 16-18 weeks of pregnancy may indicate the risk of spontaneous abortion in the second and third trimesters.

Of great importance is the assessment of the fetal karyotype. This study should be carried out not only for all pregnant women over 35 years old, but also for women with recurrent miscarriage, which is associated with an increased likelihood of fetal malformations in subsequent pregnancies.

When treating recurrent miscarriage of an unclear cause, one of the alternatives can be considered the IVF technique. This method allows you to perform a study of germ cells for the presence of chromosomal abnormalities even before artificial insemination in vitro. The combination of the application of this technique with the use of a donor egg gives positive results in the onset of the desired full-fledged pregnancy. According to statistics, a full-fledged pregnancy in women with recurrent miscarriage after this procedure occurred in 86% of cases, and the frequency of miscarriages is reduced to 11%.

In addition to the various methods described for the treatment of recurrent miscarriage, it should be noted that non-specific, background therapy, the purpose of which is to relieve the increased tone of the muscular wall of the uterus. It is the increased tone of the uterus of a different nature that is the main cause of premature miscarriages. Treatment involves the use of no-shpa, suppositories with papaverine or belladonna (introduced into the rectum), intravenous drip of magnesia.