PREGNANCY LOSS - WHAT TO DO?

25.06.2024

PREGNANCY LOSS - WHAT TO DO?

03/28/2024

MISCARRIAGE

is a pregnancy that ends spontaneously before 22 weeks, resulting in the death of the embryo (fetus). Unfortunately, most women never find out the reason for what happened. Even when they are fully examined for recurrent miscarriages, the results are usually inconclusive.

MAIN REASONS.

The first pregnancies most often end in miscarriage and 90% of them occur in the first trimester (up to 14 weeks) of pregnancy. 70% of them are caused by chromosomal abnormalities that are incompatible with life. These miscarriages were inevitable and nothing could be done to save the pregnancy.

SOME OTHER REASONS

  1. The fertilized egg implants outside the uterus ectopic pregnancy
  2. The placenta does not perform its functions
  3. The sexual partner (spouse) has an unsatisfactory quality spermogram

Maternal reasons:

  • The presence of certain gynecological and somatic diseases in women (hypothyroidism, diabetes mellitus, thrombophilia, etc.)
  • Age over 35 years
  • Violation of the anatomy of the pelvic organs (congenital anomalies of the uterus, history of surgical intervention on the cervix, etc.)
  • Bad habits (alcohol consumption, excessive caffeine consumption, smoking, drug use)
  • Overweight or underweight woman
  • Stress
  • Infections and exposure to adverse environmental factors

WHAT HAPPENS DURING A MISCARRIOR

Expulsion of the fertilized egg through the vagina occurs over several hours, days or weeks. The symptoms you experience will depend on the stage of pregnancy and the cause of the miscarriage

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TYPES OF MISCARRIOR

  1. Isthmic-cervical insufficiency - the cervix cannot hold the fetus in the uterine cavity until full-term pregnancy. Principles of treatment: suturing the cervix, using obstetric pessaries
  2. Non-developing pregnancy - there are no symptoms of miscarriage in the absence of an embryo in the fertilized egg (anembryony) or the fetus has died. Diagnosed by ultrasound.
  3. Threatened miscarriage - manifested by nagging pain in the lower abdomen, with progression, slight bloody discharge (incipient miscarriage)
  4. Abortion is in progress - against the background of cramping pain in the lower abdomen and bloody discharge, expulsion of the fertilized egg occurs
  5. Incomplete miscarriage - the uterus does not fully expulse the fertilized egg, and bleeding and discomfort continue
  6. A complete miscarriage is the complete removal of the fertilized egg from the uterine cavity.

PAY ATTENTION TO:

  • Sudden absence of morning sickness and chest tenderness
  • Intuitive feeling of absence of pregnancy
  • Cramping pain in the lower abdomen
  • Bloody discharge from the genital tract with the presence of clots
  • Specific odor of bloody discharge
  • Presence of nausea, weakness, poor health

WHAT TO DO IF SYMPTOMS OF TERMINATION APPEAR

! Seek medical help at an antenatal clinic

RECOMMENDATIONS FOR BEHAVIOR AFTER PREGNANCY INTERRUPTION

  1. During the month after an abortion, monitor your health more carefully: try not to get too cold, dress warmly, and follow the rules of intimate hygiene.
  2. Avoid strenuous physical activity.
  3. In the first month after an abortion, it is prohibited to: take a bath, swim in a pool, river or other bodies of water, or douche.
  4. Contact your gynecologist as soon as possible if, after an abortion: you experience an elevated body temperature, nagging pain in the lower abdomen, or copious discharge from the genital tract.
  5. If bleeding does not stop within 1-2 weeks, or becomes profuse, immediately visit a gynecologist.
  6. As a rule, menstruation after an abortion occurs on time according to the cycle. If after an abortion menstruation does not occur within 1 month, consult a gynecologist.
  7. You can resume sexual activity no earlier than the bleeding stops.
  8. Do not forget about contraception, as re-pregnancy can occur as early as 2 weeks after the abortion.
  9. If you want to get pregnant again, you should protect yourself from pregnancy for 1 cycle, and for those who have had complications for 3-6 cycles, use reliable methods of contraception.
  10. Provided you take all precautions, the likelihood that your subsequent pregnancies will be favorable is very high.

PREPARING FOR YOUR NEXT PREGNANCY

(PRE-GRADUATE PREPARATION)

Planning the next pregnancy is necessary together with an obstetrician-gynecologist.

REQUIRED SET OF EVENTS:

  1. Tests for infections (testing for gonorrhea, syphilis, HIV, hepatitis, Chlamydia trachomatis, Mycoplasma genitalium, HSV types 1 and 2, HPV, TORCH, etc.)
  2. Consultation with a therapist and other medical specialists according to indications
  3. Hormonal testing (according to indications) - prescribed by a doctor
  4. Glycemic profile, oral glucose tolerance test (as indicated )
  5. Examination for antiphospholipid syndrome (hereinafter referred to as APS) and high-risk hereditary thrombophilias (hereinafter referred to as thrombophilias): factor V mutation (Leiden mutation); prothrombin mutation G20210A; antithrombin III deficiency; protein C and S deficiency, homozygous MTHFR mutation (C677 T), hyperhomocysteinemia (as indicated);
  6. Correction of body mass index (BMI) (normal 18.5-24.9);
  7. Folic acid 400 mcg/day, at least 1 month before conception and up to 12 weeks of pregnancy;
  8. Potassium iodide (in the absence of contraindications) – at least 200 mcg/day
  9. According to indications, it is necessary to plan a pregnancy with specialists from miscarriage centers (State Institution Republican Scientific and Practical Center “Mother and Child”, Healthcare Institution “GKRD No. 2”)

Team of authors: senior lecturer of the Department of Obstetrics and Gynecology of the educational institution "Belarusian State Medical University" E.L. Sushch , obstetrician - gynecologist of the highest qualification category (head of department) of the gynecological department No. 2 A.V. Salamakha