Update: October 2018
Miscarriage (spontaneous abortion) is spontaneous interruption
беременности в сроке до 22 weeks. Accordingly, they are divided into
early and late. According to the dynamics of what is happening are distinguished:
- Threatening abortion
- Started abortion
- Complete (or incomplete) abortion
- Undeveloped pregnancy
The division into these species is very conditional, they can flow into each other.
friend For example, a threatened abortion turns into a full, and frozen
pregnancy still ends with the release of the ovum.
How often is pregnancy terminated?
It is believed that at least 20% of all conceptions end
spontaneous abortion. It is possible that this figure is understated. After all
many women do not even know about the terminated pregnancy,
when it happens at week 4, taking it overdue
monthly The percentage of such events increases with age.
- 80% of all sudden abortions are 1 trimester loss
- 90% loss in the first trimester and about 30% in the second – a consequence
random chromosomal abnormalities that most likely no longer
- more than half of all women with threatened miscarriage safely
bear pregnancy to 40 weeks
- at age 40, a woman has a 50% risk of spontaneous interruption
Probable causes of abortion
- Disruption of embryo development (chromosomal and genetic
- Immune failures
- Abnormalities of the uterus and its tumors
- Neck failure
- Hormonal causes
- Maternal infection
- Mother’s systemic illness
- Poisoning, injuries
Unfortunately, it is possible to establish the exact cause of such an event.
far from always. This involves most parental unrest,
planning a new pregnancy after a failure.
Embryo development disorders
Almost 90% of pregnancies that terminate before week 8 were related
with a mutation. Chromosomal anomalies, as it were, are “screened out” by nature,
to prevent the birth of unviable children. therefore за
abroad at such an early date do not even try to treat threatening
The phrase “antiphospholipid syndrome” in recent years
brings fear to all women who have lost their pregnancy at least once.
It is this diagnosis that is trying in vain to find when spontaneous.
аборте до 12 недель, сдавая ненужные analyzes.
APS – a syndrome in which antibodies are formed in the body to
own squirrels. As a result, thrombosis, thromboembolism
in the absence of visible causes of miscarriage in the early stages of 10
weeks. In addition, the risk of delayed fetal growth and severe
preeclampsia. True APS requires treatment throughout
For the diagnosis of the syndrome in addition to the detection of antiphospholipid
antibodies need certain symptoms (unexplained miscarriage
pregnancy, thrombosis). therefore нет смысла проверяться на АФС при
first pregnancy or after a single loss in her early
Abnormalities of the uterus
Congenital defects of the genital organs, for example, incomplete
uterine septum increases the risk of spontaneous abortion by almost 2
times. Surprisingly, more serious violations (two-legged and
двушеечная матка) реже приводят к прерыванию of pregnancy.
Cervical (isthmic-cervical) insufficiency
In the second trimester in the structure of spontaneous miscarriages
the role of cervical insufficiency increases. In this case, the cervix
softens and shrinks prematurely, leading to overflow
amniotic fluid and the onset of labor. The reason for this
condition may be trauma during gynecological manipulations,
anatomical features, frequent artificial abortions. More often
this process is asymptomatic, only occasionally
discharge or pain. therefore абсолютно всем женщинам в сроке 19-21
week you need to undergo cervicometry – measurement of the neck length with
using an intravaginal ultrasound probe.
There is some evidence that low progesterone levels can
быть причиной невынашивания of pregnancy. Failure
luteal phase – this is a manifestation of progesterone deficiency. AT
reality, this condition is less common than the diagnosis. Sometimes nlf
combined with changes in the ovaries, pituitary and other endocrine
organs. Very often, low progesterone is successfully combined with
ATысокая температура и сильная интоксикация материнского
the body can stimulate contractions of the uterus and cause
прерывание of pregnancy. therefore любая инфекция потенциально
dangerous. However, some diseases are especially often threatened with miscarriage.
These are rubella, toxoplasmosis, listeriosis, brucellosis (see the causes
intrauterine infection in newborns). Other infections do not
associated with increased abortion rates. ATажно отметить, что в
In the case of recurrent abortions, the role of the infection is dramatically reduced.
Mother’s systemic illness
There are diseases that not only complicate the course
pregnancy, but may increase the incidence of spontaneous abortions. TO
- Diabetes mellitus (with poor glucose control)
- Diseases of the thyroid gland
- Coagulation disorder of blood
- Autoimmune diseases
Poisoning and injuries
Clear connection between toxic substances and abortion is not
installed. It is believed that working with organic solvents and
наркотическими газами может спровоцировать прерывание of pregnancy.
The same effect has smoking, large doses of alcohol and
Accidents with damage to the abdomen, as well as surgery on
яичниках и кишечнике могут быть опасны при of pregnancy. But эмбрион
in the uterus has good protection, so most of these
interventions ends safely.
Myths about the causes of early pregnancy loss
Up to 13 weeks, abortion almost never
due to the following factors:
- Airplane flight
- Easy blunt abdominal trauma
- Sports activities (adequate)
- One previous miscarriage up to 12 weeks
- Sexual activity
About what you can and can not do during pregnancy, read in
TOак распознать аборт?
There are several main symptoms of miscarriage:
- TOровотечение различной интенсивности
ATыделение of blood объясняется частичной или полной отслойкой
chorion (future placenta). If a эта отслойка произошла в верхних
parts of the uterus, the blood may not go outside, but form
retrochorial hematoma. With threatened abortion can be easy
krovomazanie passing independently and without consequences, and
abortion in the course of bleeding is quite abundant.
Pain is usually located above the pubis, can give
in the groin, lower back and have different intensity. They can wear
persistent or cramping character. ATажно, что у большинства
pregnant women for all 9 months may occur
various unpleasant and unusual sensations in the abdomen,
who do not threaten the child. ATсе сомнения о природе болей
can dispel the doctor of female consultation.
- ATыход частей эмбриона из половых путей
Painшинство абортов оканчивается самостоятельно после выхода
all parts of the embryo. This feature is a clear confirmation.
диагноза, но порой женщина путает сгустки of blood с эмбрионом.
- Amniotic fluid rupture
ATо втором триместре излитие околоплодных вод всегда говорит о
imminent abortion. ATслед за разрывом плодных оболочек следуют
contractions and the exit of the fetus. Sometimes during pregnancy may occur
urinary incontinence or abundant vaginal discharge. When in doubt
in nature, the liquid is better to immediately consult a doctor for
special tests. Pharmacy test strips available at
amniotic fluid may give false positive
What can be confused with spontaneous abortion?
Many symptoms of miscarriage in the early stages can be and
other conditions and diseases. therefore важно обратиться к врачу для
their exceptions. Similar symptoms occur when:
- ectopic pregnancy
- cervical cancer
- torsion of ovarian cysts (without bleeding)
- cervical trauma
TOогда нужно срочно обратиться к врачу?
- TOровотечение на любом сроке
- Severe cramping pain in the lower abdomen
- Pain or discomfort in the groin area that appears
- ATыделение большого количества бесцветной жидкости из
- Temperature increase, deterioration of the general condition.
Diagnosis for symptoms of miscarriage
Using the ultrasonic sensor, you can detect the fetal egg
already from 3-4 weeks of pregnancy, and later appears
the ability to find the heartbeat of the embryo. It is believed that if at
minor bleeding and closed cervix doctor
detects the heartbeat of the fetus, then the probability to endure this
pregnancy to term is 97%. If a же кровь из половых
paths combined with a highly deformed ovum, too
a small embryo or lack of heartbeat, then an abortion
Часто при кровотечении или сильных болях внизу живота на Ultrasound
можно обнаружить retrochorial hematoma. For small sizes
it is not dangerous and requires only observation. With significant detachment
and big hematoma is high risk of abortion and strong
Chorionic gonadotropin should be determined
только в очень ранние сроки, когда на Ultrasound еще нельзя определить
embryo viability. With high-quality ultrasound
research is no longer necessary. If a срок беременности
3-4 недели, а плодное яйцо не найдено, то есть смысл определить HCG
twice, at intervals of 48 hours. AT зависимости от результатов
повторяют Ultrasound или констатируют состоявшийся выкидыш.
TOак ни странно, порой при кровотечении делают мазок на
oncocytology. Это необходимо, если на Ultrasound есть живой эмбрион,
hematoma in the chorion is not visible, and the bleeding continues. AT
In this case, the smear eliminates cervical cancer.
Treatment угрожающего аборта
depends on its intended reason. Directly affect
on the course of events in the early stages (up to 12 weeks) almost
is impossible. Usually prescribed tranexam (to stop bleeding)
and urozhestan (with unsuccessful previous pregnancies). ATо втором
trimester, it is possible to slow the shortening of the cervix during ICN (by imposing
stitches and pessary). This treatment methods are exhausted. In many
countries, early miscarriages do not even try to treat due to the high
frequency of chromosomal abnormalities. Recently there have been studies that
Utrozhestan in candles does not interfere with an exit of an abnormal embryo,
therefore, it can be used for short periods.
Что НЕ НУЖНО при кровотечении в ранние сроки
pregnancy (threatened abortion):
- Candles with papaverine
- Magne B6
- Vitamin E
- Bed rest
All of the above tools and measures are ineffective, and
because they are not recommended by leading Russian and foreign
associations of obstetricians and gynecologists. Some old ways
treatments, such as bed rest, can even harm
pregnant With limited mobility, the risk of constipation increases,
thrombosis, stress, leading to various complications.
This condition usually does not require treatment or even observation.
Usually, doctors recommend testing for HCG 3 weeks after
termination of pregnancy. If he bounces back, then you can
live quietly on. If hCG has not decreased or decreased
not enough, you can suspect a bubble skid – dangerous
condition requiring treatment.
Abortion in progress
If, when examined by a doctor, the bleeding still continues,
the ovum or the dead embryo has not yet left the uterus, then
apply three approaches:
- waiting (wait for an independent resolution of the situation in
for 7 days)
- medication completion (taking misoprostol to reduce
uterus and expulsion of the ovum)
- vacuum aspiration or curettage (cleaning) of the uterine cavity (with
severe bleeding or failure of other methods)
The question of how to complete the abortion is decided by the doctor. Therefore extremely
it is important to consult a specialist and be observed with him until the end
process. When life-threatening bleeding is prescribed
hemostatic drugs, and sometimes have to pour
blood components in the hospital.
When is progesterone prescribed?
Hormonal support (utrozhestan intravaginal candles)
appointed in the following cases:
- two or more spontaneous abortions for periods of less than 20 weeks
- one miscarriage in the period of 20 weeks in women over 35 years old or at
infertility in the past
- proven deficiency of the luteal phase of the cycle
- threatened miscarriage for cervical insufficiency
(arbitrary shortening of the cervix less than 25 mm)
In the first two cases Utrozhestan (micronized progesterone)
used for prevention, starting with preparing for pregnancy and
up to 10-12 weeks. With the existing threat of abortion up to 20 weeks
The drug is prescribed until the symptoms disappear.
How to recover from a miscarriage?
Losing a desired pregnancy is always stressful for a woman. To him
added concern about the success of future pregnancies. therefore
it is crucial to rehabilitate your health and mood before
offspring planning (see also the effects of abortion and
- With infection of the genital tract (if the bleeding is prolonged,
for example) the doctor prescribes antibiotics. It makes no sense to take them.
only as a preventive measure for self-abortion. If a
its completion was stimulated by misoprostol, then a fever in
the first day will be due to medication, not infection, therefore
do not worry. With surgery usually
prescribe a single prophylactic antibacterial
- If a потеря беременности сопровождалась ощутимым кровотечением,
you may need iron for treatment
- Under certain circumstances, a gynecologist may recommend
taking contraceptives. But with uncomplicated spontaneous
abortion on different terms you can start planning
pregnancy, as soon as the psychological mood.
- With habitual miscarriage (3 or more spontaneous abortions
in a row) it is necessary to go through additional procedures and pass
Inspection with habitual miscarriage
If a спонтанное прерывание беременности повторяется 2 и более
times (and by some standards – 3), then this state is called
habitual miscarriage. It requires careful examination and
finding out the reasons. Sample Survey Plan and Solutions
Treatment at revealing a problem
|Analysis of environmental, social conditions and habits||The elimination of bad habits, the normalization of body weight, housing
and psychological conditions
|Karyotyping of abortus and parents (definition of chromosomal
|With chromosomal breakdowns, careful genetic
embryo examination during subsequent pregnancies
|Ultrasound of the pelvic organs, hysteroscopy||Removal of fibroids, polyps, uterine septum and others
|Tests for AFS||With a confirmed syndrome in the next pregnancy – admission
low molecular weight heparin and aspirin to thin the blood
|Thrombophilia tests (only with thrombosis in the past
women and her closest relatives)
|Checking thyroid function (TSH level and other
|Treatment (more often – L-thyroxine)|
|Test for hyperprolactinemia (high hormone levels
|Dopamine Agonist Treatment|
|Determination of glycated hemoglobin (in sugar
|STI tests (CMV, herpes, chlamydia, gardnerellosis, etc.), and
|If necessary, eliminate the infection.|
Prevention of pregnancy loss
The main task for all women planning to become mothers –
Reasonable approach to your new status. It is important to take only
necessary drugs (folic acid, iron), get rid of
bad habits and stress. With repeated abortions additional
examination and treatment can also reduce the risk of failure. But the most
the main thing – it is necessary to understand that the majority of women with losses
pregnancies in the past managed to get pregnant, bear and give birth
Two years ago there was a fading of pregnancy at term 7
weeks. Now I’m pregnant again, 5 weeks, the doctor prescribed
Utrozhestan in candles. Is there any indication for this? Does it hurt
Pregnant pregnancy alone is not an indication
purpose Utrozhestan. Perhaps there are other reasons for it.
reception that you did not specify. In such a situation Utrozhestan not
Danger to the child.
Срок беременности 16 weeks. Starting from week 14, continues
profuse bleeding. On ultrasound, the fetus is alive, there is a big hematoma.
Worried that hemoglobin levels quickly fall, doctors set up
on interrupt. Is there a chance to keep the pregnancy when there is a lot of
Given that the fetus is alive, there is a chance to save the pregnancy. But
if hemoglobin levels continue to fall, it is in the interest
maternal health is possible interruption.
Could a cold in the period of 7 weeks provoke a miscarriage?
Theoretically, high fever can contribute to abortion. But
at such a short time most likely spontaneous genetic
How much after a failed pregnancy (ended at 6
week) can you plan a new one?
In the absence of complications, you can start planning immediately.
But лучше выждать 1-2 менструальных цикла для психологической
preparing and taking folic acid.
What are the symptoms at week 2 with miscarriage?
If a рассматривать акушерский метод определения срока
during the last menstruation, then at 2 weeks
Conception occurred. If a имеется в виду возраст эмбриона, то он
corresponds to a period of 4 weeks. Such an interrupted pregnancy
is called biochemical, because nothing can be seen on the ultrasound.
therefore симптомом будет кровотечение, по срокам совпадающее с
monthly or delayed by several days.