The threat of miscarriage in the early stagesof pregnancy

Update: October 2018

Up to 20% of women wishing to become mothers face
самопроизвольным прерыванием of pregnancy. Miscarriage in the early stages
registered in 80% of pregnant women, and in a third of cases
It happens up to 8 weeks of gestation and is caused by anembrionia. With the threat
выкидыша, особенно в ранние сроки of pregnancy, то есть до 12
weeks, almost every expectant mother can face, but with
competent and timely treatment and compliance with medical
recommendations pregnancy ends safely – birth
healthy baby.

The essence of miscarriage and its classification

Miscarriage or spontaneous abortion is called an interruption.
of pregnancy, когда оно произошло без медицинского участия или
mechanical intervention. As a result of miscarriage and fetus
shells are expelled from the uterus, which is accompanied by abundant
bleeding and cramping abdominal pain.

Miscarriage classification

Miscarriages, depending on the period of interruption of gestation, are divided into
early and late:

  • early miscarriages are those that happened before the end of the first
    trimester, that is, up to 12 weeks;
  • late miscarriages – occur in periods from 13 to 22 weeks.

Miscarriages in the early stages include spontaneous
прерывание биохимической of pregnancy. About biochemical
pregnancy, or rather its interruption, they say when it happened
ovulation, the egg cell was fertilized by sperm, but by
for some reason she could not implant in the uterus and left
her, and menstruation came on time or with a slight delay. And
единственным признаком подобной of pregnancy является
weakly positive test, since the level of hCG in the urine or blood is not
exceeds 100 units. Сосчитать частоту of pregnancy, которая едва
started, immediately ended, difficult, according to some data
such miscarriages in very early periods are found in 65 – 70%.

Depending on the clinical picture, there are several stages.
miscarriage:угроза выкидыша на ранних сроках

  • threat of interruption;
  • miscarriage has begun;
  • spontaneous abortion in the course;
  • incomplete miscarriage (at this stage a surgical
    intervention – curettage of the uterus);
  • complete miscarriage.

Separately allocate missed abortion or failed
abortion when the ovum is detached from the uterine wall but not
покинуло пределы uterus.

The reasons

In the threat of miscarriage in small terms, the leading position is occupied by
chromosomal abnormalities of the embryo, the frequency of which is 82 – 88%.
In second place is endometritis, which results in
inflammation in the lining of the uterus, which makes it impossible
normal implantation and further development of the embryo. Also
spontaneous abortion in small terms cause anatomical and
hormonal problems, infectious and immunological factors,
приводящие к привычному невынашиванию of pregnancy.

Risk factors

In the high-risk group for early miscarriages are women
having the following warning factors:

  • Age

The threat of early miscarriage increases with age. Than старше
woman, the more likely it is the development of this complication
of pregnancy. В 20 – 30 лет риск прерывания of pregnancy находится
within 9 – 17%, by the age of 35 it increases to 20%, to 40 – to 40%,
and in 44 and older, the risk of early miscarriage reaches 80%.

  • Parity

Having 2 or more pregnancies in the past increases the risk
miscarriage doubled (compared to women not giving birth).

  • Miscarriages in the past

Than больше было самопроизвольных прерываний of pregnancy в
the earlier the time the higher the risk of early miscarriage
of pregnancy.

  • Smoking

If a pregnant woman smokes more than 10 cigarettes daily, she has
значительно возрастает риск раннего miscarriage.

  • Acceptance of NSAIDs

Acceptance of NSAIDs (аспирин, индометацин, найз и другие) накануне
conception inhibits prostaglandin synthesis, and, accordingly,
impairs implantation.

  • Fever

With an increase in body temperature (37.7 degrees or more) risk
miscarriage in the early stages increases.

  • Uterine injury

Mechanical injury (fall, stroke) or prenatal methods
diagnostics (choriocentesis, amniotic fluid intake, cordocentesis)
increase the risk of miscarriage up to 3 – 5%.

  • Caffeine

Excessive caffeine intake (strong tea, coffee) is one of
факторов риска прерывания of pregnancy в малых сроках.

  • Effect of teratogens

The teratogens are infectious pathogens,
toxic substances, some drugs that also increase
риск раннего miscarriage.

  • Folic acid

Ее недостаток в период планирования of pregnancy и в первые 3
months after conception leads to the formation of a pathological
кариотипа у плода и прерыванию of pregnancy.

  • Hormonal disorders

Lack of hormones (estrogen and progesterone), excess
androgen, thrombophilic conditions (antiphospholipid syndrome)
as a rule, are the causes of habitual miscarriage, but also
cause a threat of interruption at an early date.

  • Stress
  • IVF (up to 25% of cases)
  • Rhesus conflict.

Symptoms of threatened miscarriage

The threat of miscarriage in the early stages сопровождается следующими
key symptoms: pain, bleeding from the genital tract on
delay background monthly

Pains

Signs of threatened abortion at short notice
almost always include pain. There are stifling sensations
lower abdomen and / or lumbar region which may become
more intense. In some cases (trauma, stress) pain
start abruptly, suddenly and quickly become cramped,
accompanied by abundant blood secretions, which indicates
about the transition threatening abortion in the abortion stage in progress, when
pregnancy can no longer be saved. When conducting vaginal
studies diagnosed cervix normal length (not her
shortening and smoothing), closed inner throat. Bimanual
palpation allows you to probe the uterus, the dimensions of which correspond
the period of delay monthly, but the tone of the uterus is increased. This is determined by
according to its density and tension (normal pregnant uterus
soft).

Allotment

Allotment при угрозе обычно незначительные, серозно-кровянистого
character But there may be a lack of blood in the beginning
development threatening abortion. If you do not take timely
treatment and prophylactic measures, blood excretion becomes more
intense character, their color changes from dark red
(started miscarriage) to bright scarlet (abortion in progress). Appearance
secretions in threatened miscarriage due to gradual detachment
the ovum from the uterine wall, which is accompanied by damage
blood vessels and excretion of blood.

Other symptoms

Other additional signs of threatened miscarriage.
serve as:

Lower basal temperature

As a rule, doctors monitor the basal temperature
after making a diagnosis of threatening early miscarriage. But in
some cases (hormonal disorders, prolonged absence
pregnancy) expectant mothers have and continue to lead even before conception
basal temperature chart. Normally, upon pregnancy
basal temperature exceeds 37 degrees and is on
this level up to 12 – 14 weeks. Indirect sign of threatened miscarriage
serves to reduce the rectal temperature to 37 and below.

Pregnancy test

Some women are so worried about their long-awaited
pregnancy that are ready to conduct a pregnancy test daily.
In such cases, pausing not so long ago, such a bright second
the strip on the test, which is associated with a drop in the level of hCG (it is on his
content and based test). Sometimes a test can only show
one strip, even in the absence of bleeding, that
Of course, not very good, but fixable.

HCG level

For each gestational age there are standards for the content of hCG
in blood. A decrease in hCG indicates a threat
miscarriage.

Ultrasound

Far from indicative of a threat, especially at short notice.
pregnancy (for example, at 5 weeks). Can not with certainty
talk about the threat of miscarriage in the presence of only increased tone
матки по Ultrasound. It is possible that hypertonus caused
ultrasound, but then the uterus relaxes again.
But in случае обнаружения ретрохориальной гематомы, которая является
a sign of detachment of the ovum, diagnosis of threatened miscarriage in small
The timing is quite legitimate.

Diagnostics

Diagnostics угрозы раннего выкидыша не представляет сложностей.
The diagnosis is made after a thorough history and complaints, general
and gynecological examination. During the gynecological
examination, the doctor assesses the condition of the cervix (there is / no her
shortening and smoothness, external pharynx closure), the presence or
lack of blood discharge, palpation of the uterus (does
gestational age, is it reduced in response to palpation).

Also обязательно проводится Ultrasound, на котором оценивается тонус
uterus, whether there is a fetus in the uterus and whether its heartbeat is determined,
whether it corresponds to the term of gestation, presence / absence
retroplacental hematoma.

From laboratory methods used:

  • Hormonal studies

Determination of the level of progesterone, hCG, 17 ketosteroids, by
thyroid hormones.

  • Colpocytology study

The karyopicnotic index (KPI) is calculated, on
the basis of which it is possible to suspect a threat in the early stages even before
the emergence of the clinic (increase KPI first bell threatening
miscarriage).

  • Vaginal smears

This item includes a study on hidden sex
infections.

  • Blood type and Rh factor

Для исключения резус-конфликтной of pregnancy.

  • Blood clotting

Essential for suspected thrombophilic conditions.

Treatment

Abroad (Europe, USA) treatment of the threat to 12 weeks of gestation
prefer not to spend, citing the fact that up to 80%
pregnancy is terminated due to genetic and chromosomal
pathologies. In Russia, doctors insist on the appointment of a comprehensive
therapy in case of threatened abortion in any period. Than
the earlier treatment is started, the higher the probability of saving
of pregnancy. Treatment угрожающего выкидыша должно быть комплексным
and includes drug and non-drug therapy, compliance
regime and diet, psychotherapy, and, as a rule, is carried out in
hospital

Basic therapy

Under basic therapy implies regimen and diet. Pregnant with
the threat of miscarriage recommended limitation of physical activity,
up to bed rest, elimination of stresses and experiences,
diet, sexual rest, good sleep. In nutrition
pregnant women should attend proteins, fats and carbohydrates in
balanced amount, and the diet should be rich in vitamins.
Also shown are psychotherapy and autotraining sessions that will help
normalize the emotional state of women and calm down.

Drug treatment

Sedatives

Motherwort and
valerian tablets or tinctures / infusions.

Antispasmodics

Antispasmodics (но-шпа, папаверин или дротаверин) расслабляют
uterine muscles and appointed with marked pains below
abdomen (intramuscularly). Well proven pills
Magne-B6. The composition of Magne-B6 includes magnesium (antispasmodic) and vitamin
B6, which helps magnesium penetrate inside the cell, is prescribed by
1 tablet 3 – 4 times a day. As candles at the threat
interrupts use suppositories with papaverine rectally.
Papaverine is well absorbed by the intestinal mucosa, quickly relieves
pain syndrome.

Hormonal drugs

Progestin progesterone is recommended to take when
insufficient function of the corpus luteum. Progesterone is the main
pregnancy hormone that is responsible for its preservation and further
development. Duphaston with the threat of miscarriage in the early stages appointed
at a dose of 40 mg (4 tablets) immediately and then 1 tablet every 8
hours If signs of threat are not stopped, the dosage is increased.
1 tablet at each next dose. The composition of Duphaston includes
synthetic progesterone, and they continue treatment for up to 16 weeks (until
formation of the placenta). Another progesterone drug
is utrozhestan (natural progesterone). Utrozhestan at
the threat is assigned either orally or intravaginally. Dosage: by
1 – 2 capsules twice a day. And utrozhestan, and Duphaston well
transferred, and the abolition of drugs produced gradually.

With underdevelopment or malformations of the uterus, it is advisable
an appointment to treatment with gestagens to connect estrogen therapy
(folliculin, microfollin). Estrogens are administered in tablet
and injectable form.

In the case of ovarian hypofunction during treatment with estrogen and
gestagenami appointed choriogonin (pregnil) intramuscularly twice in
a week

With hyperandrogenism or immune disorders (antiphospholipid
syndrome) is recommended to receive glucocorticoids (dexamethasone,
metipred).

Hemostatics

In the case of bloody discharge with the threat of miscarriage
prescribe hemostatic drugs. Of hemostatic
funds used Ditsinon, Vikasol, Askorutin. Hemostatics
strengthen the vascular wall, normalize microcirculation, increase
blood clotting.

Vitamins

When pregnancy is shown taking vitamins, as their lack
can cause stunting and development of the fetus or defects
development. In case of a threat of early miscarriage, vitamin E is prescribed.
(as an antioxidant), folic acid (preventing blemishes
development of the central nervous system), vitamins of group B.

Non-drug treatment

As non-drug treatments are prescribed
physiotherapy:

  • Electroanalgesia

It has a sedative effect, reduces the severity of pain
syndrome

  • Magnesium electrophoresis

Magnesium electrophoresis СМТ – это введение препаратов магния в
the body using an electric current. Renders sedative
action, relaxes the uterine muscles.

  • Electrorelaxation of the uterus

This method provides a reflex effect on the uterus that
снимает гипертонус и купирует pain syndrome.

  • Hyperbaric oxygenation

The method is based on treatment with oxygen under pressure in pressure chambers.
It improves microcirculation in the vessels, has antihypoxic and
antimicrobial effect, prevents the formation of toxins.

  • Acupuncture

Normalizes the tone of the uterus, stabilizes blood pressure,
improves psycho-emotional state and sleep.

Recommendations for threatened miscarriage

To quickly stop the signs of miscarriage threat, you need to
follow a set of recommendations.

What can not be at risk:

  • have sex;
  • drink strong tea and coffee, sweet carbonated drinks;
  • eat chocolate;
  • use products that increase gas formation: cabbage,
    legumes, soybeans (swollen intestines press against the uterus and increase its
    tone);
  • eat fast food (high content of preservatives,
    stabilizers, salt);
  • follow a diet for weight loss;
  • to visit baths and saunas (high temperature can provoke
    uterine bleeding and abortion);
  • take a hot bath, especially with bleeding;
  • consume raw foods (eggs, meat, fish in the form of sushi or
    rolls);
  • physical exertion and weight lifting (over 3 kg);
  • experiencing stress, nervous;
  • traveling on any kind of transport, especially prohibited
    air travel;
  • smoke and take alcohol.

What is possible with the threat:

  • listen to pleasant, calm music;
  • sleep (at least 8 hours a day) with a mandatory afternoon
    rest;
  • walk in the park or forest (if not assigned strict bed
    mode);
  • read your favorite books;
  • eat fresh fruits and vegetables (except prohibited) as
    sources of vitamins;
  • aromatherapy (citrus oils, peppermint);
  • take a warm shower;
  • drink compotes, juices, herbal teas (instead of the usual coffee and
    black tea).

Prevention

Preventive measures for threatened abortion
must begin before its onset. But even with the already occurring and
desired pregnancy should not let things take their course.

The threat of miscarriage in the early stages: how to prevent:

  • do not postpone registration in the antenatal clinic;
  • follow all the recommendations of the doctor;
  • categorically refuse bad habits;
  • avoid stress, emotional outbursts, conflicts;
  • refuse to do hard physical work and lift
    weights (optimally take time off during the critical period – 8
    – 12 weeks);
  • normalize the regime of the day and rest;
  • Revise your diet (abandon various diets,
    snacks on the run, fast food);
  • If possible, do not travel long distances,
    especially related to climate and time zone change;
  • avoid taking medicines (antibiotics, NSAIDs and some
    others);
  • walk more often;
  • avoid injuries to the abdomen, falls.

During pregnancy planning, prevent the risk of miscarriage
in the future will help:

  • taking folic acid 3 months before conception;
  • maintaining a healthy lifestyle at least 3 months before
    conception;
  • correction and stabilization of chronic gynecological and
    extragenital diseases;
  • examination, and if necessary, treatment of hidden genital
    infections;
  •  routine vaccinations no later than 3 months
    before conception.

Question answer

Вопрос: Почему при угрозе выкидыша нельзя
have sex?

During intercourse, a woman experiences an orgasm, which
promotes the production of oxytocin. Oxytocin, in turn,
stimulates the contractile activity of the uterus, which aggravates
detachment of the ovum from its walls and makes it heavier during this
pregnancy complications. In addition, in the presence of bloody
discharge does not exclude the possibility of infection in
uterine cavity and intrauterine infection of the embryo that also
contributes to abortion.

Вопрос: Меня выписали из больницы с выздоровлением
после угрозы miscarriage. Do i need to continue
comply with the recommendations of the doctor, which were given under the threat
abortion?

Yes, be sure to continue to comply with all medical
recommendations, as well as medications that were
discharged in the hospital (hormones, vitamins, antispasmodics). Even in
In case of complete cupping of signs of danger, any deviation
(eating disorders, daily regimen, weight lifting) may again
cause signs of threatening abortion and end with interruption
of pregnancy.

Вопрос: Можно ли при наличии кровяных выделений и
threatened miscarriage using tampons?

In no case. The use of tampons may provoke
infection of the vagina, cervix, and after them the cavity
uterus.

Вопрос: У меня высокий риск развития угрозы
abortion, can i go to the pool?

If there are no signs of threatening abortion, and the general condition
allows for an active lifestyle, then a visit to the pool
pregnancy is not only not prohibited, but
recommended.

Вопрос: У меня случился выкидыш. When can I
plan next pregnancy?

Any termination of pregnancy (artificial or
spontaneous) involves a break (use of contraception)
not less than 6 months. After this period you can begin
планирование of pregnancy.

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