A miscarriage or natural spontaneous abortion is a premature termination of pregnancy within the first 20 weeks of pregnancy (SSW) during which the fetus is not yet able to survive outside the uterus.
About 10-15% of detected pregnancies take this end. More than 40% of all pregnancies can end in miscarriage, because bleeding from the uterus often occurs before the woman has noticed her pregnancy.
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What causes a miscarriage?
Many of the early miscarriages are thought to be due to chromosomal errors.
As a rule, such genetic defects are occasionally noticeable and rarely occur again.
Errors in the genetic material that lead to miscarriage occur more often when the mother has passed the age of 35.
Factors that can increase the risk of miscarriage include:
- Smoking. Smokers who smoke more than 14 cigarettes a day have twice the risk of miscarriage as non-smokers.
- Excessive alcohol consumption. A liter of beer or 4 glasses of wine a week can already increase the risk of miscarriage.
- Drug consumption.
- Overweight or obesity. Overweight women can reduce the risk of miscarriage if they lose weight before pregnancy.
- Abnormalities of the uterus or weakness of the cervix (cervical insufficiency).
- Certain diseases (e.g. lupus).
- Uncontrolled diabetes mellitus.
Less common causes of miscarriage include: hormonal imbalance and some infectious diseases, such as listeriosis and rubella.
Investigations into the causes of a miscarriage are usually only carried out after three or more consecutive miscarriages.
Most women do not have another spontaneous abortion after a miscarriage.
Two miscarriages may have another condition.
Common misconception after a miscarriage
After a miscarriage, women often struggle with feelings of guilt because they think they have done or failed to do something bad.
This is practically never the case.
In particular, a miscarriage is not caused by lifting, exertion, labor, digestive problems, stress, worries, sexual intercourse, spicy food and normal everyday activities.
Even a longer waiting period after the miscarriage does not increase the likelihood that the next pregnancy will go smoothly.
What are the signs and symptoms of miscarriage?
Red or brownish spots and vaginal bleeding are usually the first signs of miscarriage.
It should be noted that up to 25% of women have weak bleeding at the beginning of pregnancy (blood stains on toilet paper or panties) and most of these pregnancies do not end in miscarriage.
- Pain in the ovaries, which usually occurs after vaginal bleeding, may be noticeable.
- Cramps, back pain, headaches or a more or less strong feeling of pressure in the pelvic area are possible.
- Leakage of fluids or fetal tissue.
- Bleeding and possibly cramping in the lower abdomen.
If bleeding and pain occur, the probability of staying pregnant is much lower.
It is important to know that vaginal bleeding, blood stains or pain at the beginning of pregnancy may also indicate an extrauterine (ectopic) pregnancy or bladder mole.
If the mother is Rh-negative, she may have to receive anti-D immunoglobulin on the following two to three days if bleeding occurs, unless the father is also Rh-negative.
In some cases, the suspicion of miscarriage becomes noticeable during routine screening, when the midwife or gynecologist does not hear the child’s heartbeat or when the growth of the uterus does not meet expectations. Often, the development of the embryo or fetus stops a few weeks before symptoms such as bleeding or cramping appear.
Many women think they have suffered a miscarriage without symptoms and without realizing it, but something conspicuous is always noticeable.
If the doctor fears miscarriage, he usually performs an ultrasound to see what’s going on inside the uterus. He may also order a blood test.
Examination and diagnosis
The doctor can perform a number of examinations: Gynecological examination:
The gynaecologist checks whether the cervix has already begun to open.
Ultrasound: During this examination, the doctor can check the child’s heartbeat and determine whether the embryo is developing normally.
Blood test: After an abortion, in some cases the value of the hormone concentration of beta-hCG can indicate whether the placenta has been completely removed.
Tissue analysis: Removed tissue can be examined in the laboratory to confirm the miscarriage and to rule out other causes of bleeding.
Possible diagnoses:
Impending miscarriage (abortion imminens)
There is bleeding from the uterus, but the cervix is still closed, there is a threat of miscarriage. These pregnancies often progress without any further problems.
Unavoidable miscarriage (abortus incipiens)
Vaginal bleeding, contraction of the uterus and open cervix.
Incomplete miscarriage (abortus incompletus)
Part of the fetus or placenta is expelled, other parts remain in the uterus.
Missed abortion
The fruit plant is dead, but remains in the uterus, the embryo is dead or has not formed at all.
Abortive fruit (wind egg)
The embryo has not developed, although the egg has implanted itself in the uterus; the amniotic sac is empty.
Complete miscarriage (Abortus completus)
This is a complete departure of the complete fruit. This form of miscarriage is common and occurs before the 12th week of pregnancy.
Septic miscarriage (abortion febrilis)
One speaks of a febrile or septic miscarriage when there is an infection of the uterus.
Ectopic pregnancy
This form of extrauterine ravity occurs when the pregnancy implants in the fallopian tube instead of the uterus.
1-2% of pregnancies are ectopic. Without treatment, it can pose a serious threat to health and fertility.
Do you have to go to the hospital?
If bleeding occurs during pregnancy, the doctor must always be informed about it.
A correct diagnosis is important because miscarriage is not the only cause of vaginal bleeding.
In case of heavy bleeding or severe abdominal pain during pregnancy, the ambulance service must be called immediately.
Most women with bleeding at the beginning of pregnancy need to see a specialist, that is, a gynecologist.
The gynecologist performs a transvaginal ultrasound examination, in which the small ultrasound head is inserted into the vagina to fathom the cause of the bleeding.
Possible causes:
- imminent miscarriage,
- Miscarriage
- other causes of bleeding (for example, an ectopic pregnancy).
If the ultrasound does not show a clear result, it can be repeated after two weeks.
Is treatment necessary?
Conservative treatment
Many women today believe that they “let nature take its course”. In most cases, the pregnancy tissue is expelled naturally and the bleeding stops after a few days.
It may take 14 days for the situation to be completely resolved.
A miscarriage must be treated by a doctor if the woman has already suffered a miscarriage, if there are blood clotting disorders or if there are signs of infection.
If the bleeding becomes heavier or does not stop, the doctor may recommend an alternative form of therapy.
One can also opt for a final treatment.
If bleeding and pain subside, a pregnancy test must be done three weeks later.
If the test is positive, a medical consultation is necessary to assess the situation.
Drug therapy
In some cases, medical treatment for abortion may be performed.
To do this, a drug is taken or inserted into the vagina.
The agent is used to empty the uterus and has the same effect as surgery.
As a rule, hospitalization is not required.
After pharmacological treatment, bleeding may continue for another three weeks.
However, it must be a slight bleeding.
Many women prefer this type of treatment because there is no need for hospitalization and surgery.
Three weeks after medical treatment, a pregnancy test must be performed.
If this is positive, a medical consultation must be given.
The doctor may consider surgery if the bleeding does not stop within a few days or if it becomes severe.
Surgical therapy
If the mentioned treatment options are out of the question or unsuccessful, the doctor may advise surgery. Medical therapy to remove the fetal remains is called scraping (curettage).
In this procedure, the cervix is carefully dilated and a thin suction tube is inserted into the uterus. The scraping with suction takes about 10 minutes and is usually performed without general anesthesia.
Some women develop an infection after surgical abortion. In case of fever, foul-smelling discharge or abdominal pain, a doctor should be consulted immediately.
Any type of infection is treated with antibiotics.
What happens after a miscarriage?
How long does recovery take?
Possible are mild cramps lasting a few days, similar to menstrual cramps, and light bleeding that can last for two weeks, regardless of whether a natural or surgical abortion has occurred.
For the abdominal cramps, Dolormin (ibuprofene) or Ben-u-ron (paracetamol) can be taken.
For at least two weeks, sexual intercourse, swimming, vaginal washes and vaginal medication should be avoided until the bleeding stops.
In case of heavy bleeding (one full bandage per hour) and signs of infection (e.g. fever, pain or foul-smelling discharge), a doctor must be notified immediately or the emergency room must be consulted.
Prevention
Prenatal care is the best way to prevent pregnancy complications such as miscarriage.
Spontaneous abortions caused by systemic diseases can be avoided if the disease is cured before pregnancy occurs.
Miscarriages occur less frequently when X-rays, drugs, alcohol, increased caffeine consumption, and infectious diseases are avoided.
If the mother’s body has difficulty maintaining a pregnancy, signs such as mild vaginal bleeding may appear.
This means that miscarriage is possible.
But it doesn’t mean that a miscarriage will happen for sure.
Next menstrual period after a miscarriage
As a rule, the ovaries produce an egg about 2 weeks after the miscarriage.
The first menstrual period would have to occur within 4 to 6 weeks.
6 weeks after a miscarriage, a follow-up should be done to see if there are any problems and if the uterus has returned to its normal size.
Effects of miscarriage on future pregnancies
Most problems that lead to miscarriage happen by chance and are unlikely to happen again.
A miscarriage does not significantly increase the risk of another miscarriage at the next pregnancy.
Usually, no specific tests are recommended to look for specific conditions if the woman has only had one or two miscarriages, because it is difficult to find anything here.
However, if a woman has suffered at least three miscarriages in a row (this is referred to as a “habitual abortion” or “repeated miscarriage”), there is a high risk that this will happen again in future pregnancies.
Pregnancy intentions after a miscarriage
There is no right moment for a new pregnancy. Some couples want to wait to process the loss, others want to try again immediately.
Usually, it is recommended to wait at least one monthly cycle until a new pregnancy is sought.
Since you can get pregnant again immediately in the days after the miscarriage, it is important to use contraceptives until the moment has come for a new pregnancy.
The mother is Rh-negative
If the mother’s blood group is Rh-negative, she should be injected with anti-D immunoglobulin after the miscarriage.
In this way, problems with the Rhesus factor are avoided in future pregnancies.
Preparing for a new pregnancy after a miscarriage
Although most causes of miscarriage cannot be avoided, the likelihood of long-term fertility and carrying a pregnancy to term can be increased in the following ways:
- Quit smoking.
- Regular physical activity and balanced nutrition.
- Decreased stress.
Folic acid intake
All women who wish to have children are recommended to take folic acid, which promotes the normal development of the child’s nervous system. The recommended amount is 0.5 mg daily one month before pregnancy begins, until the 12th week of pregnancy.
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