A miscarriage is the abortion of the pregnancy that occurs in the first 20 weeks, long before the fetus is able to survive outside the womb.
Approximately 10-15% of recognized pregnancies end in this way. Over 40 percent of all pregnancies can end in miscarriage. This is because many lossesoccur before the woman realizes she is pregnant.
- 1 What are the causes of abortion?
- 2 False myths after an abortion
- 3 What are the signs and symptoms of miscarriage?
- 4 Test and Diagnosis
- 5 Differential diagnosis. The possible diagnoses are:
- 6 Is it necessary to go to the hospital?
- 7 Need a treatment?
- 8 Medical abortion
- 9 Surgical abortion
- 10 What happens after an abortion? What is the recovery time?
- 11 Prevention
- 12 The next menstruation after a miscarriage
- 13 Look for another pregnancy after a miscarriage
- 14 If you are Rh negative
- 15 Get ready for another pregnancy after an abortion
- 16 Take folic acid
What are the causes of abortion?
Many of the first miscarriages are thought to be caused by a chromosomal defect.
This is usually an isolated genetic error and rarely occurs again.
Genetic errors that cause miscarriage are more common when the mother is over 35 years old.
Factors that increase the risk of spontaneous abortion are:
- Smoke . Smoking more than 14 cigarettes a day doubles the risk of nonsmokers.
- Drink lots of alcohol . Drinking 2 liters of beer or four glasses of wine per week increases the risk of miscarriage.
- The use of drugs
- Being overweight or obese . Those who are overweight can reduce the chances of having an abortion if they lose weight before becoming pregnant.
- There is an abnormality of the uterus or weakness of the cervix.
- Suffer from certain diseases (such as lupus).
- Have uncontrolled diabetes mellitus .
There are other less common causes of miscarriage: hormonal imbalances, some infections such as listeria and rubella.
Exams to find the cause of a miscarriage are not made unless you have already had three or more consecutive miscarriages.
Most women who abort once do not have another miscarriage.
Whoever has two miscarriages probably suffers from other illnesses.
False myths after an abortion
After a miscarriage it is normal to feel guilty for having done something or for having avoided doing something.
This almost never occurs.
In particular, spontaneous abortion is not caused by elevation, fatigue, labor, constipation , stress, worries, sexual intercourse, eating spicy foods or regular exercises done at home.
Also, waiting for a certain period of time after an abortion does not increase the likelihood that the next pregnancy is healthy.
What are the signs and symptoms of miscarriage?
Red or brown spots and vaginal bleeding are usually the first sign of miscarriage.
Remember that up to 25% of pregnant women have a small amount of bleeding in early pregnancy (blood spots found on toilet paper or underpants) and almost half of pregnancies end in miscarriage.
- You may experience pain in the ovaries that usually begins after seeing the loss of blood.
The duration of pain depends on the week, for example if the abortion occurs in the ninth week it lasts much longer in consideration of the first.
- You may feel cramps , back pain , headache or a feeling of pelvic pressure that can be mild or strong;
- Loss of tissue or fetal fluid;
- Bleeding that may be accompanied by abdominal cramps (in the lower belly).
If you have bleeding and feel pain, the chances of getting pregnant are much lower.
It is very important to be aware that vaginal bleeding, spotting or pain in early pregnancy can also be caused by an ectopic or molar pregnancy.
In addition, if the mother’s blood is Rh negative, she may need an injection of Rh immunoglobulin on two or three successive days if you notice a bleeding, unless the baby’s father is Rh negative.
Some spontaneous abortions are suspected during a prenatal routine visit, when the doctor or ostetrics does not feel the baby’s heartbeat , or if you notice that the uterus is not growing as it should.
Often, the embryo or fetus stops developing two weeks before it has symptoms such as bleeding or cramping.
Many women think that they have an abortion without symptoms or without realizing, in fact something is always noticeable.
If your doctor suspects a miscarriage, usually ask for an ultrasound to see what is happening in the uterus.
You can also prescribe blood tests .
Test and Diagnosis
Your doctor can do a series of tests:
- Pelvic examination . The gynecologist checks if the cervix has begun to dilate
- Ultrasound . This test helps the doctor check the fetal heart rate and determine if the embryo develops normally
- Blood tests . After a miscarriage, the value of the hormone beta HcG may be useful in certain cases to determine if the placenta has been completely removed
- Tissue analysis . When tissues are removed, a sample may be sent to the laboratory to confirm abortion and exclude other causes of bleeding
Differential diagnosis. The possible diagnoses are:
Threat of miscarriage
If bleeding occurs, but the cervix has not yet begun to dilate, it is called the threat of abortion. These pregnancies often go on without further problems.
In case of bleeding, the uterus contracts and the cervix dilates.
Incomplete Spontaneous Abortion
This occurs when there is no loss of material from the fetus or placenta, but some parts remain in the uterus.
Placental and embryonic tissues remain in the uterus, but the embryo is dead or never formed.
Abortion of white (or blind) egg
The embryo did not develop even though the egg is implanted in the uterus, so an empty gestational sac forms.
Complete Spontaneous Abortion
If you lose all pregnancy tissues it is considered a complete miscarriage. This is not uncommon in spontaneous abortions occurring before the twelfth week.
abortion Septic abortion is said if an infection develops in the uterus.
This occurs when the fetus develops in the fallopian tubes instead of the uterus.
1/2% of all pregnancies are ectopic. Without treatment, an ectopic pregnancy can seriously affect health and fertility.
Is it necessary to go to the hospital?
Bleeding during pregnancy should always be reported to your doctor.
It is important to have a correct diagnosis because abortion is not the only cause of vaginal bleeding .
However, if you bleed heavily or experience severe belly pain (abdominal pain) when you are pregnant, immediately call an ambulance.
Most women who report bleeding early in pregnancy should consult a specialist doctor, a gynecologist.
During the consultation, the doctor performs a transvaginal ultrasonography. This test involves inserting a small tube into the vagina to determine the cause of the bleeding.
The possible causes are:
- The threat of abortion,
- A miscarriage,
- Other causes of bleeding (eg, an ectopic pregnancy).
If the result of the ultrasound is not clear, the doctor may ask you to repeat the examination after two weeks.
Need a treatment?
Many women now choose to let “nature take its course”. In most cases, the pregnancy tissue is expelled naturally and the bleeding stops after a few days.
For full resolution it may take up to 14 days.
Abortion needs medical intervention if the woman has had another miscarriage in the past if you have a bleeding disorder or if there is evidence of infection.
However, if the condition worsens and bleeding does not stabilize or increase, your doctor may suggest an alternative treatment.
You may also decide to make a definitive treatment.
If bleeding and pain are reduced, a pregnancy test is required after three weeks.
If the test is positive, you need to consult your doctor for an evaluation.
In some cases, medical treatment for abortion is possible.
This treatment involves the recruitment or insertion into the vagina of a drug.
The medicine helps to empty the uterus and does not have the same effect as an operation.
You do not usually need to be hospitalized.
You can continue to bleed for up to three weeks after pharmacological treatment.
However, the bleeding should be mild.
Many women prefer this treatment because they generally do not need hospitalization or surgery.
You should have a pregnancy test three weeks after receiving medical treatment.
If you are positive, you need to consult your doctor for an evaluation.
Your doctor may recommend surgery if the bleeding does not stop within a few days or if the bleeding is severe.
If the above options are not appropriate or have failed, your doctor may recommend surgery. Removal of fetal remains is a surgery called curettage .
In this operation, the cervix is opened gently and a suction tube is placed. The scraping with suction lasts for about 10 minutes and is usually performed without general anesthesia .
Some women develop an infection after surgical abortion. Feels fever , vaginal discharge with bad smell or abdominal pain, should go to the doctor immediately.
Any infection is treated with antibiotics .
What happens after an abortion? What is the recovery time?
You may have mild cramps similar to menstrual cramps for a few days and bleed for two weeks regardless of whether the abortion is natural or surgical.
You can take Mefenamic Acid (Ponstan®) or paracetamol for colic.
Avoid sexual intercourse, swimming, vaginal washes and using vaginal medications for at least a couple of weeks until the bleeding stops.
If you begin to bleed a lot (absorbent full hourly) and see signs of infection (such as fever, pain or foul-smelling vaginal discharge) you should immediately call your doctor or go to the emergency room.
Early prenatal care is the best prevention for complications of pregnancy, such as miscarriage.
Abortions that are caused by systemic diseases can be avoided if you cure the disease before becoming pregnant.
Spontaneous abortions are less likely if you avoid x-rays, drugs, alcohol, high caffeine consumption and infectious diseases.
When a mother’s body has difficulty maintaining a pregnancy, signs such as mild vaginal bleeding may occur.
This means that there is a possibility of abortion.
But that does not mean that it had occurred with certainty.
The next menstruation after a miscarriage
Normally, the ovaries produce an egg approximately two weeks after the abortion.
The first cycle should arrive in four to six weeks.
You should check into the clinic six weeks after the abortion to find out if there is a problem and make sure the uterus has returned to normal size.
The Consequences of Miscarriage in Future Pregnancies
Most problems that cause miscarriage occur by chance and are not likely to happen again.
A miscarriage does not significantly increase the risk of recurrence in the next pregnancy.
We usually do not recommend testing for specific diseases for women who have had only one or two miscarriages because it is difficult to find anything.
However, women who had at least three consecutive miscarriages (known as recurrent miscarriages) have a high risk of miscarriage in subsequent pregnancies.
Look for another pregnancy after a miscarriage
There is no time to try another pregnancy. Some couples decide to wait to recover from the loss, while others want to try it straight away.
Usually, it is suggested to wait, at least the next cycle before trying again.
Since you can get pregnant again in the days after the abortions, it is important to use contraception until you are ready to try again.
If you are Rh negative
Those who have a Rh-negative blood type should take an anti-D immunoglobulin injection after a miscarriage.
This avoids problems with the Rh factor in future pregnancies.
Get ready for another pregnancy after an abortion
Although the most common reasons for miscarriage can not be avoided, you can improve your chances of being fertile in the long run and not interrupt your pregnancy like this:
- Quit smoking
- Doing regular exercise and following a balanced diet
- Reduce stress
Take folic acid
Doctors recommend to all women who are planning a pregnancy to take folic acidwhich promotes the normal development of the child’s nervous system. We recommend taking 0.5 mg per day for one month before pregnancy and up to 12 weeks of gestation.