Spontaneous miscarriage– spontaneous termination of pregnancy, which ends with the birth of an immature and non-viable fetus before the 22nd week of pregnancy, or the birth of a fetus weighing less than 500 grams (1)

Habitual miscarriage– spontaneous termination of 3 or more pregnancies before 22 weeks (WHO).
The risk of recurrent miscarriage is significantly higher in pregnant women with antiphospholipid antibodies or lupus anticoagulant (LA) (2, 3, 4, 5). Anticardiolipin (ACL) antibodies (the most commonly detected antiphospholipid antibodies) are present in less than 10% of normal pregnant women (2, 3, 6). Women with ACL antibodies have a 3- to 9-fold increased risk of fetal loss compared with those who do not have these antibodies (2, 3, 6). Antiphospholipid antibodies promote arterial and venous thrombosis.

Failed miscarriage(non-developing pregnancy, missed abortion) - The term “early antenatal fetal death” refers to situations when the fetus has already died, but the uterus has not yet begun to expel it. Previously, many terms were used to describe this condition, including “empty sac,” “failed miscarriage,” and “frozen pregnancy.” In practice, in such situations, the fetus is dead, but the cervical canal remains closed. Diagnosis is made by ultrasound after detecting clinical symptoms such as vaginal spotting, absence of fetal heartbeat on electronic auscultation (from 12 weeks), absence of fetal movements (from 16 weeks) or if the uterine size is much smaller than expected (2).

At any stage, the reasons for termination of pregnancy can be:
- genetic;
— immunological (APS, HLA antigens, histocompatibility);
- infectious;
- anatomical (congenital anomalies, genital infantilism, intrauterine synechiae, isthmic-cervical insufficiency);
- endocrine (progesterone deficiency).

I. INTRODUCTORY PART

Protocol name: Spontaneous miscarriage
Protocol code:

ICD-10 code(s):
O03 – Spontaneous miscarriage
020.0 – Threatened miscarriage
O02.1 – Failed miscarriage

Abbreviations used in the protocol:
Ultrasound – ultrasound examination
WHO – World Health Organization
NP - non-developing pregnancy
APS - antiphospholipid syndrome
VA – lupus anticoagulant

Protocol development date: April 2013.

Protocol users: obstetricians-gynecologists, GPs.

Classification

Clinical classification (WHO)

By gestational age:
— Early – spontaneous miscarriage before the 12th week of pregnancy.
- Late - spontaneous miscarriage in terms of more than 12 weeks to 21 weeks of pregnancy.

According to clinical manifestations:
- threatened miscarriage;
- abortion is in progress;
- incomplete miscarriage;
- complete miscarriage;
- failed miscarriage (non-developing pregnancy).

Abortion is in progress, incomplete and complete miscarriages are accompanied by bleeding (see protocol: “Bleeding in early pregnancy”).

Diagnostics

II. METHODS, APPROACHES AND PROCEDURES FOR DIAGNOSIS AND TREATMENT

List of basic diagnostic measures

Basic:
1. Study of complaints, anamnesis (delay of menstruation by 1 month or more), special obstetric examination: external obstetric examination (height of the uterine fundus), examination of the cervix on speculum, vaginal examination.
2. Ultrasound examination is the main one for NB.
3. A short list of studies for hospitalization - not provided.

Diagnostic criteria

Complaints and anamnesis
Light spotting during a threatened miscarriage and in the presence of clinical manifestations of a failed miscarriage, sometimes accompanied by pain in the lower abdomen, when menstruation is delayed by 1 month or more or when pregnancy is established. There may be a history of spontaneous miscarriages, infertility, and menstrual dysfunction.

When pregnancy does not develop, subjective signs of pregnancy disappear, the mammary glands decrease in size and become soft. Menstruation does not return. No movement is noted at the expected time. However, if fetal movements appear, they stop. Clinical signs of an undeveloped pregnancy (pain, bleeding from the genital tract, lag in the size of the uterus from the expected gestational age) appear 2-6 weeks after the cessation of embryo development. The stages of interruption of NB correspond to the stages of spontaneous abortion: threatened miscarriage, abortion in progress, incomplete abortion.

A thorough examination of the medical history is required to determine the clinical criteria for the presence of APS in order to determine the scope of the examination and further management.

In case of threatened miscarriage in women with recurrent miscarriage, if she was not examined before the onset of real pregnancy; in women with a history of stillbirth, in women with a history of thromboembolic complications, it is necessary to conduct an examination during this pregnancy in order to prevent spontaneous miscarriage and/or premature birth. In the event of a missed miscarriage, a thorough history of APS is necessary for further management after removal of the fertilized egg.

Physical examination

Aobstetric examination
1. VSDM – corresponds to the gestational age in case of threatened miscarriage, does not correspond to NB.
2. Examination of the cervix on speculum, vaginal examination:
- light bleeding;
- the cervix is ​​closed;
- the uterus corresponds to the expected gestational age in case of threatened miscarriage and does not correspond in case of NB.

Laboratory research:
— determination of the concentration of hCG in the blood. The hCG concentration corresponds to the duration of pregnancy in case of threatened miscarriage, lower - in case of non-developing pregnancy;
- examination for suspected APS: lupus anticoagulant and the presence of antiphospholipid and anticardiolipid antibodies, AChTV, antithrombin 3, D-dimer, platelet aggregation;
- study of hemostasis indicators in case of failed miscarriage: blood clotting time, fibrinogen concentration, APT, INR, prothrombin time.

Instrumental studies

Ultrasonography:
— the presence of the fetus and its heartbeat, possibly the presence of a retroplacental hematoma;
- absence of an embryo in the cavity of the ovum after 7 weeks of pregnancy or absence of a heartbeat during a non-developing pregnancy.

Indications for consultation with specialists:
— if APS is suspected, consult a therapist/hematologist with laboratory test results;
- in case of a failed miscarriage with severe deviations in hemostasis - consultation with a hemostasiologist.

Differential diagnosis

Disease	Complaints	Examination of the cervix in speculum, bimanual examination	Human chorionic gonadotropin	Ultrasonography
Threatened miscarriage	Delayed menstruation, nagging pain in the lower abdomen, bleeding from the genital tract	Bloody discharge, the cervix is ​​closed, the uterus corresponds to the gestational age	Corresponds to the gestational age or slightly less	A fertilized egg is detected in the uterine cavity; there may be areas of detachment with the formation of hematomas
Failed miscarriage	Delayed menstruation, nagging pain in the lower abdomen, bloody discharge from the genital tract when a failed miscarriage is terminated	The cervix is ​​closed, the uterus is at or below the expected gestational age, and sometimes there is scanty bleeding	Reduced	In the uterus, the fertilized egg is 3 weeks or more less than the expected gestational age
Ectopic pregnancy	Delayed menstruation, abdominal pain, fainting, easy bleeding,	Scanty bleeding from the cervical canal, closed cervix, uterus slightly larger than normal, uterus softer than normal, painful mass in the adnexal area, pain when moving the cervix	Less than the norm accepted for a given stage of pregnancy, but may be within normal limits.	The fertilized egg is not detected in the uterine cavity, but a formation is detected in the area of ​​the appendages. It is possible to visualize the embryo and its heartbeat outside the uterine cavity. Free fluid may be detected in the abdominal cavity
Menstrual irregularities	Delayed menstruation, bleeding. As a rule, this is not the first episode of such violations	The cervix is ​​closed, the uterus is of normal size	Test negative	The fertilized egg is not detected in the uterine cavity

Treatment

Treatment Goals: prolongation of pregnancy in case of threatened pregnancy and removal of the fertilized egg in case of failed abortion.

Treatment tactics

Threatened miscarriage

Non-drug treatment (7):
- Drug treatment is usually not necessary.
— Advise the woman to refrain from strenuous activities and sexual intercourse, but bed rest is not necessary.
— If the bleeding has stopped, continue observation in the gastrointestinal tract. If bleeding recurs, reassess the woman's condition.
— If bleeding continues, assess fetal viability (pregnancy test/ultrasound) or the possibility of ectopic pregnancy (ultrasound). Continued bleeding, especially if the uterus is larger than expected, may indicate twins or hydatidiform mole.
- If ICI is suspected, determine the length of the cervix using an ultrasound scan using a vaginal sensor at 18-24 weeks of pregnancy (A,8).

Drug treatment
A review of randomized or quasi-randomized controlled trials was conducted that compared progestin with placebo, no treatment, or any other treatment prescribed for the treatment of threatened miscarriage. Two studies (84 participants) were included in the meta-analysis. In one study, all participants met the inclusion criteria, and in the other, only the subgroup of participants who met these criteria was included in the analysis. There was no evidence that vaginal progesterone was more effective in reducing the risk of miscarriage than placebo (relative risk 0.47; 95% confidence interval (CI) 0.17 to 1.30). Sparse data from two methodologically weak studies did not provide evidence to support the routine use of progestins for the treatment of threatened miscarriage. There is no information about potential harm to the mother or child, or both, when using gestagens. Further, large, randomized controlled trials of the effect of progestins in the treatment of threatened miscarriage are needed to examine potential harms and benefits (9,10).

Progesterone is not routinely prescribed for threatened miscarriage. Can be prescribed for threatened miscarriage caused by gestagenic insufficiency of the corpus luteum. RecommendationsFDAcategoryD(Category D — there is evidence of the risk of adverse effects of drugs on the human fetus obtained during research or practice. However, the potential benefits of using drugs in pregnant women may justify its use, despite the possible risks).

Natural micronized progesterone is not routinely prescribed for threatened miscarriage. Can be prescribed for threatened miscarriage caused by gestagenic insufficiency of the corpus luteum. RecommendationsFDAcategoryD. (There is evidence of the risk of adverse effects of the drug on the human fetus, obtained from research or practice. However, the potential benefit when using the drug in pregnant women may justify its use, despite the possible risk).

Dydrogesterone is not routinely prescribed for threatened miscarriage. Can be prescribed for threatened miscarriage caused by gestagenic insufficiency of the corpus luteum, the presence of chronic endometritis, the presence of retrochorial hematoma, the presence of antibodies to progesterone. Recommendation category FDAnot determined.(In the absence of objective information confirming the safety of using drugs in pregnant and/or breastfeeding women, you should refrain from prescribing them to these categories of patients).

A review of randomized or quasi-randomized controlled trials in pregnant women who had at least one history of fetal loss, the presence of antiphospholipid (APL) antibodies, and who received any therapy found that the only significant benefit of the observed therapy was that the combination of unfractionated heparin and aspirin reduced the rate of fetal loss by 54% (relative risk [RR] 0.46, 95% confidence interval [CI]: 0.29 to 0.71) compared with aspirin alone. When studies of low molecular weight heparin (LMW) and unfractionated heparin were pooled together, there was a 35% reduction in miscarriage and preterm birth (RR 0.65, 95% CI: 0.49 to 0.86). The different dosages of heparin used in the different studies included in the review did not affect outcomes. Therefore, the optimal dose of heparin (the one that brings the maximum benefit while causing the minimum harm) is not yet known. None of the other treatments studied had any significant beneficial effect on pregnancy outcome compared with placebo, although a small beneficial effect of aspirin cannot be ruled out (11,12,13,14).

Other treatments– the use of pissaries for a short cervix after the symptoms of a threatened miscarriage disappear, but today there is no reliable data on its effectiveness.

Surgical intervention: in the presence of ICN, it is possible to apply a suture to the uterus, but today there is no reliable data on its effectiveness.

Preventive actions: prevention of premature birth in risk groups:
Examination for APS in the presence of anamnestic and clinical criteria (see below) - lupus anticoagulant and the presence of antiphospholipid and anticardiolipid antibodies, APT, antithrombin 3, D-dimer, platelet aggregation.

Further management: clinical observation, according to the protocol for the management of pregnant women.

Failed miscarriage

Non-drug treatment: No.

Drug treatment
Intravaginal use of misoprostol is an effective method for terminating a frozen pregnancy up to 24 weeks of gestation. Although the optimal dosage for the first trimester has not yet been clearly established, according to the Gilles study (15), intravaginal use of 800 mcg repeated after three days was effective in 79% of women by day seven (or 87% by day 30). . In the second trimester (10–24 weeks), a lower dosage of 200 mcg intravaginally repeated after 12 hours is recommended (Jain study (16)).

Other treatments- No

Surgical intervention: evacuation of the fertilized egg up to 14-16 weeks, preferably manual vacuum aspiration (17,18,19).

Preventive actions
Prevention of infection during evacuation of the fertilized egg - maintaining asepsis, prescribing preventive antibacterial therapy.
Prevention of miscarriage in groups of women with recurrent pregnancy loss or verified insufficiency of corpus luteum function, including induced pregnancies and pregnancies after IVF, is carried out by using:
- natural micronized progesterone (see FDA recommendations above) 200-400 mg intravaginally in the 1st-2nd trimesters of pregnancy to prevent habitual and threatened miscarriage.
- kraynona (progesterone) - FDA recommendations category D, for maintaining the luteal phase during the use of assisted reproductive technologies (ART) 1 applicator (90 mg of progesterone) intravaginally daily, starting from the day of embryo transfer, for 30 days from the date of clinically confirmed pregnancy.
- dydrogesterone (see FDA recommendations above) 10 mg 2 times a day until 16-20 weeks of pregnancy in case of recurrent miscarriage.

Further management
— Prescription of microdoses of combined oral contraceptives from the first day of termination of pregnancy.
— Screening for STIs
— Medical genetic counseling is recommended for couples with recurrent BN.
— Treatment of chronic inflammation – chronic endometritis, chronic salpingitis, vaginitis, vaginosis, if present.
— Examination for APS if available diagnostic criteria (Sapporo, 1999) cadditions (MiyakisS. Etal.,2006): Anamnestic: cephalalgia, ischemic heart disease, arterial and venous thrombosis, transient cerebrovascular accidents, fetal loss syndrome, preeclampsia, eclampsia.
Clinical:
1. Vascular thrombosis
2. Pathology of pregnancy: - one or more cases of intrauterine death of a morphologically normal fetus after 10 weeks of gestation, or - one or more cases of premature birth of a morphologically normal fetus before the 34th week of gestation due to severe preeclampsia or eclampsia or severe placental insufficiency, or - three and more consistent cases of spontaneous abortions before the 10th week of pregnancy (exceptions are anatomical defects of the uterus, hormonal disorders, maternal or paternal chromosomal disorders).
- Persistent manifestations of the threat of spontaneous miscarriage during therapy, the development of severe preeclampsia in the early stages of gestation.
— Determination of lupus anticoagulant and the presence of antiphospholipid and anticardiolipid antibodies, AChTV, antithrombin 3, D-dimer, platelet aggregation.

Habitual miscarriage:
a) genetic research (study of the karyotype of the parents) for recurrent miscarriage in the early stages;

b) if anatomical reasons are suspected, the following are carried out:
— Ultrasound in the 1st phase of the menstrual cycle can diagnose a submucosal uterus, intrauterine synechiae, in the 2nd phase of the cycle - an intrauterine septum and a bicornuate uterus;
— MRI of the pelvis;
- hysterosalpingography in the first phase of the menstrual cycle allows us to identify the presence of submucosal myomatous nodes, synechiae, and septum.

If there are anatomical causes, surgical removal is indicated. Surgical removal of the intrauterine septum, synechiae, and submucous fibroid nodes is accompanied by the elimination of miscarriage in 70-80% of cases (category C). The most effective surgical treatment is using hysteroresectoscopy. Abdominal metroplasty is associated with a risk of postoperative infertility (category B) and does not improve the prognosis of subsequent pregnancies. After surgery to remove the intrauterine septum, synechiae, depending on the severity of the pathology and the extent of the surgical intervention, contraceptive estrogen-gestagen drugs are prescribed; in case of extensive lesions, an intrauterine contraceptive or a Foley catheter is introduced into the uterine cavity against the background of hormonal therapy for 3 menstrual cycles, followed by their removal and continuation of hormonal therapy for another 3 cycles; physical treatment. When pregnancy occurs, natural micronized progesterone 200-400 mg until 20 weeks of pregnancy.

ICI is a common cause of miscarriage in the second trimester of pregnancy. Pathognomonic signs of ICI are painless shortening and subsequent opening of the cervix ending in miscarriage, which in the 2nd trimester leads to prolapse of the amniotic sac and/or rupture of amniotic fluid, and in the 3rd trimester to the birth of a premature baby. It is usually impossible to assess the likelihood of ICI before pregnancy.

c) if infectious causes of recurrent miscarriage are suspected (late miscarriages and premature births are most typical), the following is carried out:
- Gram microscopy of smears from the vagina and cervix,
- bacteriological examination of the cervical canal with quantitative determination of the degree of colonization by pathogenic and opportunistic microflora and the content of lactobacilli,
— detection of gonorrheal, chlamydial, trichomonas infections, carriage of HSV and CMV using PCR;
— determination of IgG and IgM to HSV and CMV in the blood;
- endometrial biopsy on the 7-8th day of the menstrual cycle with histological examination, PCR and bacteriological examination of material from the uterine cavity is carried out to exclude an infectious cause of miscarriage.

d) In case of hormonal insufficiency of the corpus luteum function caused by insufficiency of the corpus luteum in the preconception preparation program, the use of progesterone, natural micronized progesterone, dydrogesterone.

Indicators of treatment effectiveness:
— Possibility of further prolongation of pregnancy in case of threatened miscarriage in women with recurrent miscarriage.
— Absence of early complications after evacuation of the fertilized egg during a failed abortion.

Hospitalization

Indications for hospitalization:
- emergency - threatened miscarriage with increased bleeding; failed abortion.

Miscarriage, or spontaneous abortion, is an unexpected spontaneous termination of pregnancy before 24 weeks. In most cases, there is abnormal vaginal bleeding and cramping pain in the lower abdomen.

A significant number of spontaneous abortions occur before 14 weeks, and sometimes the miscarriage occurs so early that the woman does not even suspect that she was pregnant.

More than 25% of all pregnancies end in miscarriage or loss of the fetus before the 24th week of pregnancy.

At-risk groups

Most often, spontaneous abortion occurs in women under the age of 16 or over 35 years. In some cases, it is a consequence of chromosomal or gene pathology of the fetus. Risk factors include smoking and taking alcohol or drugs during pregnancy. The risk group for late miscarriages also includes women with diabetes.

In approximately 6 out of 10 cases, the cause of spontaneous abortion is the presence of a genetic disease or pathology in the fetus.

Early miscarriage is typical for multiple pregnancies and can occur due to low levels of the hormone progesterone. The cause of late spontaneous abortion (between the 14th and 24th weeks) may be weakness of the cervix or an acute infectious disease in the mother. Pathology of the shape of the uterus or a benign tumor in the wall of the uterus can also lead to spontaneous abortion.

Classification by type of leakage

• Threatened abortion. The fetus is alive, the cervix is ​​closed. Although vaginal bleeding may occur and is usually painless, the pregnancy will usually persist. The baby develops throughout the allotted period; birth occurs around the 40th week. However, in some cases, a threatened abortion can turn into an abortion in progress.
• Abortion is in progress. Usually characterized by fetal death and dilation of the cervix. In most cases, it is accompanied by pain caused by contractions of the uterus, through which the fetus is expelled. The pain can range from mild, similar to what a woman experiences during menstruation, to severe, and may include vaginal bleeding with clots. Such an abortion can be complete (the entire contents of the uterus are expelled) or incomplete (parts of the fertilized egg remain in the uterus).
• Failed abortion. The fetus dies, but there may be no bleeding or pain. The uterus does not contract, the cervix remains closed, and the dead fetus remains inside the uterus.

Diagnostics

If necessary, the doctor will use a vaginal dilator to examine the cervix. If the cervix remains closed, there is still a chance of continuing the pregnancy. In order to make sure that the fetus has not died, patients are usually sent for an ultrasound. If the cervix opens and the fetus dies, an ultrasound scan is performed to determine whether all the contents of the uterus have been expelled.

If a woman is diagnosed with a threatened abortion, she will be advised to remain in bed for several days until the bleeding stops. In addition, the doctor will prescribe treatment for any identified causes of the condition, such as an infectious disease.

If a spontaneous abortion occurs, the choice of treatment options will depend on whether the abortion was complete or incomplete. Usually a course of drug treatment is carried out to achieve complete expulsion of the fetus from the uterus; in addition, in case of severe pain, they can be prescribed.

If an incomplete spontaneous miscarriage occurs, the patient will require hospitalization. In order to prevent infection of the uterus, the remaining tissue in the uterus will be surgically removed in the hospital. The same procedure is performed in the case of an early failed abortion. If a failed abortion occurs later in pregnancy, labor may be artificially induced.

The loss of a child is always painful for the mother, and some time must pass before she can come to terms with what happened. If the patient has any doubts about future pregnancies, they should discuss them with the doctor.

The threat of miscarriage is a condition in which the uterus begins to contract vigorously, getting rid of the fetus located in its cavity. The occurrence of this pathology is possible at any stage of pregnancy and is a common problem in obstetrics and gynecology.

The likelihood of spontaneous abortion from the moment of conception until the 22nd week of pregnancy is considered to be a threat of early miscarriage, which is not uncommon. A threatened late-term abortion is considered to be a pathology that occurs from 22 to 28 weeks of pregnancy. From 28 to 37 weeks, the appearance of uterine hypertonicity can lead to premature birth, which can have negative consequences for the health and development of the baby.

The appearance of a threatening state of pregnancy is dangerous for the health of a woman and the life of her unborn child - untimely detection of the symptoms of this disease and delay in receiving medical care lead to a fatal outcome of pregnancy.

There are several types of pathology:

• anembryony - absence of an embryo in the fertilized egg;
• Chorioadenoma - pathological placental formation from the father's chromosomes;
• threatened miscarriage - the likelihood of detachment of the fertilized egg from the uterine wall;
• beginning miscarriage - partial rejection of the embryo;
• complete miscarriage - the fertilized egg exfoliates completely and leaves the uterine cavity;
• incomplete miscarriage - when the embryo is rejected, fetal particles remain in the uterus;
• failed miscarriage - the fertilized egg does not detach, but dissolves.

According to the list of the International Classification of Diseases (ICD-10), this diagnosis is presented as “Threatened abortion” and has code O20.

If there is a threat of miscarriage in the early stages, pregnancy cannot always be maintained

Causes of threatened abortion in the early stages

There are several reasons that create a risk of miscarriage:

1. Hormonal imbalances. With the onset of pregnancy, changes in hormone levels occur in a woman's blood. If the norms necessary for the successful gestation of the fetus are violated, there is a threat of miscarriage. In many cases, this occurs due to progesterone deficiency, which can occur due to an excess of prolactin in the pregnant body. A threatened abortion is also possible when the level of male hormones increases - this condition is called hyperandrogenism.
2. Genetic failures. There are situations when, in the initial stages of pregnancy, chromosomal or gene mutations occur, the consequences of which are abnormal malformations of the fetus. In case of genetic failures incompatible with life, spontaneous abortion occurs in the first two months of pregnancy (up to the eighth week). If the pathology is not fatal (for example, with Down syndrome), then the pregnancy can be saved, but the risks of miscarriage will be high throughout its entire duration. Genetic failures can be caused by heredity or adverse effects of external factors, such as poor ecology, chemicals in food, radiation, etc.
3. The presence of infectious or inflammatory processes in the pelvic organs. With the onset of pregnancy, the body's immunity decreases - at this time, the expectant mother is more exposed to the emergence of new and exacerbation of chronic diseases. When infections and inflammation occur, the reproductive system of a pregnant woman weakens and ceases to function fully, which can contribute to miscarriage.
4. The occurrence of Rh conflict (immunological cause). A woman’s body that has a negative Rh factor in the blood while carrying a child with a positive Rh factor may perceive the fetus as a foreign formation in the body and will spontaneously try to get rid of it.
5. Presence of gynecological pathologies. Abnormal structure of the uterus (bicornuate or with a septum), endometriosis, fibroids - lead to dysfunction of the reproductive organ, which is the cause of miscarriage.
6. Isthmic-cervical insufficiency. With this pathology, the cervix is ​​weakened and is not able to support the fetus, which is constantly increasing in size. Miscarriage for this reason in most cases occurs at the beginning of the second trimester.
7. Exposure to stress and emotional turmoil. Regular exposure to stressful or conflict situations and nervous tension can negatively affect the development of pregnancy, and in some cases cause its termination.
8. Getting injured. Injury to the abdominal area can lead to partial or complete placental abruption, which will lead to fetal death and miscarriage.

The threat of spontaneous abortion can occur for any of the above reasons or a combination of several.

Symptoms of threatened abortion

Symptoms that occur when there is a threat of miscarriage can be both obvious and mild:

• pulling or cramping pain in the lower abdomen and lower back;
• bloody discharge from the genital tract (even in small quantities);
• copious clear or cloudy discharge - may be amniotic fluid (leakage is possible from the beginning of the second trimester);
• hypertonicity of the uterus - strong tension in the muscles of the reproductive organ, leading to a “fossilization” of the abdomen.

If even one symptom appears, a pregnant woman requires immediate medical attention.

The appearance of nagging pain in the lower abdomen may indicate the onset of spontaneous abortion

Diagnostics

If there is a suspicion of a threat of spontaneous abortion, the woman is first sent for a gynecological examination to determine the condition of the cervix, as well as to exclude anomalies in the structure of this organ (if the pregnant woman has not yet registered). During the examination, the doctor must take a smear to check for sexually transmitted diseases or endocrine disorders.

The most effective way to diagnose pregnancy problems is an ultrasound examination, based on the results of which the doctor can determine the degree of risk of miscarriage or its type and subsequently prescribe the necessary treatment.

To identify hormonal disorders, as well as infectious or inflammatory diseases, a pregnant woman is given directions for blood and urine tests: general, biochemical, and hormones.

Determination of genetic disorders or immunological problems is carried out using laboratory blood tests and ultrasound diagnostics.

Based on the results of ultrasound diagnostics, the doctor concludes that it is rational to continue pregnancy

If necessary, the attending physician may prescribe an additional examination of the pregnant woman’s health by specialized specialists: a cardiologist, neurologist, surgeon and others.

Treatment

If the threat of spontaneous abortion is identified in a timely manner, the causes are determined and proper treatment is prescribed, the pregnancy can be saved.

Drug therapy

Treatment is carried out both on an outpatient basis and in a hospital setting - it depends on the degree of threat of interruption.

The main condition for a positive treatment result is to provide the expectant mother with physical and psychological peace, therefore, in some cases, the woman is first prescribed sedatives. For example, Persen or Novopassit - these products consist of natural ingredients and do not harm the fetus (in the absence of intolerance to the components of the drug).

In case of hormonal imbalance, a woman is prescribed special hormonal medications. For a lack of progesterone - Duphaston, Utrozhestan. For high levels of male hormones - Dexamethasone, Digostin, Cyproterone and others.

To eliminate uterine hypertonicity, medications that relax smooth muscles are used. The most common remedy is Magnesia (magnesium sulfate), which is administered into the body in doses determined by the doctor using a dropper. Papaverine suppositories are also often used to reduce uterine hypertonicity.

To relieve pain, pregnant women are prescribed antispasmodics: Drotaverine (injections), No-shpa (tablets).

In the event of a Rh conflict situation between mother and fetus, drugs are used that inhibit the production of antibodies - immunoglobulins. And the method of intrauterine blood transfusion to the fetus through the umbilical vein is also effective. This procedure can be carried out from the 22nd week of pregnancy.

When bleeding occurs, hemostatic drugs are used: Tranexam, Dicinone - administered intravenously, by drip.

If the threat of miscarriage appears due to isthmic-cervical insufficiency, then to preserve the pregnancy, an obstetric pessary is placed on the uterus - a ring that supports the cervix. When used, the gestation period of the baby is extended until the due date of birth. In some similar cases, instead of using a pessary, sutures are placed on the cervix, which prevents premature opening of the uterine pharynx. The method of eliminating isthmic-cervical insufficiency is determined by the attending physician individually for each case.

Treatment of infectious and inflammatory processes, as well as chronic diseases in acute form, is possible only as prescribed and under the supervision of the attending physician.

ethnoscience

The use of traditional medicine when there is a threat of miscarriage is strictly prohibited without consultation with a medical specialist. This method of eliminating the problem can harm health even more, which will lead to an irreversible negative outcome of pregnancy.

The most popular folk remedies are:

1. Dandelion herb decoction. One teaspoon of the herb should be poured into a glass of water and boiled for three minutes. Take one-fourth cup of the decoction in small sips 3 times a day.
2. A decoction of viburnum bark. One teaspoon of crushed young bark is poured into 250 ml of boiling water and boiled for 5 minutes. It is recommended to take 1-2 tablespoons three times a day.
3. Tincture of viburnum flowers. Two tablespoons of flowers are poured into 500 ml of boiling water and infused in a thermos for about two hours. The strained tincture is taken one quarter glass three times a day.
4. A decoction of the medicinal collection: licorice roots, cinquefoil and elecampane, black currant berries, nettle herb. Two tablespoons of the collection should be added to 500 ml of boiling water and simmer for 15 minutes. Strain the resulting broth and cool, take half a glass three times a day.

The use of folk remedies without medications does not have a positive result, and therefore cannot be used as the main treatment.

First aid for threatened miscarriage

If symptoms occur that may indicate a threat of miscarriage, you need to call an ambulance as soon as possible or consult a gynecologist yourself. You should wait for the ambulance to arrive in a motionless position, preferably lying down.

After an examination by a gynecologist, ultrasound diagnostics are performed and the necessary blood tests are done - for the presence of diseases, hormones, etc. All studies are aimed at establishing the reasons that create the threat of spontaneous abortion, as well as to determine the level of danger of the complication that has begun.

If there is a chance of maintaining the pregnancy, the doctor most often places the woman in a hospital for treatment and close monitoring of the patient’s health. Treatment at home is possible only if there are no pronounced symptoms of pregnancy pathology and strict adherence to all doctor’s instructions.

The threat of spontaneous miscarriage cannot disappear on its own; to eliminate it, the help of medical specialists is required. Otherwise, the woman risks losing her unborn child.

Forecasts

The course of pregnancy after the threat of miscarriage in the early stages depends on the reason why this happened, as well as on the effectiveness of the prescribed treatment.

When hormone levels are normalized, infectious or inflammatory processes are cured, and the problem of isthmic-cervical insufficiency is resolved, pregnancy can develop further without pathology.

If the threat of abortion arose for an immunological reason, then the pregnancy will be under close medical supervision, since the likelihood of its failure may arise again at any stage.

In case of genetic failures incompatible with life, the fetus is not preserved. But this is not a guarantee that the problem will recur with the onset of a new pregnancy.

In most cases, after the threat of spontaneous abortion at an early stage of pregnancy, it is subsequently possible to safely give birth to a healthy child on time.

Prevention

Preventive measures against the threat of miscarriage include:

1. Pregnancy planning. At this stage, both parents are recommended to undergo a full medical examination and cure all existing diseases. In particular, it is necessary to visit the office of a geneticist, who will determine the compatibility of the parents and the likelihood of Rh conflict.
2. The right way of life. With the onset of pregnancy, you should give up bad habits, eat right, take regular walks in the fresh air, maintain the correct daily routine - eat on time, do not overwork during the day, sleep at least 9 hours a day.
3. Favorable psychological environment. While carrying a baby, it is recommended to avoid stressful situations and prevent nervous breakdowns and hysterics.

Compliance with preventive measures cannot provide a 100% guarantee of eliminating the threat of spontaneous abortion. But a responsible attitude towards one’s health and a serious approach to pregnancy planning significantly reduce the risks of this pathology.

By undergoing a medical examination before pregnancy, a doctor can identify in advance possible problems after conception. In my case, the use of Duphaston was prescribed from 3 to 18 weeks of pregnancy. Thanks to supportive hormone therapy, I managed to avoid the threat of spontaneous miscarriage.

Topic No. 5: Diagnosis of miscarriage and post-term pregnancy

Pregnancy

Lecture outline

1.Relevance of the problem of miscarriage

2.Basic concepts: miscarriage, prematurity, recurrent miscarriage. Classification.

3. Etiology, pathogenesis of miscarriage. Risk factors for miscarriage

4.Clinic, diagnosis of spontaneous miscarriage.

5. Differential diagnosis of spontaneous miscarriage.

6.Clinic, diagnosis of premature birth. Complications from the mother and fetus.

7.Relevance of the problem of postmaturity. The concept of post-term and prolonged pregnancy. Risk factors for postmaturity.

8.Diagnostics, complications from the mother and fetus during post-term pregnancy.

MISTARRIAGE

Definition of the concept, classification and frequency of miscarriage.

Miscarriage is called its interruption from the moment of conception to 37 weeks of pregnancy.

Habitual miscarriage (miscarriage) It is generally accepted that women have a history of two or more spontaneous abortions in a row within a period of up to 22 weeks.

The frequency of spontaneous abortion in Russia remains quite high and ranges from 15 to 23% of all registered pregnancies, while up to 50% of miscarriages occur due to recurrent miscarriage. (see Appendix 2)

Depending on the stage of pregnancy at which termination of pregnancy occurs, spontaneous miscarriages and premature births are distinguished.

Spontaneous miscarriage (abortion)– this is a spontaneous termination of pregnancy before the fetus reaches a viable gestational age (body weight 500 g or more).

Prematurity (premature birth) according to WHO definition, the birth of a child is called from 22 to 37 weeks of pregnancy, starting from the 1st day of the last normal menstruation with a regular menstrual cycle, while the fetal body weight is 500-2500 g. In our country, births that occur from 28 to 37 weeks of pregnancy are considered premature. Spontaneous termination of pregnancy between 22 and 37 weeks is classified as a separate category, not related to premature birth, and the death of a child is taken into account only if he lived at least 7 days outside the womb.

The frequency of premature births in the world in recent years is 5-10% and, despite the emergence of new technologies, is not decreasing, and in developed countries it is increasing, primarily as a result of the use of new reproductive technologies.

Premature babies account for 60-70% of cases of early neonatal mortality, 50% of neurological diseases, and severe chronic lung diseases.

Stillbirth during premature birth is 8-13 times more common than during term birth.

Classification of spontaneous miscarriages (abortions) and premature births.

ICD – 10

O03 – spontaneous abortion

O20.0 – threatened abortion

N96 – recurrent miscarriage

O60 – premature birth

1.Period of pregnancy at which termination of pregnancy occurs:

· Early spontaneous miscarriages (up to 12 weeks) up to 14 weeks (Russia)

· Late spontaneous miscarriages (from 12 to 22 weeks)

Premature birth (22 to 37 weeks)

2.Clinical forms (stages) of spontaneous miscarriages:

· Threatened miscarriage (abortion);

· Started abortion;

· Abortion in progress;

· Incomplete abortion;

· Complete abortion;

· Infected abortion;

· Non-developing (frozen) pregnancy.

3.Clinical forms of preterm birth (PL):

· Threatening PR

· Beginning PR

· Started PR

Etiology and pathogenesis of miscarriage

The etiology of miscarriage is extremely diverse and depends on many factors.

1.Chromosomal abnormalities(usually miscarriage occurs before 8 weeks).

2.Endocrine causes(thyroid disease, hyperandrogenism of various origins, ovarian hypofunction) – antiphospholipid syndrome.

3.Anatomical reasons(malformations of the uterus, uterine fibroids, ICI - isthmic-cervical insufficiency, etc.).

4.Immunological causes(eg, autoimmune process with the formation of autoantibodies to hCG, antiphospholipid syndrome).

5.Infectious diseases of the mother:

acute infectious diseases during pregnancy (respiratory infections, urinary tract infections, etc.).

chronic extragenital diseases (chronic tonsillitis, chronic pyelonephritis, etc.).

urogenital infections and pelvic inflammatory diseases (PID) (colpitis in pregnant women is diagnosed in 55-65% of cases).

6.Unexplained reasons.

Risk factors for miscarriage

1. Socio-demographic factors (maternal age, insufficient/malnutrition, occupational hazards, low social status, environmental factors, heavy smoking, drug use).

2. Maternal extragenital diseases (EGD) (arterial hypertension, bronchial asthma, heart disease, hyperthyroidism, diabetes mellitus, anemia with a hemoglobin level of less than 90 g/l).

3. Complications of pregnancy (preeclampsia, polyhydramnios, multiple births, placenta previa).

Clinic and diagnosis of early and late spontaneous miscarriage (abortion)

The clinical picture of spontaneous abortion is characterized by the following signs:

- pain in the lower abdomen of varying degrees of intensity;

- bloody discharge from the genital tract.

Depending on the severity of these symptoms, the following stages of spontaneous miscarriage are distinguished:

· Threatened miscarriage: nagging pain in the lower abdomen and lumbar region, bleeding, as a rule, is absent. The tone of the uterus is increased. The uterus is enlarged according to the period of delay of menstruation, there are no changes in the cervix. Vaginal examination revealed no pathological changes.

· Beginning spontaneous miscarriage: pain intensifies, slight (moderate) bloody discharge from the genital tract appears. During vaginal examination, the size of the uterus corresponds to the gestational age. The cervix is ​​preserved, the cervical canal is closed or slightly open.

· Abortion in progress: regular cramping pain in the lower abdomen, often heavy bleeding. The size of the uterus is less than the expected gestational age, the internal and external uterine os are open (elements of the fertilized egg may be in the cervical canal or in the vagina). In later stages of pregnancy, leakage of amniotic fluid is possible. The pregnancy can no longer be saved.

· Incomplete abortion: bleeding continues (can lead to significant blood loss and hemorrhagic shock). On bimanual examination, the uterus is smaller than the expected gestational age.

· Complete abortion: bleeding stops, the cervical canal closes, the uterus contracts. Diagnosis is retrospective and based on medical history. (this happens if the pregnancy is terminated in the early stages).

· Infected abortion: characterized by fever, chills, pain in the lower abdomen, bloody discharge from the genital tract, sometimes purulent. On examination: tachycardia, tachypnea, tension in the muscles of the anterior abdominal wall (because infection has begun). On bimanual examination, the uterus was of a softish consistency, painful on palpation, and the cervical canal was dilated. In uncomplicated abortion, the infection is limited to the uterine cavity. Complicated infected abortion - the infection went higher.

· Non-developing pregnancy(antenatal fetal death): uterine contractility is absent. The dead fertilized egg is not expelled from the uterus, but undergoes autolysis (embryo mummification).

To clarify the diagnosis, a speculum examination of the vagina and cervix and a bimanual examination are performed.

Additional research methods:

· determination of hCG to confirm pregnancy and diagnose its condition.

· Ultrasound OMT - during intrauterine pregnancy there are signs of impaired development of the ovum (absence of embryonic heartbeat, absence of embryo, etc.).

The main complication of spontaneous miscarriage- uterine bleeding.

Miscarriage is a true tragedy for women who dream of experiencing the joy of motherhood. Of course, the pathological process has its own etiology, but the result is the same - ridding the body of the fetus.

Most often, such a diagnosis occurs in the first trimester of pregnancy, and it affects not so much the physical health of the failed mother, but rather her emotional background. To protect your own body from an extremely unwanted abortion, you need to understand in detail why there is a threat of miscarriage in the early stages, and how to deal with this pathological condition.

According to statistics, in 20% of all clinical pictures in obstetrics there is a threat of termination of pregnancy, that is, doctors do not exclude spontaneous miscarriage in the early stages. The phenomenon is really unpleasant; moreover, it makes the expectant mother fairly panic and nervous. And, nevertheless, most often the pathology occurs when a woman is unaware of her “interesting situation,” that is, for up to 12 obstetric weeks.

As you know, the process of bearing a fetus is complex and lengthy, requiring the participation of all internal organs and systems of the female body. If one of them is dysfunctional, an unexpected termination of pregnancy is possible, that is, the woman’s inability to bear a fetus.

It is necessary to discuss in more detail the following pathogenic factors that lead to unexpected termination of pregnancy at the beginning of the first trimester. This:

1. Hormonal imbalance in the female body. If testosterone predominates, and in a high concentration, then a miscarriage becomes a consequence of its increased activity. is determined even during the period of planning a child, so it is advisable to restore the disturbed hormonal balance before conception.
2. Pathogenic infections. If an infection that is transmitted through sexual contact predominates in the body of sexual partners, then there is a high probability of infection of the fetus already in early pregnancy. As a result, the embryo dies at 5-7 obstetric weeks, which is why when planning a pregnancy, diagnosing both partners and treating as necessary is so important.
3. Genetic factor. If the chromosomal sequence is disrupted in the body of the unborn baby, or the activity of a mutating gene increases, then the fetus is considered non-viable and a miscarriage occurs.
4. . Quite often, the signs of miscarriage in the early stages of pregnancy progress precisely for this reason. This is explained simply: if the mother has a positive Rh factor, and the father has a negative Rh factor, then the baby can take it over from his father. It turns out that the mother’s positive antibodies come into so-called “conflict” with the negative conflict antibodies, as a result a miscarriage can occur (usually in 80% of such clinical pictures).
5. Infectious diseases and acute inflammatory processes, accompanied by an increase, often cause miscarriage at the very beginning of pregnancy. The symptoms of the disease are a consequence of general intoxication of the body, so the weakened resource is not able to hold the embryo, and spontaneous miscarriage occurs.

However, these are not all the factors that lead to premature termination of pregnancy. This result is often the result of the patient’s poor lifestyle, in particular:

• previous abortions;
• unauthorized taking of medications;
• stress;
• chronic lack of sleep;
• increased physical activity;
• poor nutrition;
• bad ecology;

That is why every woman striving for motherhood must be vigilant during the period of family planning in order to avoid the activity of such pathogenic factors even in an “interesting situation.”

If the doctor ascertains the fact that there is a threat of termination of pregnancy, treatment should follow immediately, and there is a high probability that the woman will be sent to a hospital to continue the pregnancy.

Important! Regardless of the reasons that caused the threat of termination of pregnancy, it is imperative to undergo a course of treatment and follow all doctor’s recommendations in the future.

Symptoms of pathology

Only a doctor can confirm or refute the threat of miscarriage by examining the patient. But a pregnant woman can guess about her abnormal condition even at home.

What could be bothering her so much?

• bloody discharge from the vagina of varying intensity and abundance;
• temperature violation, fever;
• nagging pain in the lower abdomen;
• confusion, fainting.

The symptoms of a threatened miscarriage are quite eloquent and cannot be ignored.

The symptoms eloquently indicate that a woman should pay attention to her health, go to hospital in a timely manner and undergo a full course of treatment prescribed by qualified specialists strictly according to indications.

As a rule, such alarming signs appear unexpectedly, and the woman can no longer do anything to prevent this pathological phenomenon. But, if she is more attentive to her body, she will save the baby’s life if there is a threat of miscarriage. For example, you should consult a doctor if you have a pulling sensation in the lower abdomen or brown vaginal discharge of a thick consistency. A similar problem occurs with increased uterine tone.

As a rule, the solution begins with performing an unscheduled ultrasound, which allows us to characterize the pathology with extreme accuracy and suggest the causes of its occurrence in the female body.

Delay in this matter may cost the child’s life, and the health of the expectant mother will be worsened. That is why, at the first sign of a threat of miscarriage, you should immediately contact a leading gynecologist, without waiting for a scheduled examination.

If the threat of miscarriage does lead to an unpleasant outcome, then the failed mother is obliged to receive all medical reports, certificates and other documents that record the diagnosis, causes and consequences. This is necessary in order to take into account all the negative aspects of the next pregnancy and take measures to prevent miscarriage.

Such records may contain some kind of code or cipher. In this way, diagnoses are coded in accordance with ICD-10 - the International Classification of Diseases, 10th revision. And a woman should know that the threat of miscarriage also has its own code according to ICD-10 and you should not be afraid of these numbers, you just need to check with the doctor what exactly they mean.

Diagnostics

Depending on the specific situation and deviations in health identified at the first stage of the examination, a wider range of studies may be prescribed.

If menstruation comes late and is accompanied by acute pain and blood clots from the vagina, then most likely there has been a spontaneous miscarriage. Doctors in such clinical pictures often say that the fertilized egg simply did not take root (did not attach) in the female body.

If a blood clot is detected, a woman should urgently contact her gynecologist and reliably find out whether additional cleaning is required.

Important! A control ultrasound of the pelvic organs will also not be amiss!

If a doctor diagnoses a miscarriage in the early stages, how does the pathological process occur in the female body? As a rule, a woman is unaware of her “interesting situation”, waiting for the arrival of her monthly menstruation. In some situations, she never finds out about the miscarriage, since moderate pain in the lower abdomen and heavy bleeding are considered symptoms of menstruation.

As a rule, the symptoms of miscarriage in the early stages of pregnancy are not clearly expressed, but are very similar to the signs of PMS. However, every woman should monitor the amount of blood loss in order to immediately respond to heavy bleeding if something happens. In such situations, doctors resort to drug therapy, which provides a lasting effect immediately after starting treatment.

Before pregnancy

The risk of miscarriage can be reduced to a minimum even at the planning stage if you undergo the necessary examinations:

• visit a gynecologist;
• take smears for flora and infections;
• sexually transmitted;
• do an ultrasound.

Laboratory tests will also be required:

• general blood and urine analysis;
• blood chemistry;
• blood test for HIV;
• syphilis;
• hepatitis B and C;
• rubella;
• toxoplasmosis;
• cytomegalovirus.

If the doctor deems it necessary, hormonal levels, the blood coagulation system and immunity are also examined.

Important! If you have already encountered the problem of miscarriage and suffered a spontaneous miscarriage or a non-developing pregnancy, then in addition to the listed examinations, genetic counseling is required (it must be completed together with your spouse).

During pregnancy

If symptoms of a threatened miscarriage occur during pregnancy, in addition to the examinations required for any pregnancy, a blood test for hormones and antibodies to phospholipids is prescribed - this analysis makes it possible to determine whether there is a so-called antiphospholipid syndrome - a condition in which the mother’s immune system rejects the fetus.

All pregnant women must undergo so-called prenatal screening - a blood test that makes it possible to indirectly judge the presence of a genetic pathology in the fetus. If deviations in prenatal screening indicators are detected, amnio- or cordocentesis may be recommended - studies in which the anterior abdominal wall, uterine wall are pierced and amniotic fluid (with amniocentesis) or umbilical cord blood (with cordocentesis) is collected.

Examination of the cervix allows us to exclude the formation of isthmic-cervical insufficiency. An ultrasound examination provides information about the presence of uterine tone, the condition of the cervix, possible abruption of the ovum or placenta, and also allows you to assess the condition of the fetus.

When there is a threat of miscarriage, cardiotocography is widely used - a study that gives an idea of ​​uterine contractions and the condition of the fetus. Tocography is used to monitor the effectiveness of treatment.

Unfortunately, even with a thorough examination it is not always possible to identify the cause of miscarriage, but it is necessary to try to do this, otherwise the situation may repeat.

Treatment

For treatment of threatened miscarriage, antispasmodics and hormonal drugs may be prescribed.

A pregnant woman should carefully listen to her inner feelings. Continuing pregnancy in a hospital may be necessary when the pregnant woman exhibits some dangerous symptoms: nagging pain in the lower abdomen, comparable to the sensations of menstruation, aches in the lumbosacral region, strong contractions of the uterus, and sudden bleeding.

Such symptoms should immediately warn the woman that there is a threat of miscarriage (if the symptoms are strong, then it is possible that this misfortune has already occurred). But in any case, the woman must be hospitalized under the supervision of doctors.

What to do if there is a threat of miscarriage? Already a tugging feeling in the stomach should alert the expectant mother and become a reason to contact a specialist.

If there is a threat of miscarriage, treatment is carried out in a specialized clinic. If necessary, the woman is placed in “conservation.” In the hospital, the pregnant woman will be provided with the most gentle regimen (including bed rest), medications that relieve increased uterine tone, vitamins, etc. will be prescribed. depending on the cause of the violation.

In some cases, for example, with istic-cervical insufficiency, surgical intervention (suturing the cervix, etc.) may be required.

Expectant mothers with recurrent miscarriage are also hospitalized “for preservation” in pregnancy pathology departments of maternity hospitals or miscarriage departments of specialized women’s centers.

Medication

Effective therapy will be prescribed immediately. First of all, this is the rest of the expectant mother and the additional use of sedatives, in particular, valerian or motherwort.

If, based on the results of the ultrasound, it becomes obvious that the uterus is in uterine sac, the doctor individually prescribes suppositories with Papaverine or No-shpu, because these medications will allow the smooth muscles to somewhat relax and stop the rhythmic contractions of the uterus. Ginipral and magnesium preparations are used later, since their use in early pregnancy is undesirable.

Utrozhestan also demonstrates high effectiveness in cases of threatened abortion, since its hormonal composition contains progesterone, which is vital for maintaining pregnancy. It is he who supports the vital activity of the fetus, eliminates uterine contractions, and prevents miscarriage at any time. You can take the medication only on the recommendation of a doctor, otherwise, out of ignorance, you can only harm your unborn baby.

Also, intensive vitamin therapy to increase the immunity of the mother and fetus in the womb will not be superfluous, and special attention should be paid to such multivitamin complexes as Magne B6, Vitrum, Duovit, and others.

If there is an MBC code on the sick leave, meaning a threatened abortion (this could be 020.0 - a threatened abortion), the doctor only recommends conserving the patient, and the final decision is up to the expectant mother. Of course, the desire to go to the hospital is not always present, but sometimes there is simply no other way out to save the child’s life. So there is no need to risk a child’s life, especially since this pathological condition can be easily eliminated with a competent medical approach and the vigilance of a pregnant woman.

Prevention

It is very important to consult a doctor or call an ambulance when the first unpleasant symptoms appear. A woman should completely avoid any physical activity.

Important! At the slightest threat of miscarriage, doctors advise bed rest.

After determining the causes of the threat of miscarriage in the early stages, the doctor prescribes special treatment. Most often it involves taking progesterone medications. As a rule, the expectant mother is placed in a hospital under the supervision of doctors to carry out measures to maintain the pregnancy.

The woman may be prescribed additional examinations, in particular intrauterine ultrasound. In some cases, to maintain pregnancy, it becomes necessary to perform a surgical operation to place sutures on the cervix.

It is difficult to treat such a disease, and conservative methods are not always appropriate. That is why doctors strongly recommend taking all preventive measures.

For successful conception you need:

• always stay in a good mood, don’t get nervous over trifles;
• take vitamins in tablets and natural products;
• treat the underlying condition, if any;
• avoid increased physical activity and emotional shocks;
• take care of the treatment and prevention of infections in your sexual partner.

If you approach planning a long-awaited pregnancy wisely, the risk of miscarriage will be minimal. If it is present solely for health reasons, then it is advisable to go to the hospital in the first trimester and remain under the supervision of doctors.

Prevention of miscarriages should begin at least a year before conception, when sensible parents, like prudent hosts, prepare their bodies to receive a long-awaited guest.

Important! The health of the unborn child is closely related to the emotional and mental attitude of a woman towards a healthy pregnancy.

Prevention of miscarriages in an emotional sense is extremely important during pregnancy: joyful and confident anticipation of the child, constant and quiet conversations with him, welcoming every push, affectionate stroking of the belly by mother and father and older children - all this is vital for the future baby.

Remember, according to the latest scientific research, the unborn child hears everything, feels everything, understands everything much earlier than previously thought.

Although there should never be a day without physical activity, preventing miscarriage requires reasonable restrictions. On the days corresponding to menstruation before the onset of pregnancy, no physical exercise should be performed, except for training in deep breathing and alternating tension and relaxation during rest. For those women who have previously had a threat of miscarriage, this is a matter of paramount importance.

Do not get carried away with physical activity, it is better to do several exercises, but for longer, slowly increasing the load. The best exercise is vigorous walks (without overwork) in the fresh air.

Preventing miscarriage means avoiding sudden movements at the very beginning of pregnancy; you should not:

• reaching up with your arms too quickly;
• get up quickly from the bath;
• run too fast;
• ice skating, skiing, cycling, horseback riding (there is a danger of falling).

It is better not to go for a walk in slippery weather. Buy comfortable flat shoes that don't slip, leaving fashionable high heels for better times.

After a miscarriage

First of all, you should wait at least 2 weeks before having sexual intercourse (you should also not use tampons during this period). Some women resume sexual activity only after the first menstrual period after a miscarriage, which usually occurs 4-6 weeks after pregnancy loss.

Ovulation usually precedes menstruation, so after a miscarriage there is a risk of a rapid subsequent pregnancy. Experts recommend using contraceptive methods for at least three to four months after a miscarriage.

It should be recognized that there are known risks associated with rapid onset of another pregnancy after a miscarriage. But waiting is preferable not for medical reasons, but for psychological reasons.

After losing a pregnancy, a woman is worried about what will happen next. She feels afraid and constantly asks herself if she will be able to get pregnant again and give birth to a child. This is an abnormal mental state that does not contribute to the orderly development of pregnancy.

Important! Miscarriages usually do not cause each other. The first miscarriage does not mean that the next pregnancy will be the same.

After three consecutive miscarriages, the chances of having a baby are 70%, four – 50%. If you lose your first pregnancy in the first three months, your risk of losing another pregnancy is only slightly higher than for others. So, although there is no guarantee that another pregnancy will proceed without any problems, a miscarriage does not cancel the chance of a happy motherhood.