A miscarriage or abortion is an unwanted termination of pregnancy within the first 23 weeks of pregnancy. The baby shows no signs of life, such as umbilical cord pulse, heartbeat, or breathing, and its weight is less than 500 grams.
What is a miscarriage?
At regular intervals during pregnancy, the fetus is examined for possible diseases and malformations. In most cases, this can detect a potential miscarriage early. A miscarriage occurs when there is an unwanted termination of pregnancy before the fetus is viable. It is classified by the cause or by the time of occurrence. Thus, spontaneous abortion is said to occur when the abortion has a natural cause. Furthermore, there is artificial abortion, which is caused by chemicals, drugs, or abortion. An early miscarriage usually has genetic damage as its cause and often occurs together with the expected menstruation. Sometimes the woman does not even know at that moment that she has been pregnant. She is merely wondering about delayed menstruation and possibly increased blood flow. If the miscarriage occurs before the 12th week of pregnancy, it is called early miscarriage. A miscarriage after the 13th week of pregnancy is called late abortion.
Causes
The causes of miscarriage can be many and can rarely be detected. Basically, they are divided into fetal, maternal, and paternal causes. Typical fetal causes of miscarriage include a mutation of chromosomes, infections of the unborn child, and exposure to drugs or X-rays. Maternal causes include malformation of the uterus, maldevelopment of the placenta, mechanical trauma such as a fall, maternal infections, tumors, hormonal disorders, rhesus incompatibility, heavy caffeine intake, and drug use. However, miscarriage can also be due to the father. These include different types of sperm abnormalities and genetic disorders. Furthermore, in addition to the aforementioned causes, there exist pregnancy-specific hormonal disorders of the mother or the child that can lead to endocrine miscarriage. In general, then, the causes can be divided into six groups:
- Fetoplacental causes (Usrachen by the fetus): e.g., disorders of the genome, abnormalities of the umbilical cord, disorders of the placenta.
- Causes by the mother: e.g., uterine rupture (uterine rupture), premature placental abruption, or cervicitis.
- Hormonal disorders
- Trauma
- Infectious diseases: e.g. rubella
- Poisonings: e.g. lead poisoning.
Symptoms, complaints and signs
A miscarriage is usually indicated by very strong and contraction-like pain. The pregnant woman feels stronger contractions in the abdomen, usually cramping. Unlike normal contractions, which first occur weakly and then slowly increase, the contractions that initiate a miscarriage usually begin very suddenly and violently. If such strong contractions occur even though the due date has not yet been reached, a hospital should be visited or an emergency doctor alerted as soon as possible. Another sign of an impending miscarriage can be bleeding. These can vary in severity. Not all bleeding is immediately associated with a miscarriage, but the symptoms should also be clarified by a doctor. If the pregnancy has already progressed beyond the 15th to 20th week, the expectant mother usually already feels the movements of the child. Strongly changing fetal movements can also be a sign of an impending miscarriage. In most cases, the baby’s movements become much weaker or stop altogether. Usually, the expectant mother herself has a very good sense of whether the child in her womb is just resting or sleeping, or whether something is actually wrong. The mother’s state of health also usually changes before a miscarriage. She feels bad and sick, fatigued and especially tired. In some cases, fever is added.
Diagnosis
If the miscarriage occurs in the first weeks of pregnancy, some women do not even notice it, because it resembles menstrual bleeding. Depending on the week of pregnancy, vaginal bleeding is also joined by the onset of labor as a sign of miscarriage.With the help of an ultrasound examination, the doctor can see whether the fetus is still alive or not. If the heart sounds are still audible, a miscarriage can still be prevented with the help of anti labor drugs, magnesium and strict bed rest. If this is no longer possible, the birth is terminated as quickly as possible with labor-promoting drugs and by scraping the uterus. With the help of another ultrasound examination, the doctor can determine the extent to which parts of the pregnancy are still present in the uterus after the miscarriage.
Complications
A miscarriage can result in a number of complications. Acutely, menstrual irregularities and severe physical discomfort may occur after an abortion. Temporarily, digestive problems and gastrointestinal disorders may also occur. Often, psychological and emotional discomfort also occurs as a result of the death of the child. Affected women often suffer from the loss of the child for years to come and have difficulty saying goodbye due to the procedure, which is usually performed quickly. Children who have already been born often suffer from this as well. Restlessness and sadness as well as sleep disturbances are among the typical consequences for the immediate family. In addition, physical complaints may also occur. In Asherman’s syndrome, there are adhesions in the anterior and posterior wall of the uterus, which can lead to menstrual cramps, premature birth and secondary sterility. Miscarriage generally increases the risk of preterm birth during the next pregnancy. If an unnoticed miscarriage occurs, circulatory problems and life-threatening thrombosis can occur. The longer the miscarriage goes unnoticed, the greater the risk for serious complications. Therefore, pregnancy and especially miscarriage should always be discussed with the gynecologist and psychological counseling as well.
When should you go to the doctor?
Often women do not realize that they have had a miscarriage. But if they do, a visit to the gynecologist is advisable. In addition, a doctor should always be consulted in the event of a miscarriage if the patient is suffering from psychological complaints or depression. The life partner or relatives may also be affected and then also need treatment. In this case, a visit to a therapist or a psychologist is particularly suitable, although discussions with other women can also be helpful. However, direct treatment of the miscarriage cannot take place. A doctor should also be consulted if the woman suffers from sudden vaginal bleeding during pregnancy. This usually occurs unexpectedly and is relatively heavy. The complaint is accompanied by severe pain in the abdomen or vagina. This pain is equally indicative of a miscarriage. An open cervix may also indicate discomfort. In the case of these complaints, a doctor must usually be consulted immediately. If the pain is very severe, call an emergency physician.
Treatment and therapy
The treatment of a miscarriage depends primarily on the stage of the miscarriage as well as a possibility of preserving the pregnancy. It is always advisable to seek medical advice. An important medical therapy is the scraping of the prematurely deceased fetus as well as the remaining placental remains. After the 12th week of pregnancy, the foetus should usually be delivered naturally, with the presence of a midwife or nurse. This natural birth is more painful, but is usually preferred to a curettage for emotional reasons. Both treatment options carry low risks. Which option is chosen is up to the woman. In addition to medical treatment, psychotherapeutic counseling may be useful. This can also take the form of a self-help group. This facilitates the grieving process and the processing of the traumatic experience. If the woman suffers various unwanted miscarriages, human genetic counseling may be the solution. In the course of this, the causes are investigated. If it is possible, not only both parents should be examined, but also the dead child of the miscarriage.
Prospect and prognosis
If scraping is not performed, a chorionic carcinoma or bladder mole may develop if necessary. Furthermore, a uterus with remnants of the fetus and blood is an ideal breeding ground for bacteria and germs. A possible inflammation of the uterus is also related to this.In the worst case, even the peritoneum can be affected. Even sepsis is conceivable in this case. Further adhesions and possibly infertility are then the result. In the case of a miscarriage, the unborn child dies. This leads to emotional and psychological problems for most mothers, but also for fathers-to-be. Depending on the personality of the parents, the miscarriage is processed quite individually. Accordingly, the prognosis must also be assessed according to the personal circumstances of those affected. Also to be taken into account are the previous history, the age of the parents, the intensity of the desire to have children, and the circumstances that led to the miscarriage. If the desire to have children is not very pronounced, it is often easier to process what has happened. Parents who have tried everything for several years to conceive offspring often have greater difficulty in looking optimistically and confidently to future developments. If the miscarriage occurred as a result of an accident, a fall or the use of external force, the trigger must be processed at the same time. This process usually leads to a deterioration of the general condition and prolongs the healing process. The prognosis improves if the support of a therapist is taken up and at the same time other areas of the parents’ life are given importance. If there is nothing to prevent a new pregnancy for health reasons, a miscarriage is normally better handled. The situation is unfavorable if the woman is infertile after the miscarriage and there is a desire to have children.
Prevention
Miscarriage can be prevented primarily by a healthy lifestyle. Furthermore, the administration of hormones can be useful. Furthermore, reducing stress during pregnancy is important, which is why relaxation exercises are advised. Occasionally, however, a miscarriage cannot be prevented, as some causes cannot be influenced.
Aftercare
The aftercare for a miscarriage depends on the form of the miscarriage. Scraping the uterus (curettage) is often not necessary. It is recommended to wait a few days before such an intervention. This often allows the patient to accept the situation better. Often the tissue is shed naturally. The progress of the shedding should be monitored medically. Even after curettage, a control examination should be performed to check whether all tissue remnants have been removed and excreted. Generally, at least one ultrasound examination is performed for this purpose about two weeks later. Often, the hCG level is also checked, which affected women can determine themselves using a pregnancy test. In any case, the affected woman is entitled to the care of a midwife. This can not only accompany the physical process, but also help to deal with the grief. It is still possible and common to consult a midwife months after the miscarriage. Many of those affected feel the miscarriage as a strong psychological burden. It is therefore sometimes advisable to seek psychological help. The next ovulation after miscarriage takes place two to eight weeks after the miscarriage. If the affected person does not feel ready for another pregnancy, it is recommended to provide appropriate contraceptive measures.
What you can do yourself
A miscarriage (the abortion) is a drastic experience in the life of a woman. In many cases, this event cannot be influenced. Nevertheless, there are some things a woman can do in everyday life as part of self-help to either avoid a miscarriage or regain her physical and psychological strength as quickly as possible after an abortion. Averting an impending miscarriage is often associated with rest and sparing. In addition to seeing a doctor at the first signs and possibly taking medication, it is best for the pregnant woman to relax for a large part of the day in a lying or sitting position. Physical exertion such as carrying heavy objects, cycling and also sexual contact should be avoided. Hot baths and alcohol are also discouraged. Drinking enough and eating a diet rich in fiber will aid digestion and help avoid heavy pushing when using the toilet. After a miscarriage, women are often physically able to recover quickly. Because of medical advice, bathing or sexual intercourse may have to be avoided for a few days.An abortion that was associated with heavy bleeding can lead to a significant deterioration in iron levels, so an iron cure is helpful here. Sufficient drinking helps to stabilize the circulation. For psychological processing of the miscarriage, herbal sedatives, conversations with a therapist or confidant, dosed exercise in nature or yoga are suitable.
