In this form the pregnancy is still intact. This means that the cervical canal (cervical canal) including the cervix is completely closed and the fetus is still alive (heart sounds present). A threat here is vaginal bleeding, which under certain circumstances can even be accompanied by contractions.
This can also lead to a bruise behind the placenta, which can then be seen in the ultrasound. Therapy options: The therapy here consists of bed rest, physical rest and possibly the administration of magnesium tablets to stop the process. If contractions occur at the same time (see: Birth), the pregnant woman is given tocolytics (contraceptive drugs) from the 22nd week of pregnancy.
If corpus luteum insufficiency is the cause of bleeding, gestagens are prescribed until the 14th week of pregnancy. The condition of the fetus should be checked regularly by ultrasound and measurement of pregnancy hormone (hCG). If the bleeding stops, the prognosis for the further course of the pregnancy is very good.
At this stage, a miscarriage can be averted in about 50% of women. At this stage/indication the miscarriage is already unstoppable. This condition is defined by the open cervix (cervical canal passable for one finger!
), which is usually accompanied by severe pain (contractions and lower back pain) and bleeding. The loss of amniotic fluid can also be a warning sign. In this form, there may be no evidence of signs of life in the child (fetal vitality signs).
Therapy options: See: Therapy of miscarriageThis is usually a sign of a beginning abortion (see above), which has come to a premature stop. By definition, all abortions (miscarriage) up to the 24th week of pregnancy are considered incomplete, since the placenta can rarely be completely expelled by this time due to its immaturity. During this incomplete expulsion of the “pregnancy material”, remnants, often the placenta (placenta), remain back in the uterus, causing persistent vaginal bleeding.
This material can then be detected during the gynecological examination. Therapy options: Since this condition can easily lead to an ascending infection and possibly even to the development of cancerous tissue (malignant degeneration), a scraping (curettage) should be performed soon. This should be followed by bleeding.
Another possibility is the administration of the “contraction hormone” oxytocin, which is also physiologically released by the maternal brain during each contraction and triggers uterine contractions so that the remaining material can be expelled. This also usually occurs as a result of a beginning miscarriage. Here, the complete and synchronous expulsion of the entire pregnancy material (embryo/foetus, placenta and egg skins) takes place.
Therapy options: If the bleeding stops by itself and the 24th week of pregnancy is exceeded, no scraping is necessary here. However, if this has to be performed, an extrauterine pregnancy (S. Pregnancy complications) should be ruled out in advance, otherwise complications may occur with these signs of miscarriage. In this special form of the signs of miscarriage, the fruit has died without being expelled from the uterus.
The pregnancy seems to be completely intact: There is no bleeding or contractions, the uterine canal and the cervix are completely closed. The decisive factor here is the lack of sonographic evidence of fetal vital signs such as heart action and child movements. Other signs of pregnancy such as uterine growth, nausea and breast tenderness are also usually absent.
A rare complication of this form of abortion is the dead-fetus syndrome. Here, the dead fetus remains in the maternal uterus for several weeks after the 12th week of pregnancy. This condition can cause thromboplastic material to enter the maternal bloodstream, leading to life-threatening intravascular clotting.
Treatment Options: The therapy is a so-called suction curettage until the 12th week of pregnancy. This is preceded by a prostaglandin injection (hormone type) to prepare the cervix for surgery by loosening and softening it, thus minimizing the risk of injury.Beyond the 12th week of pregnancy, a drip of oxytocin and prostaglandins is administered to induce labor. Here too, however, a post-curettage is performed afterwards.
A rare subspecies of the restrained abortion is the abortus cervicalis, in which a scarred cervix prevents expulsion of the fruit. A miscarriage leads to a feverish infection (pathogens mainly streptococci, staphylococci and Clostridium perfringens). In the best case (uncomplicated course) only the uterine mucosa is affected.
However, the infection can also spread to the entire uterus including the adnexes (fallopian tubes, ovaries). If the infection even spreads to the pelvic organs and peritoneum and bacterial endotoxins (toxins) are flushed out into the maternal bloodstream, this is the septic form. This is accompanied by blood poisoning and can lead to death through toxic shock with disseminated intravascular coagulation.
Signs of miscarriage are shown here in the form of high fever above 39° C, chills and purulent vaginal discharge and amniotic fluid. Massive pressure pain in the area of the uterus is also one of the symptoms. Therapy options: As therapy, antibiotics are administered first, followed by a scraping after the fever has subsided.
In severe cases, a heparin therapy and possibly the entire removal of the focus of inflammation (uterus) must be carried out to prevent a dangerous coagulation disorder. This is the malformation of a fertilized egg, in which there are no or only malformed embryonic parts in the hollow amniotic sac. This plant rarely exceeds the size of a few centimeters, which also leads to a growth retardation of the uterus.
Furthermore, typical pregnancy complaints or signs of pregnancy are very rare, but spotting can occur. This abnormal development rarely overcomes the first weeks of pregnancy and is the main cause of spontaneous abortions in the first 2 months of pregnancy. Genetic defects, poisoning and lack of oxygen supply to the fruit are discussed as causes.
Therapy options: The treatment is a scraping and after exceeding the 12th week of pregnancy a birth initiation with post-curettage is necessary (see: Therapy miscarriage). With these signs, miscarriages occur repeatedly (by definition at least 3 times) in the woman. In half of the affected cases, no cause can be found.
However, if a cause is discovered, miscarriages in early pregnancy are often genetic (chromosomal changes) or developmental disorders of the uterus. In late pregnancy, anatomical and functional impairments of the female reproductive organs are more often found as a cause. It is estimated that about 1% of all couples who wish to have children are affected.
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