Spontaneous abortion: signs to pay attention to and prevention

Although being pregnant can be extremely exciting, statistics remind us that we must never forget that there is also the risk of a miscarriage: this is a fact whose existence and dynamics it is better to be aware of than to be caught off guard.

We aim to provide only some basic knowledge: as with all complications related to pregnancy, remember that the best person to contact is always and only your trusted doctor.

Abortion and miscarriage

The abortion. An abortion is a termination of pregnancy. Interruption which may be due to natural, voluntary, pathological, therapeutic or voluntary causes.

Abortion is the most common way of losing a child (embryo or fetus, more correctly). Worldwide, 10 to 25% of clinically known pregnancies end in miscarriage.

Among the many possible causes (which we will discuss later) at the base of 50-75% of total abortions are artificial inseminations.

The miscarriage.  The expression miscarriage is used to indicate a pregnancy that terminates on its own, independently of the woman’s will, within the first  20 weeks of pregnancy . Most miscarriages occur within  13 weeks of pregnancy .

Miscarriage should be viewed as a process rather than as a single event.

There are many reasons that can cause a spontaneous abortion, and very often the causes that determine it are not clearly identifiable.

During the  first trimester , the most common causes of miscarriage are chromosomal abnormalities, which are alterations in the number or structure of chromosomes: that is, the baby’s chromosomes are not “right”.

Most of these problems result from a damaged egg or sperm, or from a problem dividing the zygote.

Among other causes of miscarriage, the most common are due,

  • hormonal problems, infections or mother’s health problems;
  • the mother’s lifestyle: the mother smokes, uses drugs, does not eat properly, makes excessive use of  caffeine  or is exposed to radiation or toxic substances;
  • to the unsuccessful implantation of the embryo into the uterine wall;
  • at maternal age: the risk of miscarriage increases with age, as we will see below;
  • to any trauma that may happen to the mother.

What are the chances of miscarriage

Of childbearing age.  For women of childbearing age, the chances of miscarriage can be 10 to 25%.

In old age . Increasing maternal age is a risk factor for miscarriage. Indeed:

  • women under 35 have about a 15% chance of having an abortion;
  • women aged 35 to 45 have about a 20-35% chance of having an abortion;
  • women over the age of 45 may have up to a 50% chance of having an abortion.

In the case of a previous miscarriage . A woman who has already had a miscarriage has a 25% chance of having another one, so she has a slightly higher risk than a woman who has never had a miscarriage.

Symptoms of a miscarriage

If you are pregnant, and experience any of the following symptoms, contact your doctor right away to find out if you could be experiencing a miscarriage:

  • sudden disappearance of pregnancy symptoms,
  • severe (stronger than menstrual cramps) back pain;
  • weight loss;
  • white/pink mucus;
  • painful contractions every 5-20 minutes;
  • brown or bright red bleeding, with or without cramps: it should also be said in this regard that in 20-30% of pregnancies bleeding occurs in the early stages of pregnancy, and of these 50% are normal pregnancies without any problems;
  • discharge of clot-like materials from the vagina.

Types of spontaneous abortion

There are different types of miscarriage. Most of the time you only hear about miscarriage, in general and that’s it. But if we want to be precise, we can distinguish different types of abortion.

Threatened abortion . It is a fairly frequent condition, which affects 14-21% of pregnancies.

  1. In this case there is uterine bleeding accompanied by cramps and lower back pain.
  2. The cervix remains closed.
  3. This bleeding is usually the result of the implant.

Incomplete abortion . In this case, abdominal or back pain is accompanied by bleeding, and the cervix is ​​open.

  1. Abortion is virtually inevitable when there is dilation of the cervix or when the membranes rupture.
  2. If the abortion is not completed, bleeding and cramping may persist.

Complete abortion . A complete abortion occurs when the embryo or products of conception are expelled from the uterus.

  1. In this case the cramps, along with the pain and bleeding should subside quickly.
  2. Complete miscarriage is confirmed by ultrasound or uterine scraping.

Missed or silent abortion . Some women may miscarry without realizing it.

  • A missed abortion occurs when there is embryonic death, but the embryo is not expelled. It is not known why this happens.
  • The characteristic signs of silent abortion are the sudden absence of pregnancy symptoms, and the absence of a fetal heartbeat on ultrasound.

Recurrent miscarriage . It manifests itself as a first trimester miscarriage that occurs three or more times in a row.

Anembryonic pregnancy or clear egg : the fertilized egg implants itself in the uterine wall, but development never begins. Often, in these cases there is a management sac (with or without a yolk sac), but there is an absence of fetal growth.

Ectopic pregnancy . It occurs when a fertilized egg implants itself outside the uterus, usually in the fallopian tubes.

  • In this case, it is necessary to treat  this condition immediately  to prevent the implanted egg from developing.
  • If an ectopic pregnancy is not treated, serious complications can arise for the mother.

Molar pregnancy . It is a genetic error during fertilization, which leads to the growth of abnormal tissue in the uterus.

  • Molar pregnancies rarely involve an actual developing embryo.
  • They usually have the most common pregnancy symptoms such as missed periods, positive pregnancy tests , and severe nausea.

Treatments in case of abortion

The main goal of miscarriage treatments is to prevent bleeding and infection.

During pregnancy, the sooner a miscarriage occurs, the more likely it is that the body will expel the fetal tissue on its own, and that no further medical procedures will be needed.

However, if the body cannot expel all the embryonic tissue, the most common procedure to stop bleeding and prevent infection is  curettage .

After this type of surgery, medications are usually prescribed to control the bleeding.

Even once the woman is home, the bleeding should be monitored: if you notice it increasing or if you have chills and fever, it is best to call your doctor right away.

How to prevent the risks of an abortion

Since the leading cause of miscarriage is chromosomal abnormalities, there isn’t much that can be done to prevent it.

An important step is to arrive at pregnancy as healthily as possible so that fertilization takes place in a suitable environment. So,

  • exercise regularly,
  • eat healthy,
  • learn to manage stress,
  • maintain your normal weight,
  • take folic acid every day
  • not smoking,
  • drink alcohol in moderation (or don’t drink it at all)

Once you know you are pregnant, try to maintain your health to provide the healthiest possible environment for your baby to grow. So,

  • keep your abdomen protected and avoid those activities (work, sports, etc.) that are at risk of injury,
  • do not smoke or stay in places where smoking is smoked,
  • don’t drink alcohol,
  • check with your doctor which medicines you can take, and which ones are best avoided,
  • limit or eliminate caffeine,
  • avoid environmental dangers such as radiation, infections, various diseases, etc…

The consequent emotional management

Unfortunately, miscarriage can affect anyone. In such cases, it is not uncommon for it to leave a deep mark not only on the woman but also on the couple.

The emotional or psychological aspect of an abortion can have important repercussions and as such should not be underestimated. If sometimes a dialogue and a comparison with the partner, with friends and parents is sufficient, sometimes the support of a psychotherapist may be necessary.

Katherine Johnson, M.D., is a board-certified obstetrician-gynecologist with clinical expertise in general obstetrics and gynecology, family planning, women’s health, and gynecology.

She is affiliated with the Obstetrics and Gynecology division at an undisclosed healthcare institution and the online platform, Maternicity.com.

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