Miscarriage – causes, symptoms, prevention. How to recognize a miscarriage?

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In theory, a miscarriage is premature termination of pregnancy before the end of the 22nd week. Symptoms of miscarriage, on the one hand, can be very characteristic, on the other hand, they may not be noticed at all. However, regardless of the trimester of pregnancy and any other circumstances, any abnormalities should be reported to the gynecologist. How do you recognize the symptoms of a miscarriage?

Miscarriage – How Does It Happen?

Experts agree that about 20% of pregnancies end in miscarriage, especially in their early stages. Many women are unaware that a miscarriage has occurred because they did not even know they were pregnant. The causes of a miscarriage are rarely defined as they are not always known.

To characterize a miscarriage, it is necessary to trace the process of fertilization of the ovum itself. During ovulation, an egg is released from the ovary and travels towards the uterus. In the course of this pathway, fertilization can be accomplished by sperm. After fertilization, the egg is divided into cells and around day 10 the blastocyst implants into the uterus.

Once the embryo is established in the uterus, the corpus luteum begins to release progesterone to protect the embryo from rejection. If the production of progesterone is insufficient, the uterine wall may peel off and cause a miscarriage. Symptoms of miscarriage for this reason may simply resemble a more abundant and painful period, so they are often simply unrecognizable.

See also: Biochemical pregnancy – definition, biochemical and in vitro pregnancy

Symptoms of miscarriage – bleeding

Slight bleeding may occur during the implantation of the embryo. However, brown or light red spotting, which is additionally accompanied by cramps, is disturbing. Bleeding during pregnancy can indicate a miscarriage if it is particularly intense, contains clots or pieces of tissue, and is sudden and increases in profusion.

If you start bleeding, contact your doctor or midwife immediately. If this is impossible, you must go to the emergency department or call an ambulance.

Also read: Spotting in pregnancy – appearance, causes, risks

Symptoms of miscarriage – cramps

Cramps during pregnancy are a natural symptom, but only if they are mild and temporary. An alarming symptom during pregnancy, indicating a miscarriage, is contractions stronger than those experienced during standard menstruation and the accompanying pain in the area of ​​the sacral spine. Cramps that indicate a miscarriage usually last for a long time and often bleed along with them. Any of the above symptoms should be a signal to call for medical assistance.

Symptoms of miscarriage – vaginal discharge

A symptom of miscarriage may also be a leakage of a watery discharge or mucus that turns white-pink. Visible tissue fragments may also appear in this mucus, usually indicating placental tissue. The more profuse mucus leakage, the more likely a miscarriage will occur. As with the previous symptoms, this cannot be ignored. You should call for help as soon as possible or go to the nearest hospital.

Other symptoms of miscarriage

A miscarriage can also manifest itself through other symptoms. One of the symptoms of miscarriage is unexplained weight loss, although, for example, in the first months of pregnancy, weight loss is a common affliction of expectant mothers. A miscarriage can also be manifested by a sudden disappearance of symptoms characteristic of the pregnancy period.

Miscarriage – types

There are many types of miscarriages, depending on the type of division:

1. Pathomorphological division of miscarriages

1. Complete miscarriage – it is very rare and we are talking about it when the fetal egg, i.e. the embryo in the amniotic sac with the chorionic stalk, is completely excreted due to uterine contractions (fetus and chorion). There is no need to curettage the uterus.
2. Incomplete miscarriage – we are talking about it when the fetus is expelled from the uterine cavity, sometimes with fragments of the placenta and chorion. It is then necessary to perform a curettage treatment.
3. Simultaneous miscarriage – early pregnancy is a miscarriage that occurs most often in the first 3 months of life (up to the 12th week of pregnancy).
4. Two-term miscarriage – late: is a miscarriage that happens when the placenta fully develops, i.e. between 13th and 22nd weeks of pregnancy.

2. Clinical classification of miscarriages

1. Miscarriage in progress (abortus in tractu) – we deal with it when a woman neglects the first signs of a miscarriage or when the treatment supporting the pregnancy does not bring results. It should be mentioned that a pending miscarriage may develop from a threatening miscarriage. The symptoms of miscarriage in a year include, among others, severe pain and cramps in the lower abdomen, or intense bleeding.
2. Imminent miscarriage (abortus imminens) – this type of miscarriage is associated with slight bleeding combined with pain in the lower abdomen when the cervical canal is closed. However, it is worth knowing that most of these pregnancies can be saved. According to specialists, the woman should then stay in bed, preferably in a hospital setting. In such cases, an ultrasound scan is performed to assess the development of the fetus, and hormonal tests to find out if the hormone levels are sufficient to maintain the pregnancy.
3. Stopped miscarriage (graviditas obsoleta) – miscarriage in which the deceased embryo or fetus is not expelled from the uterine cavity within 8 weeks of death.
4. Cervical miscarriage (abortus cervicalis) – this miscarriage occurs when the fetal egg becomes trapped in the dilated canal of the cervix and cannot be expelled to the outside due to the closed outlet.
5. An empty fetal egg (blind ovum) – a clinical situation in which a fetal egg without embryonic elements develops in the uterine cavity.
6. Habitual miscarriage (abortus habitualis) – we talk about it when there are three or more spontaneous miscarriages in succession. Most of these types of miscarriages are caused by a developmental defect of the embryo.

See also: Empty fetal egg – diagnosis, treatment

Miscarriage – causes

There can be many reasons for a miscarriage, including:

1. The abnormalities result from the structure of the uterus

That is, pathological changes within the reproductive organ of a woman that may affect her not keeping the pregnancy. Such abnormalities include, for example, two-horned and one-horned uterus, uterine fibroids or cervical failure.

1. Hormonal disorders

These types of disorders are one of the most common causes of fertility problems and termination of pregnancy. In the event of an endocrine miscarriage, the cause may be, for example, in: diabetes mellitus, polycystic ovary syndrome or thyroid disease.

1. Immunological factors

Another cause of numerous miscarriages may be immunological factors, as it sometimes happens that the immune system can produce antibodies, which in turn attack the woman’s body. According to the data, these factors may be responsible for 65% -70% of pregnancy loss in women with habitual miscarriages.

1. Infections caused by viruses and bacteria

These factors are mainly responsible for sporadic miscarriages and less frequently for recurrent miscarriages. Unfortunately, diseases such as cytomegaly and chlamydiosis, rubella or toxoplasmosis are a very big threat to the proper course of pregnancy, which means that tests excluding these examples should be performed during the first trimester. It is worth mentioning that these diseases are responsible for an increase in body temperature, which can pose a risk to a child.

1. Genetic defects

The genetic defects of the embryo account for over 60% of miscarriage cases. The abnormalities occur during the fusion of the egg with the sperm or shortly after fertilization, and they mostly concern the number or structure of the embryo’s chromosomes. It also happens that a miscarriage may be caused by a genetic defect in a couple trying to conceive. Research shows that 3 to 6 percent of couples have an abnormal karyotype, which may lead to further miscarriages.

In addition, another of the reasons for the occurrence of the so-called spontaneous abortion may be thrombophilia, which is associated with blood coagulation disorders. Then, thrombotic changes make it difficult for the embryo to implant in the uterus and may contribute to limiting the growth of the fetus, disturbances in the development of the placenta, and even pregnancy loss.

1. Mental state

According to information provided by American specialists, the stress faced by women in the first three weeks of pregnancy may increase the likelihood of losing a baby up to three times. It is caused by cortisol, a stress hormone, which is understood by the woman’s body as a sign that the prevailing conditions are unfavorable for the maintenance of pregnancy, and thus the pregnancy should be terminated. In addition, the same cortisol reduces the level of progesterone, a hormone that prepares the uterus to implement a fertilized egg.

1. Age of the woman 

Nowadays, a lot of women choose to have a baby later in life, which is understandable, but it must not be forgotten that after the age of 30, female fertility begins to decline. Then it comes to the emergence of anovulatory cycles. In women over 35, the frequency of early pregnancy loss increases and in women over 40 it may be as high as 50%. An important question regarding the risk of miscarriage is whether it is the first or the subsequent pregnancy. For women who have given birth, the risk is only slightly greater than for primiparous women.

Find out more: The eight most common causes of miscarriage

In the case of habitual miscarriages, we recommend HLA-C genotyping – a mail-order study available on Medonet Market.

Miscarriage – post-miscarriage examinations

After a miscarriage, it is very important to do the appropriate tests so that the woman finds out what caused the loss of pregnancy and helps her become a mother if she still wants to. The tests are designed to determine the risk of another miscarriage, to find out the reasons for the miscarriage and how to deal with it. It should be added here that the woman’s partner should also undergo the tests, because miscarriage may also be the result of abnormalities related to the man’s sperm.

The possible tests include:

1. Hormonal tests

Testing for sex hormones (e.g. progesterone); Test for the detection of thyroid diseases: TSH / f-T3 / f-T4 / anti-TG (antibodies against thyroglublin) / anti-TPO (antibodies against thyroid peroxidase) / anti-TSH receptor

1. Genetic research

Study of the partners’ karyotype; Genetic examination of the aborted fetus; Testing for thrombosis (eg, testing for MTHFR mutation, prothrombin gene mutation); Azoospermia met. PCR; Cystic fibrosis research; Factor v leiden (PCR method); ChrY microdeletion.

Shipment blood test for factor V Leiden mutation can be found in the Medonet Market offer. Order the test and use the sample collection kit provided.

1. Investigation of infectious agents

Cytomegaly; Toxoplasmosis; Rubella; Chlamydiosis; Mycoplasma and ureaplasma.

1. Semen tests

Thorough examination of semen to determine the quality and quantity of sperm in the semen, as well as tests to check the presence of bacteria in the semen.

1. Immunological research

Testing for antibodies that can cause thyroid disease; Research on the antiphospholipid syndrome; Antinuclear antibodies.

See also: It is possible to get pregnant shortly after the miscarriage

Miscarriage – miscarriage prevention

Most often, right after the first miscarriage, the doctor performs an ultrasound examination and orders a blood test for hormone levels, additionally recommending taking folic acid before the next conception. However, the help of a specialist psychologist can be invaluable here.

In the case of a third miscarriage, other more detailed tests should be performed, such as tests for rubella infections, tests for progesterone and prolactin levels, tests for thyroid function (TSH), toxoplasmosis, Chlamydia, or immunological tests for the presence of antiphospholipid antibodies.

When it comes to defects related to the structure of the uterus, they are detected by X-ray after introducing intrauterine contrast. On the other hand, when there is slight bleeding, the doctor recommends staying in bed in most cases to support the pregnancy. If the bleeding stops and the ultrasound scan shows that the fetus is okay, the pregnancy may continue until the delivery date.

It is important to refrain from sexual intercourse and increased physical activity for the duration of the threat to pregnancy. In a situation where a miscarriage occurs, unfortunately, it cannot be stopped in most cases, and when we are dealing with the so-called incomplete miscarriage, the remaining fetal tissue must be removed from the uterus. Then the so-called curettage of the uterine cavity.

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Miscarriage and another pregnancy

One very important topic in the event of a miscarriage is when the couple will be able to try for another baby. The next pregnancy will largely depend on how mentally and physically the woman feels and what type of miscarriage we are dealing with And so, in the case of spontaneous miscarriage, you can usually try to get another pregnancy in the next menstrual cycle, but, for example, a stopped or incomplete miscarriage will be related to the removal of dead tissue from the uterine cavity beforehand.

When it comes to curettage, the couple will have to wait at least three months before trying to get pregnant again. However, there are other methods that are increasingly used by specialists, such as induction of miscarriage. In this method, a woman who has died of pregnancy is given drugs to induce contractions. This causes the uterus to self-cleanse.

Thanks to the use of this method, a couple can try to get pregnant after just one correct cycle. On the other hand, in the case of miscarriages after the 13th week, a gynecological procedure is usually performed, which means that a couple will be able to try for another child only after three correct cycles.

Usually, after the first miscarriage, there is a high probability of a successful next pregnancy. However, it is worth for a woman to undergo appropriate tests, such as hormone tests, genetic tests or those that can exclude problems with the structure of the reproductive system. Diagnostics plays a key role here and allows to identify the cause of miscarriage in order to exclude it in the next pregnancy.

It is also worth considering a visit to a psychologist. However, the most important thing is to follow the doctor’s instructions and properly plan the next pregnancy under the care of a specialist who will help the couple achieve their goal, which is to have a healthy baby.

Miscarriage and psychological and emotional issues

A miscarriage can lead to feelings of anxiety, depression or stress not only in the women who have had a miscarriage but also in the people involved. A miscarriage can affect the entire family. Many people who experience a miscarriage go through a mourning process. There is often a so-called “Prenatal attachment” that can be viewed as parental sensitivity, love and care for the unborn child.

A severe emotional impact usually occurs immediately after a miscarriage. In some cases, the sensations may be similar to the termination of an ectopic pregnancy. In some cases, it may take weeks for a loss to be realized. Providing family support for those experiencing loss can be a difficult task as some people may find it positive to talk about a miscarriage, while others may find the event too painful to talk about.

Importantly, the father may feel the loss of his child by his partner in a similar way. Interestingly, expressing grief and loss can sometimes be more difficult for men. Some women may start planning another pregnancy after a few weeks of miscarriage. For others, planning another pregnancy may be too difficult.

The help of a psychologist after a miscarriage is often very important for a woman, but most often the woman does not want to leave the house. In such a situation, it is worth thinking about an online consultation via the halodoctor.pl portal, which will take place at the patient’s home. The woman will not have to leave the house, which will minimize the stress associated with the visit.

Worth knowing: He needs closeness, her bed is a grave … Grief after a miscarriage

Miscarriage and curettage

For obvious reasons, many women have trouble waiting for a spontaneous miscarriage and the bleeding to stop. The body itself hardly withstands prolonged bleeding, which is why many women prefer to undergo the curettage treatment. The curettage procedure is nothing more than suction of the uterine contents with a thin tube, previously inserted through the vagina (uterus contents can also be removed using a tool called a scraper). When all residues are removed, the bleeding stops on its own after a few days.

The curettage procedure is quick and lasts from 5 to 10 minutes. During its duration, the woman is under general anesthesia. It is worth knowing that some medical facilities also offer local anesthesia. In the latter, the cervix is ​​anesthetized with several injections inserted into the vagina. This is also when a sedative is usually administered, causing drowsiness and indifference. However, it should be remembered that local anesthesia does not exclude pain, although most often it is possible to endure this pain and return home on the same day.

There is also no reason to be concerned, as the curettage procedure does not have a high chance of complications, which would require further treatment.

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