Miscarriage ( spontaneous abortion ) pregnancy - Causes, Symptoms and Treatment .MF .
Miscarriage - a spontaneous abortion before 37 weeks.Termination of pregnancy can occur at any stage of pregnancy, but more often it occurs in the first trimester.If pregnancy is interrupted before 28 weeks, it is referred to as a miscarriage or an abortion.If after 28 weeks of pregnancy, then it is a premature birth.
Causes of miscarriage
Genetic causes of miscarriage
There are many causes of this disease.Approximately 10% of cases, pregnancy is terminated due to chromosomal abnormalities.In other words, the fetus has genetic malformations incompatible with life, leading to his death, that is, the spontaneous abortion.Thus, according to geneticists, nature holds natural selection.
miscarriage due to chromosomal abnormalities are more common in families that already have had a miscarriage or pregnancy beslodiya, and if in the family somebody of the parents already had babies with congenital malformations or children with mental retardation.
Valuable information is abortions cytogenetic analysis
To find out whether the genetic factor is a major cause of miscarriage - you need to study the karyotype of both parents.In the case of detection of pathology in the karyotype of married couple should consult a physician-geneticist.
the presence of abnormal karyotype in at least one of the parents of the risk of congenital malformations in the fetus is increased by several times.Therefore, such couples Genetics recommend prenatal diagnosis (chorionic villus sampling, amniocentesis, cordocentesis).
Endocrine causes of miscarriage
Other common causes of miscarriage include endocrine disruption, or rather, the lack of the luteal phase, an excess of androgens, hyperprolactinemia, thyroid dysfunction and diabetes.Endocrine disorders in 25% of cases the cause of miscarriage in early pregnancy.
Insufficient luteal phase due to reduced levels of progesterone - the hormone "pregnancy", which is essential for normal pregnancy.Progesterone levels is crucial in the first trimester of pregnancy, progesterone because it is involved in implantation and retention of the ovum in the uterus.Appropriately, the insufficient level of progesterone in the body can lead to infertility and miscarriage.
To correct level of progesterone during the first trimester of pregnancy used progestins - Duphaston, Utrozhestan.If nedostaka progesterone combined with an excess of androgens, the prescribed glucocorticoids (metipred, Dexamethasone).
excess androgens or scientifically " hyperandrogenism " - are also a common cause of miscarriage.Hyperandrogenism can be caused by excessive production of testosterone by the adrenal glands, ovaries, or both, and others.
Hyperandrogenism adrenal genesis arises because of hereditary diseases caused by genetic defects of enzymes of steroidogenesis (congenital adrenal hyperplasia, congenital adrenal hyperplasia).
Hyperandrogenism ovarian origin is in polycystic ovary syndrome.
Excess androgens mixed genesis occurs in violation of the hypothalamic-pituitary function (for neyroobmennoendokrinnom and hypothalamic syndrome).
Hyperprolactinaemia due to diseases of the hypothalamic-pituitary system (trauma, infection, brain tumor).In addition, hyperprolactinemia can be caused by taking certain drugs (antidepressants, birth control pills).
From thyroid disease great danger to the pregnancy are thyroiditis and iodine deficiency.The fact that the thyroiditis and iodine deficiency thyroid gland produces thyroid hormones lower than required for normal development and maintenance of pregnancy and fetal.Accordingly, that pregnancy proceeded normally, a woman prescribed hormone replacement therapy and / or iodine preparations.
Diabetes can also lead to miscarriage due to lower sensitivity of tissues to insulin.Therefore, a correction of pregnancy insulin doses.
In identifying endocrine disorders necessarily shows hormonal therapy not only during pregnancy, but in some cases, pre-pregnancy, so it is very important to timely, before planning pregnancy to be examined by a gynecologist.If you find any abnormality doctor will refer you to an endocrinologist.
Anatomical causes of miscarriage
Next cause of miscarriage - this anatomical anomaly.The percentage to this cause has to 10-16% of the total number of cases of miscarriage.By anatomical anomalies include uterine malformations: a doubling of the uterus;horned, horned saddle or uterus;the presence of an intrauterine septum.In addition to malformations of the uterus, to the anatomical anomalies attributed acquired uterine defects such as intrauterine adhesions, uterine myoma with submucous location node.The latter is more common than the others.
cervical incompetence (CIN) in approximately 10% of the causes of miscarriage.What it is?This short cervix with subsequent opening.In most cases CIN develops in the second and third trimester of pregnancy.To reduce the risk of preterm birth before 33 weeks of pregnancy, pregnant women with this pathology cervix sutured.Outside of pregnancy often spend cervical plastic.
have a negative impact on pregnancy Infectious causes of miscarriage
Infectious and viral genital diseases (chlamydia, ureaplasmosis, mycoplasmosis, trichomoniasis, HPV, HSV, CMV) and TORCH -infektsii (herpes, rubella, toxoplasmosis, cytomegalovirus infection).According to studies, more than 40% of miscarriages and premature births are caused by infectious or viral origin.Therefore, women with these diseases during pregnancy immunoglobulinoterapiyu carried out, depending on the type of agent in the second and third trimester carried antibiotics and antiviral drugs.
Note that even if any of these infections, pregnancy is not interrupted at all and not always.Therefore, in most cases, miscarriage due to infections or viruses associated with the weakness of the immune system during pregnancy.
Immunological causes miscarriage
And finally, the most mysterious causes of miscarriage - is immunological.If the rest of the above causes of miscarriage in the survey are excluded, then, as a rule, cause miscarriage "credited" is to immunological.What is meant by an immunological disorders?Kinda - this is an inadequate reaction to the aggressive immune system against foreign tissues of the fetus (alloimmune disorders) or against their own mother tissues (autoimmune disorders).In autoimmune blood disorders in women detect antinuclear, antithyroid and antiphospholipid antibodies.When alloimmune disorders are present in the blood of pregnant antibodies to hCG.
therapy aimed at preserving pregnancy in immunological disorders, is held for a long time, sometimes for the entire pregnancy.For the treatment of these pathologies used anticoagulants, glucocorticoids, antiplatelet agents, progestins, etc.Throughout pregnancy, a careful monitoring of the condition of the fetus.
It should be noted that physical activity, including sex, despite the common belief do not have any adverse effect on pregnancy vynashivaemost.Causes of miscarriage are more serious.
Screening and Diagnosis for miscarriage
All pregnant women whose pregnancy was interrupted at spontaneous abortion, at hospital discharge is recommended to pass outpatient examination by a gynecologist to determine the cause of miscarriage, which includes:
- pelvic ultrasound in bothphase of the menstrual cycle;
- cytogenetic study remnants of fetal eggs;
- screening for reproductive tract infections: chlamydia, ureaplasmosis, mycoplasmosis, trichomoniasis, HPV, HSV, CMV;
- blood test for TORCH infections: rubella, herpes, toxoplasmosis, cytomegalovirus infection;
- blood test for hormones: estradiol, LH, FSH, cortisol, testosterone, DHEA, prolactin, progesterone, 17-OH progesterone;
- blood test for thyroid hormones: TSH binding.T3, St. T4;
- coagulation, hemostasiogram;
- karyotype for both partners;
- advice endocrinologist and geneticist;
- semen of her husband;
- a blood test for antibodies against hCG, antinuclear, antithyroid and antiphospholipid antibodies.
volume of diagnostic studies is determined individually.
After miscarriage woman recommend protected from pregnancy for 6 months for the recovery, examination and treatment of identified pathology.To prevent pregnancy prescribe oral contraceptives with a therapeutic effect (Jeanine, Yarina, Jess), to be applied from 3 to 6 months of contraceptive scheme.
treatment for miscarriage
Treatment is determined by the cause that caused the miscarriage and reduced to its elimination and prevention.
Complications of miscarriage:
- heavy bleeding can lead to hemorrhagic shock;
- the spread of infection in the peritoneal cavity, which can cause peritonitis;
- purulent blood poisoning, or sepsis;
- prematurity in preterm fetus, intrauterine fetal death, fetal death immediately after birth.
prevention of miscarriage:
- examined by a gynecologist before planning pregnancy;
- timely treatment ginekolocheskih and endocrine diseases before pregnancy;
- the rejection of abortion;
- a healthy lifestyle, avoiding harmful habits, regular exercise.
Consultation of obstetrician on miscarriage:
1. Can I get pregnant soon after a miscarriage?
possible, but it is better to first be examined by a gynecologist, and only then try to get pregnant.
2. sure to drink oral contraceptives after the abortion?
not obyazatelno.Vse vykidysha.No depends on the cause in most cases, prescribe oral contraceptives for the treatment and recovery of the body after a miscarriage.
3. I have uterine fibroids.Will I be able to bear a child normal?
It all depends on the size of fibroids and their location.If the nodes are small and there is no contact with the placenta unit, in most cases, pregnancy is beneficial.
4. Could there be a miscarriage because of cervical erosion?
No.Cervical erosion vynashivaemost no effect on pregnancy.
5. Could there be a miscarriage because of frequent ultrasound?
6. I have had four miscarriages.The doctors have not figured out the cause.What should I do, I'm afraid to get pregnant again?
you and your spouse need to go through a consultation with genetics.
7. gynecologist discovered I ureaplasmosis.But I did not have time to treat it immediately became pregnant.How will ureaplasmosis pregnancy?
Ureaplasmosis can lead to miscarriage and fetal infections.But fortunately, this is not always the case.During pregnancy, the treatment is carried out ureaplasmosis antibiotics at 20-22 weeks of pregnancy.
8. Can orgasms trigger premature labor?
No.According to some reports, orgasm on the contrary, good for the health of the fetus.But for 2-3 weeks before giving birth by sex should be abandoned.
Obstetrician-gynecologist, k.m.n.Kristina Frambos
* Miscarriages associated with a family history of heart disease
A new study (February 2011) have suggested that there may be a link between heart disease from their parents, and the risk of miscarriagein their adult daughter.
Scientists from the UK found that women who have had two miscarriages before the birth of their first child, had a higher than average risk of having a parent with heart disease.This risk was even higher in women who have had three miscarriages before the birth of their first child, write Dr. Gordon Smith (Gordon Smith) (Cambridge University) and his colleagues.
In a previous study, including nearly 130,000 Scottish women, researchers found that women with frequent miscarriages more likely to have heart problems, with increasing age.This led to wonder whether such women - already at risk for heart disease - are also more likely to have a family history of heart disease, suggesting a genetic link.
Thus, the authors examined data from nearly 75 000 women who gave birth to their first child between 1992 and 2006, along with medical information about the parents of about two-thirds of women.
Compared with women who gave birth without any previous miscarriages in women who have had two miscarriages, 25% more likely to have parents who died or were hospitalized due to heart disease.When a woman has had three miscarriages before giving birth, she has 56% more likely to have parents with severe heart disease.
Factors such as income, education and smoking, did not explain the link between heart disease in parents and miscarriages in their grown daughters.