Early spontaneous miscarriage, causes, symptoms, treatment

One in five pregnancies ends in miscarriage; More than 80% of miscarriages occur in the first 3 months of pregnancy. However, their actual number may be underestimated, since most occur in the early stages, when pregnancy has not yet been diagnosed. No matter when your miscarriage occurs, you may feel shock, despair and anger. A sharp decrease in estrogen can cause a decline in mood, although most women become depressed without it. Best friends or even family members will sometimes refer to what happened as a “bad period” or “a pregnancy that wasn’t meant to be,” which only adds to your grief. Many women feel guilty, thinking that something wrong was the cause of their miscarriage. What if it's because of the weights you've been lifting at the gym? Because of the computer at work? Or over a glass of wine with lunch? No. Remember that the vast majority of miscarriages are due to chromosomal abnormalities. Only a small proportion of women (4%) with a history of more than one miscarriage suffer from some kind of disease that requires diagnosis and treatment. It is important to find moral support after the incident. Give yourself time to go through all 4 stages of grief—denial, anger, depression, and acceptance—before you try to get pregnant again. Understand that this is an illness and share your pain with someone you trust. Your partner is grieving the loss just as you are, now is the time to support each other. Finally, remember that in most cases, even women who have miscarriages go on to have healthy children in the future.

Classification of miscarriage

Spontaneous miscarriages can be classified according to many criteria.

Of practical interest are classifications based on differences in gestational age, degree of miscarriage development (pathogenetic sign) and clinical course.

Spontaneous - miscarriages are distinguished:

By gestational age: a) early - in the first 12-16 weeks of pregnancy, b) late - in 16-28 weeks of pregnancy.
According to the degree of development: a) threatening, b) beginning, c) in progress, d) incomplete, e) complete, f) failed. If spontaneous miscarriages recur during successive pregnancies, they speak of a habitual miscarriage.
According to the clinical course: a) uninfected (not febrile), b) infected (feverish).

The pathogenesis based on the primary death of the fertilized egg due to toxicosis of pregnancy, acute and chronic infections, hydatidiform mole, etc. In such cases, reactive changes usually occur in the pregnant woman’s body, entailing contractions of the uterus with the subsequent expulsion of the dead fertilized egg. In other cases, reflex contractions of the uterus occur primarily and precede the death of the fetal egg (secondary death of the fetal egg), which occurs from a disruption in the connection of the fetal egg with the maternal body due to detachment of the placenta from its bed. Finally, both of these factors, i.e., contractions of the uterus and death of the egg, can be observed simultaneously.

Until 4 weeks of pregnancy, the fertilized egg is still so small that it takes up an insignificant place in the total mass of the falling membrane. Contractions of the uterus can completely or partially remove the falling membrane from its cavity. If the part of the membrane in which the egg is implanted is removed from the uterine cavity, a spontaneous miscarriage occurs, which the pregnant woman either does not notice at all or mistakes for heavy menstrual bleeding. By removing part of the falling membrane that does not contain the fertilized egg, the egg can continue to develop after the contractions have stopped. In such cases, slight bleeding from the pregnant uterus may even be mistaken for menstruation, especially since a small amount of menstruation-like discharge sometimes occurs in the first month of pregnancy. Further observation of the pregnant woman reveals the true picture.

If contractions of the uterus precede the death of the fertilized egg and cause its detachment from the bed in the area of the decidua basalis, where a rich vascular system is developed, short but severe bleeding occurs, quickly bleeding the patient, especially if half or a region is detached.

The closer to the internal os of the uterus the egg is implanted, the more severe the bleeding. This is explained by the lower contractility of the uterine isthmus compared to its body. Sometimes the fertilized egg of early pregnancy exfoliates entirely and, having overcome the obstacle from the internal uterine os, descends into the cervical canal. If at the same time the external pharynx turns out to be impassable for the egg, it seems to get stuck in the canal of the cervix and stretches its walls, and the cervix takes on a barrel-shaped appearance. This form of miscarriage is called cervical abortion (abortus cervicalis).

A miscarriage in the late stages of pregnancy (after 16 weeks) proceeds in the same way as a premature birth: first, the uterine os opens with wedging of the amniotic sac, then the amniotic sac is opened, the fetus is born, and finally, detachment and the birth of the placenta occur. In multiparous women, the membranes often remain intact, and after the opening of the uterine pharynx, the entire fertilized egg is born entirely at once.

Threatened miscarriage in the early stages: signs and symptoms

How to recognize an early miscarriage and what are the symptoms?

There are several main stages of spontaneous abortion, since it does not happen all at once. Each of these stages is characterized by its own symptoms according to the threat of miscarriage in the early stages, and sometimes this can be stopped or prevented if you seek treatment from a doctor in time.

So, the first signs of a miscarriage in the early stages, which should alert you to any manifestations of pain or pain in the back and abdominal area, which are accompanied by brown or red discharge . Sound the alarm even if a few drops of blood appear from the vagina, because this may already indicate an early miscarriage. Also pay attention to your condition: have the main signs of pregnancy disappeared?

Do not miss scheduled visits to the doctor , mandatory tests or necessary examinations. This way you can rule out any pathologies in the development of your baby and be confident that the pregnancy is going well.

Main stages of miscarriage

Threat or risk of spontaneous abortion. This condition happens very often, which is why some women are forced to remain in bed for almost the entire 9 months. It is characterized by the above-mentioned cramping pains and bleeding, sometimes even very copious ones. You can also note increased uterine tone.
The second stage is more serious - it is classified as an incipient miscarriage or spontaneous abortion. The fertilized egg has already partially detached from the walls of the uterus, so the symptoms of spontaneous miscarriage in the early stages will be pronounced. But doctors still consider this stage to be reversible, that is, with prompt and qualified intervention, they can save your child’s life.
With the so-called “miscarriage in progress,” the pregnancy cannot be saved. At this stage, the woman feels severe and sharp pain, and heavy bleeding occurs almost immediately. The fertilized egg has already died, and the cervix is open, so it can come out all at once or in parts, which will be considered an incomplete miscarriage.
The last stage is a completed spontaneous abortion . The uterus, having expelled the dead fertilized egg, contracts and returns to its previous size.

Also, on an ultrasound, the doctor can detect a failed abortion or fading pregnancy, when due to some reason the fetus died, but the miscarriage did not occur. This is also a very dangerous condition, because suppuration or blood poisoning is possible if the necessary measures are not taken in time.

Types of miscarriage

Depending on what was discovered during the examination, your doctor may name the type of miscarriage you experienced:

Risk of miscarriage. If you are bleeding, but the cervix has not begun to dilate, then this is only a threat of miscarriage. After rest, such pregnancies often continue without further problems.
Inevitable miscarriage (abortion in progress). If you are bleeding, your uterus is contracting and your cervix is dilated, a miscarriage is inevitable.
Incomplete miscarriage. If some of the tissue of the fetus or placenta is expelled, but some remains in the uterus, this is an incomplete miscarriage.
Failed miscarriage. The tissues of the placenta and embryo remain in the uterus, but the fetus died or did not form at all.
Complete miscarriage. If all the tissue associated with the pregnancy comes out, it is a complete miscarriage. This is common for miscarriages occurring before 12 weeks.
Septic miscarriage. If you develop a uterine infection, it is a septic miscarriage. Urgent treatment may be required.

Signs of a miscarriage

The final exit of the fetus from the uterus and genital tract is a complete miscarriage. Signs of miscarriage:

Bloody discharge (scarlet, dark brown, bright red).
Sharp or nagging pain in the lower abdomen, left or right in the groin area, above the pubis. The pain can radiate to the lower back, labia, anus, and perineum.
There may be a sharp deterioration in general condition, fever, nausea, weakness, fainting, and vomiting.

Was there a miscarriage? If you suspect you have had a miscarriage during pregnancy, see your doctor as soon as possible and get an ultrasound to help make a diagnosis. A home pregnancy test will not give you the answer, because it can be positive for a long time after the miscarriage.

How to diagnose a frozen pregnancy? An ultrasound scan of the uterus is the only reliable way to determine a frozen pregnancy.

Causes of miscarriage

Most miscarriages occur because the fetus does not develop normally. Abnormalities in a child's genes and chromosomes are usually the result of random errors during the division and growth of the embryo - not inherited from the parents.

Some examples of anomalies:

Dead egg (anembryony). This is a fairly common occurrence and is the cause of almost half of miscarriages in the first 12 weeks of pregnancy. Occurs when only the placenta and membranes develop from a fertilized egg, but no embryo.
Intrauterine fetal death (frozen pregnancy). In this situation, the embryo is present, but it dies before any symptoms of miscarriage appear. This also occurs due to genetic abnormalities of the fetus.
Bubble drift. Hydatidiform mole, also called trophoblastic disease of pregnancy, is uncommon. This is an abnormality of the placenta associated with disturbances at the time of fertilization. In this case, the placenta develops into a rapidly growing cystic mass in the uterus, which may or may not contain an embryo. If the embryo does exist, it will not reach maturity.

In some cases, the woman's health status may play a role. Untreated diabetes, thyroid disease, infections, and hormonal imbalances can sometimes lead to miscarriage. Other factors that increase the risk of miscarriage include:

Age. Women over 35 have a higher risk of miscarriage than younger women. At 35 years of age the risk is about 20%. At 40 years old, about 40%. At 45 - about 80%. The age of the father may also play a role.

Here are the possible causes of miscarriages:

Chromosomal abnormalities. During fertilization, the sperm and egg each contribute 23 chromosomes to the future zygote and create a set of 23 carefully selected pairs of chromosomes. This is a complex process, and the slightest disruption can lead to a genetic abnormality, which will stop the growth of the embryo. Research has shown that most miscarriages have a genetic basis. The older the woman, the more likely such anomalies are.

Hormonal imbalance . About 15% of miscarriages are mediated by hormonal imbalances. For example, insufficient progesterone levels can prevent the embryo from implanting into the uterine wall. Your doctor can diagnose the imbalance through an endometrial biopsy, a procedure usually performed at the end of the menstrual cycle to assess ovulation and the development of the lining of the uterus. Treatment uses hormonal drugs that stimulate the development of the embryo.

Diseases of the uterus . Fibrous tumor of the uterus can cause miscarriage; Such tumors often grow on the outer wall of the uterus and are harmless. If they are located inside the uterus, they can interfere with implantation of the embryo or blood flow to the fetus. Some women are born with a uterine septum, a rare defect that can cause miscarriage. The septum is a tissue wall that divides the uterus in two. Another reason may be scarring on the surface of the uterus, as a result of surgery or abortion. This excess tissue can interfere with embryo implantation and also impede blood flow to the placenta. A doctor can detect these scars using x-rays, and most are treatable.

Chronic diseases . Autoimmune diseases, heart, kidney or liver disease, and diabetes are examples of disorders that lead to approximately 6% of miscarriages. If you have a chronic condition, find an obstetrician/gynecologist who specializes in pregnancies for these women.

Heat . No matter how healthy a woman is normally, if you have a high temperature (above 39°C) in the early stages, this pregnancy may end in miscarriage. Elevated temperature is especially dangerous for an embryo up to 6 weeks.

Possible causes of pathology

The reasons for the expulsion of the fertilized egg may be associated with pathologies of the mother’s reproductive system, as well as abnormalities in the development of the fetus.

Most often it can be triggered by:

sexually transmitted infections in the mother (syphilis, chlamydia);
chromosomal defects of the embryo;
previous surgical abortions;
increased levels of male sex hormones associated with impaired ovarian function (polycystic ovary syndrome), adrenal tumors;
severe chronic diseases (diabetes mellitus, systemic autoimmune pathologies);
Rhesus conflict;
thyroid dysfunction;
intoxication with alcohol, heavy metals, chemicals;
diseases and abnormalities in the structure of the uterus (fibroids, fibroids, infantilism);
hormonal disorders in the mother, especially insufficiency of the progesterone component in the second phase of the menstrual cycle;
use of an intrauterine device;
mechanical injuries to the pelvis as a result of blows to the stomach, falls;
invasive procedures on the uterus (amniocynthesis, chorionic villus biopsy).

Risk factors include chronic alcohol abuse and smoking in both parents. If partners are over 35 years old at the time of conception, this also increases the risk of spontaneous abortion up to 9-20 weeks. The risk of premature expulsion of the fetus increases the risk of taking certain medications - non-steroidal anti-inflammatory drugs (aspirin, ibuprofen), antidepressants, antipsychotics.

Miscarriage in the 1st trimester

During this period, miscarriages occur very often, in approximately 15-20% of cases. In most cases, they are caused by a fertilization anomaly, which causes abnormalities in the chromosomes of the fetus, making it non-viable. We are talking about a mechanism of natural selection, which does not imply anomalies on either the mother's or the father's side.

Physical activity has nothing to do with it. Therefore, you don’t have to blame yourself for the fact that you, for example, didn’t get enough rest, nor feel responsible for it. A miscarriage that occurs in the first trimester of pregnancy does not require further special examination, except in cases of two or three consecutive spontaneous abortions.

Recommendations for pregnant women

If you find out that you are carrying a small life inside you, then you need to minimize as much as possible the potential risks that could lead to miscarriages. Follow simple rules: adjust your diet, give up bad habits, lead a healthy lifestyle, don’t overwork, be extremely careful, avoid stress and nervous shock.

Be sure to register with the antenatal clinic . The doctor will help identify illnesses or problems that you did not even know about, but that may pose a threat to your baby. Timely treatment or prevention will help prevent the threat of miscarriage. Follow all the recommendations your gynecologist gives you.

At the slightest sign of danger, go to the hospital immediately . In most cases, pregnancy can still be maintained. If you have experienced the loss of a child, do not despair and do not be alone with your pain.

What does not cause miscarriage?

These daily activities do not cause miscarriage:

Physical exercise.
Lifting or physical exertion.
Having sex.
Work that excludes contact with harmful substances. Some studies show that the risk of miscarriage increases if the partner is over 35 years old, and the older the father, the greater.
More than two previous miscarriages. The risk of miscarriage is higher if a woman has already had two or more miscarriages. After one miscarriage, the risk is the same as if you have never had a miscarriage.
Smoking, alcohol, drugs. Women who smoke and drink alcohol during pregnancy have a greater risk of miscarriage than women who do not smoke or drink alcohol. Drugs also increase the risk of miscarriage.
Invasive prenatal examinations. Some prenatal genetic tests, such as human chorionic villus or amniotic fluid testing, may increase the risk of miscarriage.

Symptoms and signs of spontaneous miscarriage

Often the first sign of a miscarriage is metrorrhagia (vaginal bleeding that occurs outside of menstruation) or palpable contractions of the pelvic muscles. However, bleeding is not always a symptom of a miscarriage: we are often talking about a disorder in the 1st trimester (it affects one woman in four); in most cases, pregnancy continues unimpeded.

A threatened miscarriage (abortus imminens) begins either with the destruction of the falling membrane, followed by cramping contractions of the uterus, or with the occurrence of contractions, followed by blood discharge from the uterus - a sign of the beginning detachment of the fertilized egg from its bed. The initial symptom of a threatened miscarriage is, in the first of these options, slight bleeding, in the second, cramping contractions of the uterus. If the process that has begun does not stop, it moves to the next stage - the state of an incipient miscarriage.

Thus, the diagnosis of a threatened miscarriage is made in the presence of a sign in pregnancy on the basis of one of the mentioned symptoms - minor cramping pain in the lower abdomen and sacrum and slight bleeding from the uterus (or both symptoms together), provided that there is no shortening of the cervix uterus and opening of the uterine pharynx. With a two-handed examination performed during contractions, the uterus is compacted, and the compaction remains for some time after the patient has stopped feeling pain from contractions.

Incipient miscarriage (abortus incipiens).. At this stage of miscarriage, cramping pain in the abdomen and sacrum and blood discharge from the uterus are simultaneously observed; both of these symptoms are more pronounced than in the stage of threatened miscarriage. As with a threatened miscarriage, the cervix is preserved, the external os is closed. The compaction of the uterus during contractions is more pronounced than during a threatened miscarriage. If the connection with the uterus is broken only on a small surface of the fertilized egg, for example, less than one third, its development can continue and the pregnancy is sometimes carried to term.

As the process progresses, contractions intensify and become painful, as during childbirth; bleeding also increases. The cervix shortens, the pharynx gradually opens, up to the size necessary for the passage of the fertilized egg. During a vaginal examination, due to the opening of the cervical canal, an examining finger can be inserted into it, which palpates parts of the exfoliated ovum here. This stage of the development of a miscarriage is called abortion in progress (abortus progrediens). In such cases, the fertilized egg is born partially or entirely.

When only parts of the fertilized egg are expelled from the uterine cavity, they speak of an incomplete miscarriage (abortus incom-pletus). In such cases, the main symptoms are: heavy bleeding with large clots, which can lead to acute and severe bleeding of the patient, and painful contractions. A two-manual gynecological examination reveals blood clots, often covering the entire vagina, a shortened and softened cervix, patency of the cervical canal along its entire length for one or two fingers; the presence in the vagina, in the cervical canal and in the lower part of the uterine cavity of parts of the exfoliated fertilized egg, if it was not expelled from the uterus before the examination, an increase in the body of the uterus, some softening (uneven), roundness and pain, short-term contraction of the uterus under the influence of the examination and etc.

A complete miscarriage (abortus completus) is said to occur when the entire fertilized egg is expelled from the uterus. A vaginal examination reveals that the uterus has decreased in volume and is dense, although the cervical canal is open, the bleeding has stopped, only scanty bleeding is observed; After 1-2 days, the cervix is restored and the cervical canal closes. However, although the fertilized egg is expelled from the uterus as if entirely, in the cavity of the latter there are usually still fragments of the falling membrane and villi that have not lost contact with the uterus, etc. When the uterus has expelled the fertilized egg entirely, it can only be decided after clinical observation of the patient and repeated two-manual gynecological examination. In all other cases, it is more correct to clinically consider each miscarriage as incomplete.

A failed miscarriage is recognized after clinical observation on the basis of cessation of growth of the uterus, which had previously increased in accordance with the duration of pregnancy, and then its reduction, the appearance of milk in the mammary glands instead of colostrum, a negative Ashheim-Tsondeka reaction (appears no earlier than 1-2 weeks after death of the fertilized egg), slight bleeding from the uterus, and sometimes even its absence.

One or another stage of development of a miscarriage is established (which is of great practical importance) based on the mentioned signs of each of them.

The following pathological processes can be complications of miscarriage.

Acute anemia, which often requires immediate intervention. If a woman who has a miscarriage is healthy in all other respects, especially if the body’s compensatory ability is full, then with timely and appropriate measures taken to combat acute anemia, death from the latter is very rarely observed.
Infection. During a miscarriage, a number of conditions are created that favor the development of the septic process. These include: an open uterine pharynx, which makes it possible for microorganisms from the cervical canal and vagina to penetrate into the uterine cavity; blood clots and remnants of the fertilized egg located in the uterine cavity, which serve as a good breeding ground for microorganisms; exposed placental area, which is an entrance gate easily permeable to microorganisms; the patient's exsanguinated state, which reduces the body's resistance to infection. In each case, it is necessary to determine whether there is an infected (febrile) or uninfected (non-febrile) miscarriage. An infected miscarriage will be indicated by the presence of at least one of the following signs: high temperature, palpation or percussion tenderness of the abdomen, tenderness of the uterus not associated with its contractions, as well as tenderness of its appendages and fornix, admixture of pus in the blood flowing from the uterus, phenomena of general intoxication body (fast pulse, depressed or excited state of the patient, etc.), if they are not caused by other reasons, etc.
Placental polyp. The formation of such a polyp is usually observed in cases where a small part of the placental tissue is retained in the uterine cavity. Blood oozing from the uterine vessels due to insufficient contraction of the uterus gradually permeates the remaining placental tissue, then layers on it, organizes and takes on the appearance of a polyp. The lower pole of the polyp can reach the internal pharynx, which does not contract completely due to the presence of a placental polyp (like a foreign body) in the uterus. This process is accompanied by slight bleeding from the uterus, which can last up to several weeks or even months, periodically intensifying. The entire uterus contracts poorly. When the polyp reaches a size that causes uterine irritation, contractions begin and bleeding intensifies.
Malignant degeneration of the epithelium of chorionic villi retained in the uterus - chorionepithelioma.

Treatment and consequences after miscarriage in early pregnancy

What to do after a miscarriage in early pregnancy? If it did happen that the pregnancy could not be maintained and you lost the child, then you need to undergo therapy, which is mandatory after a miscarriage. The doctor should send you for an examination of the body to determine the reason that caused the miscarriage (if this has not been done previously).

You definitely need to check whether the fertilized egg has completely left the walls of the uterus, since if the abortion is incomplete or not completed, you will need curettage. Antibiotics will also be to help cope with a possible infection, and hormonal contraceptives. This stabilizes your hormonal levels.

In addition to the physical stress on the body, a miscarriage is a very serious psychological and emotional test for any woman. The pain of loss can develop into severe, protracted depression, especially if the pregnancy was long-awaited and desired. Don’t isolate yourself during this difficult time, try to trust your spouse, parents, and loved ones so that they will support you and help you get through the grief. Allow yourself to be sad and cry, you can even seek help from a psychologist if you are unable to cope with your feelings.

You should not be afraid of the same failures in the future and despair. Just be more responsible in your next pregnancy planning after an early miscarriage. Remember that the body still needs recovery , so do not rush to become a mother again for at least six months. During this time, you can get rid of existing problems, take a course of necessary vitamins, and undergo complex therapy prescribed by the doctor.

The correct psychological attitude and only positive thoughts that everything will be fine with you, and after a certain period of time you will take your long-awaited baby in your arms is also very important.

Treatment of spontaneous miscarriage

The main issue that should be resolved at the first examination of a pregnant woman with signs of miscarriage is the possibility of maintaining the pregnancy. With proper care and treatment of a patient with a threatened miscarriage, and somewhat less often with an incipient miscarriage, the pregnancy can be saved; Once a miscarriage has developed, it is impossible to maintain the pregnancy. From this follows the doctor’s tactics when treating a patient with spontaneous miscarriage.

Having established the presence of a threatening and incipient miscarriage, the pregnant woman is immediately placed in a maternity hospital, where a medical and protective regime must be organized. Its necessary elements are bed rest, physical and mental rest, strengthening faith in maintaining pregnancy (psychotherapy, hypnosis), normal or, if necessary, extended sleep, etc.

Drug treatment is carried out taking into account the identified etiological factors that caused the miscarriage. But since this is difficult to establish in most cases, medication measures are aimed at increasing the viability of the fertilized egg and eliminating the increased excitability of the uterus. Prescribe sodium bromide (1-2% solution orally, 1 tablespoon 3 times a day), glucose (20 ml of a 40% solution intravenously once a day), the patient’s stay in the open air is beneficial (in winter, frequent inhalation of oxygen); for infectious etiologies, injections of penicillin (50,000 units every 3 hours) and other drugs are used; if there are contractions - opium preparations (opium tincture 5-10 drops 2-3 times a day orally or opium extract 0.015 g in suppositories - 2-3 suppositories per day); Progesterone injections are effective (5-10 mg daily for 10 days). After this, take a break and, if necessary, repeat the course after 5-10 days. Continuous injections of large doses of progesterone over a long period of time sometimes have an adverse effect on the course of pregnancy, in particular on the viability of the fetus.

Vitamins A, B2, C, D, E are also useful. They are prescribed in their pure form or products containing these vitamins are recommended: fish oil, brewer’s yeast, etc.

The administration of ergot, ergotine, quinine, pituitrin and other similar hemostatic agents is strictly contraindicated and is a gross medical error, since they increase uterine contractions, and at the same time contribute to further detachment of the ovum.

If these measures do not give the desired effect, bleeding and contractions intensify and the miscarriage moves to the next stage - abortion is in progress, it is not possible to save the pregnancy. In such cases, in the first 3 months of pregnancy, if there are no contraindications (infected miscarriage), they resort to instrumental evacuation of the uterine cavity - removal of the fertilized egg or its remains from the uterine cavity, followed by curettage.

After 3 months of pregnancy, the patient is prescribed conservative treatment: cold on the lower abdomen, quinine (0.15 g orally every 30-40 minutes, 4-6 times in total) and alternated with injections of pituitrin 0.25 ml every 30-45 minutes, 4-6 times in total. After the birth of the fetus, the placenta, if it is not born on its own, is removed with a finger inserted into the uterine cavity, and its remains are removed using curettes.

In the postoperative period, bed rest, application of cold to the suprapubic area, uterine contractions are prescribed: liquid ergot extract - 25 drops 2 times a day, ergotine 1 ml intramuscularly 2 times a day, etc. With a fever-free course of the postoperative period and good general condition and the patient’s well-being can be discharged 3-5 days after surgery. Before discharge, a thorough general and necessarily special gynecological (two-handed) examination must be performed.

Treatment of patients with an infected, febrile miscarriage is carried out either strictly conservatively (medications), or actively (surgery), or actively expectantly (elimination of infection followed by instrumental removal of the remaining fetal egg). When choosing a method of managing a patient, you should be guided by her general condition and the severity of the infectious process.

In this case, they distinguish:

uncomplicated infected miscarriage, when only the fetal egg or the fetal egg along with the uterus is infected, but the infection has not spread beyond the uterus;
complicated infected miscarriage, when the infection has spread beyond the uterus, but the process has not yet been generalized;
septic miscarriage, when the infection is generalized.

Complicated infected and septic miscarriage is usually observed with criminal intervention for the purpose of expulsion.

When treating patients with an infected uncomplicated miscarriage, some obstetricians prefer immediate instrumental evacuation of the uterine cavity. Another, large part of obstetricians adheres to the active expectant method: for 3-4 days the patient is prescribed bed rest and drugs that tonic the muscles of the uterus (cold on the lower abdomen, orally quinine, pituitrin, ergot preparations, etc.) and aimed at eliminating the infection ( sulfa drugs, antibiotics). After the signs of infection disappear, the uterine cavity is carefully emptied surgically.

Finally, a number of obstetricians prefer strictly conservative management of patients, without any intrauterine intervention. For this purpose, the above remedies are supplemented with injections of the estrogen hormone, pituitrin or thymophysin, the administration of castor oil, etc., in order to stimulate uterine contractions and promote the spontaneous expulsion of the remnants of the fertilized egg from the uterus. Instrumental emptying of the uterus is resorted to only in case of severe bleeding that threatens the patient’s life.

With any of the listed methods of managing patients with an infected uncomplicated miscarriage, measures are taken to increase the patient’s body’s defenses and tone. This is achieved by good care, a rational diet, easily digestible, high in calories, containing a sufficient amount of vitamins, and other measures.

Having tested for many years each of the listed methods of treating patients with uncomplicated infected miscarriage - incomplete and complete, we were convinced of the advantages of the active expectant method. We resort to urgent instrumental evacuation of the uterus only in exceptional cases, when severe bleeding from the uterus threatens the patient’s life and must be stopped immediately.

Treatment of patients with a complicated infected miscarriage, i.e. when the infection has spread beyond the uterus, should only be conservative, since surgical intervention in such cases usually leads to the occurrence of peritonitis or sepsis. Surgical intervention may be necessary only in those exceptional cases when sudden bleeding of the patient and incessant bleeding from the uterus create an immediate threat to the patient’s life.

When treating patients with missed miscarriage, competing methods are expectant-observational and active - one-stage instrumental evacuation of the uterine cavity.

Considering the danger that threatens a pregnant woman when a dead fertilized egg is retained in the uterus, caused by infection, intoxication, malignant degeneration of villi, etc., one should strive to empty the uterine cavity as soon as the diagnosis of the disease is definitely established. In case of a failed miscarriage, treatment begins with the prescription of drugs that stimulate uterine contractions and thereby provoke the onset of a miscarriage: daily injections of estrogen hormone 10,000 units are given for 2-3 days. After this, 60 g of castor oil is given orally, and after half an hour, hydrochloride quinine is given 6 times, 0.2 every 30 minutes; after taking the fourth quinine powder, make 4 injections of pituitrin, 0.25 ml every 15 minutes. Then a hot vaginal douche is prescribed, and the temperature of the liquid should not exceed 38° for the first time; in the future it is gradually increased within the limits of the patient’s endurance. Often, the fetus lingering in the uterus is expelled completely or partially without instrumental intervention, which is subsequently resorted to to remove the remnants of the fetal egg.

Even in cases where this method of treatment does not lead to the goal, i.e., the expulsion of the fertilized egg retained in the uterus, it is useful, as it increases the tone of the uterine muscles. This creates favorable conditions for subsequent surgical removal of the fertilized egg: with a well-contracted uterus, bleeding rarely occurs during and after the operation and there is no perforation of the uterus during the operation.

Treatment for placental polyp consists of instrumental removal (curettage).

Prevention of spontaneous miscarriage

Prevention of spontaneous miscarriage should precede or begin with the appearance of its first symptoms. In the antenatal clinic, at the first visit to a pregnant woman, those women who have a history of spontaneous miscarriages or premature births, especially when there were several of them (“habitual miscarriage”, “habitual premature birth”), and women with various pathological conditions, are taken into special registration. which can cause spontaneous miscarriage. Preventive measures consist of prescribing anti-inflammatory treatment, correcting the abnormal position of the uterus, combating toxicosis of pregnancy, hypovitaminosis, eliminating and preventing mental and physical trauma; in appropriate cases - prohibition of sexual intercourse during pregnancy, transfer to a lighter type of work, etc.

Pregnant women with a “habitual miscarriage,” as well as those with threatened and incipient miscarriage, should be placed in a maternity hospital, in a pregnant ward. Of great importance is strengthening the patient’s faith in the possibility of maintaining pregnancy, as well as carrying out therapeutic measures: maintaining rest, extended sleep, prescribing progesterone, painkillers, drugs that reduce uterine excitability, multivitamins, especially vitamin E, etc.

If deep ruptures of the cervix occur during childbirth, its integrity must be restored immediately after childbirth. If this has not been done, then in order to prevent further spontaneous miscarriage, plastic surgery on the cervix should be performed before the next pregnancy to restore its integrity.

How does miscarriage occur in early pregnancy?

This problem in medicine is considered quite serious, because it is encountered frequently, and in most cases the process is almost impossible to stop . If a miscarriage or spontaneous termination of pregnancy occurs at the very beginning, then the woman may not even understand what happened.

Without realizing her situation, the woman simply thinks that the menstrual cycle has gone wrong or there has been a delay (usually a week or two). Then some feel minor pain in the abdomen , and menstruation begins, which, however, can be much heavier than usual. Not all women experience such bleeding, but only those who are frightened by the release of a blood clot, similar to a burst bubble.

However, it is worth going to the doctor , even if nothing else bothers you. They will do an examination to see if it was indeed an early miscarriage, and will also check whether additional cleaning is needed after this.

If a woman knows about her pregnancy, then she needs to be very attentive to any manifestations of pain or discomfort in the abdomen and back. The slightest spotting discharge mixed with blood or tissue clots is already dangerous. Sometimes the pregnancy can still be maintained , so you should consult a doctor immediately.

Spontaneous termination of pregnancy occurs before 12 weeks, which is classified as an early miscarriage. If it happens before 22 weeks, it will already be late. Unfortunately, this also happens for a number of reasons. Then doctors define this threat as premature birth, and with prompt and timely intervention they can save the premature baby.