How to prevent the threat of miscarriage and maintain pregnancy

Good afternoon, my dear readers! Today I will tell you a sad story with a happy ending. A good friend of mine gave birth to her first child early, at the age of 18, and now, 10 years later, she decided that she wanted a second baby. She and her husband were confident that everything would work out the first time: they stopped using protection and began “working on the issue.”

And then Katerina (that’s my friend’s name) saw the coveted two stripes on the test. Happiness knew no bounds if not for the strange pains and discharge that began at 3 weeks of pregnancy. Having examined the girl on the chair, the gynecologist stated: a miscarriage... “Why?!” “What went wrong?” Katya asked the doctor in tears, but the doctor just shrugged his shoulders.

The worst thing is that the second and third attempts ended the same way, and when Katerina and her husband were completely desperate, she managed to get pregnant and... bear a healthy baby boy!

The threat of early miscarriage, the symptoms of which can be invisible and deceptive, is a problem for many modern women. According to statistics, 20% of girls encounter it and do not know why their body rejects the baby and does not allow him to grow and develop.

Today I decided to devote a separate topic to early miscarriages. Even if it has never touched you, read to the end. What if your loved ones develop a similar pathology, and you will be able to recognize it in time and, possibly, save the child.

The essence of miscarriage and its classification

Miscarriage or spontaneous abortion is the termination of pregnancy when it occurs without medical intervention or mechanical intervention. As a result of a miscarriage, the fetus and membranes are expelled from the uterine cavity, which is accompanied by profuse bleeding and cramping pain in the lower abdomen.

Classification of miscarriages

Miscarriages, depending on the timing of gestational interruption, are divided into early and late:

• early miscarriages are those that occurred before the end of the first trimester, that is, before 12 weeks;
• late miscarriages - occur between 13 and 22 weeks.

Miscarriages in the early stages also include spontaneous termination of a biochemical pregnancy. About biochemical pregnancy, or rather its interruption, they say that when ovulation occurred, the egg was fertilized by a sperm, but for some reason it could not implant in the uterus and left it, and menstruation came on time or with a slight delay. Moreover, the only sign of such a pregnancy is a weakly positive test, since the level of hCG in the urine or blood does not exceed 100 units. It is difficult to calculate the frequency of a pregnancy that has barely begun and immediately ends; according to some data, such miscarriages in very early stages occur in 65 - 70%.

Depending on the clinical picture, there are several stages of miscarriage:

• threat of interruption;
• incipient miscarriage;
• spontaneous abortion is in progress;
• incomplete miscarriage (at this stage, surgical intervention is required - curettage of the uterus);
• complete miscarriage.

Separately, a frozen pregnancy or a failed abortion is distinguished, when the fertilized egg has detached from the uterine wall, but has not left the uterus.

Why is there a risk of miscarriage in the early stages?

The causes of miscarriage are varied and numerous:

1. Genetic pathology in the embryo that is incompatible with life. Most often, it is precisely these disorders that influence the occurrence of early miscarriage. Spontaneous mutations in male and female germ cells due to medications, alcoholic beverages, and the action of viruses lead to pathology.
2. Endocrine disorders. They arise as a result of insufficient synthesis of progesterone, which is required for the maintenance and development of the fetus in the uterus. Other factors in the onset of spontaneous miscarriage are considered to be an increased level of androgens and an imbalance of thyroid and adrenal hormones.
3. Infectious diseases in a pregnant woman. Influenza, pyelonephritis, tonsillitis, and sexually transmitted diseases increase the risk of spontaneous abortion.
4. Rhesus conflict. The Rh (-) woman’s body rejects the Rh (+) fetus.
5. Lack of folic acid. With a deficiency of the substance, a pathology of the fetal karyotype develops. Termination of pregnancy for this reason most often occurs at 6-12 weeks.
6. Previous gynecological interventions and uterine inflammation. Previous curettages and endometritis in a pregnant woman often lead to spontaneous abortion.
7. Wrong lifestyle. Alcohol abuse, drug addiction, smoking, large amounts of caffeine, stress provoke the onset of spontaneous abortion.
8. Excessive physical activity , sex, falls or blows to the stomach contribute to the development of miscarriage.

Causes

In the threat of miscarriage in the short term, the leading position is occupied by chromosomal abnormalities of the embryo, the frequency of which is 82–88%. In second place is endometritis, which results in inflammation in the uterine mucosa, which leads to the impossibility of normal implantation and further development of the embryo. Also, spontaneous abortion in short terms is caused by anatomical and hormonal problems, infectious and immunological factors, leading to recurrent miscarriage.

Risk factors

Women who have the following warning factors are included in the high-risk group for early miscarriages:

• Age

The risk of early miscarriage increases with age. The older the woman, the more likely she is to develop this pregnancy complication. At 20–30 years of age, the risk of miscarriage ranges from 9–17%, by 35 years it increases to 20%, by 40 to 40%, and at 44 and older the risk of early miscarriage reaches 80%.

• Parity

Having 2 or more pregnancies in the past doubles the risk of miscarriage (compared to nulliparous women).

• Miscarriages in the past

The more spontaneous abortions there were in the early stages, the higher the risk of early miscarriage of a real pregnancy.

• Smoking

If a pregnant woman smokes more than 10 cigarettes daily, her risk of early miscarriage increases significantly.

• Taking NSAIDs

Taking NSAIDs (aspirin, indomethacin, Nise and others) on the eve of conception suppresses the synthesis of prostaglandins and, accordingly, disrupts implantation.

• Fever

When body temperature rises (37.7 degrees or more), the risk of early miscarriages increases.

• Injury to the uterus

Mechanical trauma (fall, blow) or prenatal diagnostic methods (choriocentesis, amniotic fluid sampling, cordocentesis) increase the risk of miscarriage to 3 - 5%.

• Caffeine

Excessive caffeine consumption (strong tea, coffee) is one of the risk factors for early pregnancy loss.

• Effect of teratogens

Infectious pathogens, toxic substances, and some medications act as teratogens, which also increase the risk of early miscarriage.

• Folic acid

Its deficiency during pregnancy planning and in the first 3 months after conception leads to the formation of a pathological karyotype in the fetus and termination of pregnancy.

• Hormonal disorders

Lack of hormones (estrogens and progesterone), excess androgens, thrombophilic conditions (antiphospholipid syndrome) are usually the causes of recurrent miscarriage, but also cause the threat of early miscarriage.

• Stress
• IVF (up to 25% of cases)
• Rhesus conflict.

Symptoms of threatened miscarriage

The threat of miscarriage in the early stages is accompanied by the following key symptoms: pain, blood discharge from the genital tract due to a delay in menstruation.

Pain

Signs of a threatened miscarriage in a short term pregnancy almost always include pain. A pulling sensation occurs in the lower abdomen and/or lumbar region, which may become more intense. In some cases (trauma, stress), the pain begins sharply, suddenly and quickly becomes cramping, accompanied by copious bleeding, which indicates the transition of a threatened abortion to the stage of abortion in progress, when it is no longer possible to save the pregnancy. When conducting a vaginal examination, a cervix of normal length is diagnosed (there is no shortening or smoothing), a closed internal os. Bimanual palpation allows you to palpate the uterus, the size of which corresponds to the period of menstruation delay, but the tone of the uterus is increased. This is determined by its density and tension (normally, the pregnant uterus is soft).

Discharge

Discharge when there is a threat is usually insignificant, serous-bloody in nature. But it is also possible that there is no bleeding at the beginning of the development of a threatened abortion. If treatment and preventive measures are not taken in a timely manner, the blood discharge becomes more intense, its color changes from dark red (miscarriage in progress) to bright scarlet (abortion in progress). The appearance of discharge during a threatened miscarriage is associated with the gradual detachment of the fertilized egg from the uterine wall, which is accompanied by damage to the blood vessels and bleeding.

Other symptoms

Other additional signs of a threat of early miscarriage are:

Decrease in basal temperature

As a rule, doctors recommend monitoring basal temperature after making a diagnosis of a threatening early miscarriage. But in some cases (hormonal disorders, long-term absence of pregnancy), expectant mothers have and continue to maintain a basal temperature chart even before conception. Normally, when pregnancy occurs, the basal temperature exceeds 37 degrees and remains at this level until 12–14 weeks. An indirect sign of a threatened miscarriage is a decrease in rectal temperature to 37 or below.

Pregnancy test

Some women are so worried about their long-awaited pregnancy that they are ready to take a pregnancy test every day. In such cases, not so long ago such a bright second line on the test fades, which is associated with a drop in the level of hCG (it is on its content that the test is based). Sometimes the test may show only one line, even in the absence of bloody discharge, which, of course, is not very good, but can be fixed.

HCG level

For each stage of pregnancy there are standards for the level of hCG in the blood. A decrease in hCG levels indicates a threat of miscarriage.

Ultrasound

This is far from an indicative sign of a threat, especially at short stages of pregnancy (for example, at 5 weeks). It is impossible to speak with certainty about the threat of miscarriage in the presence of only increased uterine tone according to ultrasound. It is possible that hypertonicity was caused by an ultrasound examination, but then the uterus relaxes again. But if a retrochorial hematoma is detected, which is a sign of detachment of the ovum, the diagnosis of threatened miscarriage in the short term is quite legitimate.

How to prevent the threat of miscarriage - methods of treating pathology

When a woman shows signs of spontaneous abortion, she is admitted to the hospital, where she is under observation. How long they stay in the hospital with the disease depends on the elimination of symptoms and normalization of the condition.

The specialist prescribes bed rest with complete rest. The doctor takes a smear to detect the risk of miscarriage to determine existing endocrine disorders or sexually transmitted diseases. Specialists study the microflora and calculate the karyopyknotic index (KPI), which shows the saturation of the pregnant woman’s body with estrogen. When the CPI decreases, one can judge the threat of spontaneous abortion in the early stages.

Medication

The main goal of treatment is to relieve tension in the uterus, stop bleeding and prolong pregnancy, provided that the embryo is viable. The faster medical care is provided, the greater the likelihood of maintaining the gestation.

The following medications are used:

1. Hormonal medications : necessary to ensure normal pregnancy in the early stages. Progesterone-based products are used - Duphaston and Utrozhestan tablets.
2. Hemostatic medications: pregnant women are given droppers with drugs (Tranexam, Dicynon). They are dropped to stop bleeding.
3. Antispasmodics: Drotaverine injections with further transition to tablets (No-shpa), Papaverine suppositories, magnesium droppers. They are used to relieve symptoms of the disease - increased uterine tone and severe pain.
4. Tocopherol: the instructions for use say that vitamin E is necessary for the normal functioning of the ovaries, strengthening the vascular walls and preventing blood clots.
5. Sedatives: motherwort, valerian tincture. Used for excessive nervousness of a pregnant woman.
6. Glucocorticosteroids: Dexamethasone, Metipred. Prescribed in the presence of immune disorders that cause a threat of miscarriage in the early stages.

If necessary, install a relief ring. The procedure is performed in the second trimester after 20 weeks of gestation. The device is removed no earlier than 38 weeks. It is placed to maintain the correct position of the uterus and prevent premature birth.

ethnoscience

You can use “grandmother’s” recipes only after the permission of the attending physician. Alternative medicine can sometimes be unsafe for the development of the fetus.

If there is a threat of spontaneous abortion, doctors allow the pregnant woman to use the following recipes:

1. Dandelion decoction. Take 5 g of the plant, pour 1 glass of water. Place on the stove, bring to a boil, cooking the medicine for another 5 minutes. Take the prepared product ¼ cup three times a day.
2. Viburnum bark. Prepare 1 teaspoon of crushed ingredient and pour 1 cup of boiling water. Place on the stove and cook for about 5 minutes. Drink the medicine 2 tbsp. l. three times a day.
3. Viburnum flowers. Take 30 g of the component and pour 1.5 liters of boiling water. Let it brew for about 2 hours, strain and drink ¼ glass three times a day.
4. Infusion of St. John's wort with calendula flowers. You will need to take both ingredients in equal proportions and pour 200 ml of boiling water over them. Let it brew for about half an hour. Strain the product and take 2 glasses throughout the day. If desired, you can add 1 tsp. honey

If there is a threat of miscarriage, read a prayer: according to believers, it helps even in the most difficult cases. To preserve the fruit, try reading the following prayers:

1. To the Most Holy Theotokos;
2. To the Lord God;
3. Akathists to the icons of the Mother of God “Helper in Childbirth”, “Unexpected Joy”, “Kazan”;
4. Pray to the saints and righteous Joachim and Anna.

Traditional medicine cannot be used as the main treatment for the threat of spontaneous abortion. “Grandma’s” recipes are used in combination with drug therapy.

Diagnostics

Diagnosing the threat of early miscarriage is not difficult. The diagnosis is made after a thorough collection of anamnesis and complaints, general and gynecological examination. During a gynecological examination, the doctor assesses the condition of the cervix (whether it is shortened and smooth, the external os is closed), the presence or absence of blood discharge, and palpates the uterus (whether it corresponds to the gestational age or contracts in response to palpation).

An ultrasound is also required to evaluate the tone of the uterus, whether there is a fetus in the uterus and whether its heartbeat is determined, whether it corresponds to the gestational age, and the presence/absence of a retroplacental hematoma.

Laboratory methods used:

• Hormonal studies

Determination of the level of progesterone, hCG, 17-ketosteroids, thyroid hormones according to indications.

• Colpocytological examination

The karyopyknotic index (KPI) is calculated, on the basis of which a threat can be suspected in the early stages even before the clinic appears (an increase in the KPI is the first sign of a threatening miscarriage).

• Vaginal smears

This item also includes testing for hidden sexually transmitted infections.

• Blood type and Rh factor

To exclude Rh-conflict pregnancy.

• Blood clotting

Necessary for suspected thrombophilic conditions.

Treatment

Abroad (Europe, USA), they prefer not to treat the threat before 12 weeks of gestation, citing the fact that up to 80% of pregnancies are terminated due to genetic and chromosomal pathologies. In Russia, doctors insist on prescribing complex therapy if there is a threat of termination of pregnancy at any stage. The earlier treatment is started, the higher the likelihood of maintaining pregnancy. Treatment of threatened miscarriage should be comprehensive and include drug and non-drug therapy, adherence to a regimen and diet, psychotherapy, and, as a rule, is carried out in a hospital.

Basic therapy

Basic therapy means regimen and diet. Pregnant women with a threat of miscarriage are recommended to limit physical activity, including bed rest, eliminate stress and anxiety, follow a diet, sexual rest, and proper sleep. A pregnant woman's diet should contain proteins, fats and carbohydrates in balanced amounts, and the diet should be rich in vitamins. Sessions of psychotherapy and auto-training are also shown, which will help normalize the woman’s emotional state and calm down.

Drug treatment

Sedatives

Motherwort and valerian in tablets or tinctures/infusions are prescribed as sedatives.

Antispasmodics

Antispasmodics (no-spa, papaverine or drotaverine) relax the uterine muscles and are prescribed for severe pain in the lower abdomen (intramuscular). Magne-B6 tablets have proven themselves well. Magne-B6 contains magnesium (an antispasmodic) and vitamin B6, which helps magnesium penetrate into the cell; 1 tablet is prescribed 3-4 times a day. Suppositories with papaverine rectally are used as suppositories when there is a threat of interruption. Papaverine is well absorbed by the intestinal mucosa and quickly relieves pain.

Hormonal drugs

Progestogens (progesterone) are recommended to be taken if the function of the corpus luteum is insufficient. Progesterone is the main hormone of pregnancy, which is responsible for its preservation and further development. If there is a threat of miscarriage in the early stages, Duphaston is prescribed in a dose of 40 mg (4 tablets) immediately and then 1 tablet every 8 hours. If the signs of the threat do not stop, then the dosage is increased by 1 tablet at each subsequent dose. Duphaston contains synthetic progesterone, and treatment is continued for up to 16 weeks (until the placenta forms). Another progesterone-containing drug is Utrozhestan (natural progesterone). If there is a threat, Utrozhestan is prescribed either orally or intravaginally. Dosage: 1 – 2 capsules twice a day. Both Utrozhestan and Duphaston are well tolerated, and the drugs are discontinued gradually.

In case of underdevelopment or malformations of the uterus, it is advisable to prescribe estrogen therapy (folliculin, microfollin) to treatment with gestagens. Estrogens are prescribed in tablet and injection form.

In case of ovarian hypofunction during treatment with estrogens and gestagens, choriogonin (pregnyl) is prescribed intramuscularly twice a week.

For hyperandrogenism or immune disorders (antiphospholipid syndrome), glucocorticoids (dexamethasone, metipred) are recommended.

Hemostatics

If bloody discharge appears and there is a threat of miscarriage, hemostatic drugs are prescribed. Dicynone, Vikasol, and Ascorutin are used as hemostatic agents. Hemostatics strengthen the vascular wall, normalize microcirculation, and increase blood clotting.

Vitamins

During pregnancy, taking vitamins is recommended, since their deficiency can cause retardation in the growth and development of the fetus or developmental defects. In case of threat of early miscarriage, vitamin E (as an antioxidant), folic acid (prevention of central nervous system defects), and B vitamins are prescribed.

Non-drug treatment

Physiotherapy procedures are prescribed as non-drug treatment:

• Electroanalgesia

It has a sedative effect and reduces the severity of pain.

• Magnesium electrophoresis

Magnesium electrophoresis SMT is the introduction of magnesium preparations into the body using an electric current. Has a sedative effect, relaxes the uterine muscles.

• Electrorelaxation of the uterus

This method provides a reflex effect on the uterus, which relieves hypertonicity and relieves pain.

• Hyperbaric oxygenation

The method is based on treatment with oxygen under pressure in pressure chambers. Improves microcirculation in blood vessels, has an antihypoxic and antimicrobial effect, and prevents the formation of toxins.

• Acupuncture

Normalizes the tone of the uterus, stabilizes blood pressure, improves psycho-emotional state and sleep.

Recommendations for threatened miscarriage

To quickly stop signs of a threatened miscarriage, you must follow a number of recommendations.

What not to do when there is a threat:

• have sex;
• drink strong tea and coffee, sweet carbonated drinks;
• eat chocolate;
• eat foods that increase gas formation: cabbage, legumes, soy (the swollen intestines put pressure on the uterus and increase its tone);
• eat fast food (high content of preservatives, stabilizers, salt);
• follow a diet to lose weight;
• visit baths and saunas (high temperatures can cause uterine bleeding and termination of pregnancy);
• take a hot bath, especially if there is bleeding;
• consume raw foods (eggs, meat, fish in the form of sushi or rolls);
• physical activity and heavy lifting (more than 3 kg);
• feel stressed, nervous;
• travel by any type of transport, especially air travel is prohibited;
• smoking and drinking alcohol.

What you can do in case of a threat:

• listen to pleasant, calm music;
• sleep (at least 8 hours a day) with mandatory afternoon rest;
• walks in the park or forest (unless strict bed rest is prescribed);
• read your favorite books;
• eat fresh fruits and vegetables (except for prohibited ones) as sources of vitamins;
• aromatherapy (citrus oils, mint);
• take a warm shower;
• drink compotes, juices, herbal teas (instead of the usual coffee and black tea).

How to maintain pregnancy?

The diagnosis of threatened miscarriage is made with increased uterine tone. One of the most common recommendations from doctors in this case is to limit sexual intercourse and reduce physical activity. Papaverine and No-shpa help relax the uterus when there is a threat of miscarriage.

If there is a lack of progesterone, doctors prescribe Duphaston and Utrozhestan, which can reduce the excitability of the uterus and ensure the normal development of its mucous membrane. Glucocorticoids, hormones produced by the adrenal glands, are needed when a pregnant woman's body produces large amounts of male sex hormones. In this case, the drugs Dexamethasone and Metipred are prescribed. In case of uterine bleeding, the use of antihemorrhagic and hemostatic drugs is prescribed: for example, Dicion. Also, for prevention, gynecologists prescribe microelements and vitamins:

• vitamin E;
• Magne B6;
• folic acid.

When there is a threat of miscarriage, magnesium increases uteroplacental blood flow and relaxes overly excited muscle tissue of the uterus. If there is a threat of miscarriage, droppers of magnesium (magnesium sulfate) are usually prescribed, first diluting it with a solution of sodium chloride or glucose. A one-week course is often enough to prevent spontaneous abortion.

It is difficult for a woman to determine a miscarriage in the first weeks of pregnancy, especially if it was not accompanied by pain. A pregnancy test will not help here; it will show a false positive result, since the level of the hCG hormone after a miscarriage . Therefore, if you suspect a miscarriage, you should consult a doctor without waiting for a negative test result.

Prevention

Preventive measures against the threat of miscarriage should begin even before its onset. But even if a pregnancy has already occurred and is desired, you should not leave things to chance.

Threat of miscarriage in the early stages: how to prevent:

• do not delay registration at the antenatal clinic;
• follow all doctor's recommendations;
• categorically give up bad habits;
• avoid stress, emotional outbursts, conflicts;
• refuse to perform heavy physical work and lifting weights (it is optimal to take a vacation during the critical period - 8 - 12 weeks);
• normalize the daily routine and rest;
• reconsider your diet (give up various diets, snacks on the run, fast food);
• if possible, avoid traveling long distances, especially those associated with changes in climate and time zone;
• avoid taking medications (antibiotics, NSAIDs and some others);
• walk more often;
• Avoid abdominal injuries and falls.

During pregnancy planning, the following will help prevent the threat of miscarriage in the future:

• taking folic acid 3 months before conception;
• maintaining a healthy lifestyle for at least 3 months before conception;
• correction and stabilization of chronic gynecological and extragenital diseases;
• examination and, if necessary, treatment of hidden sexually transmitted infections;
• carrying out routine vaccinations no later than 3 months before conception.

Prevention of threatened miscarriage

The threat of miscarriage becomes a real test for a woman. There are many factors due to which there is a threat of spontaneous abortion in the early stages, so it is extremely difficult to prevent the occurrence of the disease. But this does not mean at all that you need to sit idly by.

The main measure to prevent abortion is child planning: during this period, the expectant mother and father are examined. It is imperative to do tests on the genetic compatibility of the parents, especially when their age is over 35 years old, and determine the Rh factor. If a pregnant woman suffers from infectious diseases, they need to be treated before gestation. Doctors prescribe folic acid to both parents before conception in a dosage of 1 tablet per day to reduce the likelihood of intrauterine development pathologies and illnesses in the fetus.

If your pregnancy turns out to be unplanned, reconsider your lifestyle, stop smoking and drinking alcohol and drugs. Try to register in a timely manner and come to see your doctor. Eat a nutritious and balanced diet, and spend plenty of time outdoors. Try to avoid stressful situations and take medications with extreme caution.

Advice from a practitioner in the video below: