Early pregnancy losses and spontaneous pregnancy loss are common medical conditions. This situation is popularly defined as "low". The term "spontaneous miscarriage" describes a wide range of pregnancy losses that occur before the fetus reaches maturity to survive in the external environment. In cases where the embryo does not develop at all and is lost early due to genetic reasons, the cervix is loose in the 4-5th week. It covers the months until the loss of the fetus. Various terms are used for the various stages of spontaneous pregnancy loss. "Threat of miscarriage" is the most frequently used one. What is expressed in this diagnosis is that there is a danger that threatens the pregnancy. However, it is a situation that can be overcome if appropriate precautions are taken. The term "inevitable miscarriage" means that there is nothing that can be done anymore and that the miscarriage is unpreventable. When we say "partial miscarriage", it means that the miscarriage has occurred but there is material left inside. The term "missed abortion" is used to express that the pregnancy has already ended but has not been expelled yet. In the diagnosis of "empty pregnancy", a gestational sac has formed but there is no embryo and this pregnancy cannot end positively.
When pregnancy is detected clinically, a high rate of 10-20% is lost. In fact, this situation is important in terms of protecting the health of the human species. Probably, these early losses are caused by the abnormal product formed by the union of abnormal male or female germ cells. When pregnancy loss occurs in cases who are found to be pregnant only by a blood pregnancy test, before a gestational sac is seen on ultrasound; In the next month, 35% of cases experience a normal pregnancy. Again, 95% of the same cases have completely normal pregnancies in the future. Therefore, couples should keep their morale high, especially in cases of early spontaneous pregnancy loss, and it should be said that this is a natural selection.
Why does pregnancy loss occur? Especially the advanced age of the mother and the existence of such a loss before are among the most important reasons. By the age of 40, pregnancy loss is twice as common as at younger ages. The risk of recurrence in cases with multiple pregnancy losses is 25% It is around -30. When examined, almost 75% of these early losses are due to the embryo carrying a lethal chromosome number. Sometimes the chromosome arrangement of the embryo (46 XX) or (46 XY) changes to (45X0), which is the most common cause of miscarriage. Apart from this, having extra chromosomes in a chromosome sequence, that is, trisomies, causes early pregnancy loss. The most common of these is related to the 16th chromosome containing an extra number of chromosomes. Although there is no definitive rule, those who have normal chromosome number and structure and miscarriage experience this in the later weeks of pregnancy. Reasons that may be effective here are: febrile infectious diseases of the mother, chronic diseases of the mother, advanced age of the mother, excessive smoking, alcohol consumption, uncontrolled high blood pressure, diabetes in the mother, thyroid disease, blood clotting disorders in the mother. In 10% of cases, congenital disorders of the shape of the uterus cause this.
In a case of clinically diagnosed pregnancy, vaginal bleeding with or without groin pain is the first symptom. The amount of bleeding may be small, heavy, red or brown. Miscarriage usually occurs when bleeding accelerates. Despite this, there are many examples where bleeding stops and the pregnancy continues healthy. Some patients are not aware that they are pregnant, and when they consult a doctor with severe vaginal bleeding, it is understood that they have had a miscarriage. In case of a miscarriage in which the embryo cannot develop, no matter what is done, positive results cannot be obtained.
When the patient is pregnant and applies with complaints of vaginal bleeding and pain, the situation is evaluated by ultrasound examination. It is normal to see nothing but a sac at 4.5 weeks of pregnancy. The pouch should be smooth. Around the 5th week, the first structure called yolk sac is observed inside the gestational sac. Fetal heartbeats are observed around the 6th week. Of course, during this evaluation, sometimes the image may not be compatible with the patient's last menstrual period, and the sac may be smaller than expected. The possibility of late ovulation should not be ignored. If the fetus is alive and the bleeding is not life-threatening, bed rest is given and sexual intercourse is prohibited. Progesterone supplementation is given. Those who had pregnancies with bleeding in the first 3 months and then had normal pregnancies In current pregnancies, findings such as premature birth and decreased amniotic fluid may develop.
In cases of very early bleeding and cases where the diameter of the gestational sac is less than 25 mm, it may be difficult to make a decision. In this case, repeated follow-ups are recommended. If the shape of the sac is distorted, if the diameter of the sac does not grow more than 1 mm per day, if no embryo is still seen even though the diameter of the sac is 25 mm, if there is no heartbeat even though the head-rump distance of the embryo is 5-8 mm, if the heart rate is below 85 beats per minute after the 8th week, you should be alert. .
After the diagnosis of spontaneous pregnancy loss is made, the situation should be explained to the patient and their relatives, and the treatment should be tailored according to the patient's condition. People with blood incompatibility should receive a blood incompatibility injection called Rho-Gam to prevent future pregnancies being affected. Currently, the most commonly used treatment is abortion. Abortion material should be sent to pathology and genetic research. If there are no pieces in the uterus when examined with ultrasound after the miscarriage, only monitoring is done. It is important for pregnant women who have miscarriages to be psychologically supported by their families, spouses and relatives. The risk of recurrence in those who had a spontaneous miscarriage in their first pregnancy is around 20%.
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