What is miscarriage?
The spontaneous termination of pregnancy before the 20th week or when the fetus weighs less than 500g is called miscarriage.
Miscarriage. How common is it?
20% of all pregnancies end in miscarriage.
Causes of Miscarriage
1-Child causes:The most common chromosomal disorders constitute this group. It is responsible for 80% of miscarriages. The most common chromosomal disorder: trisomy cases. Among these, the most common are trisomy-16 cases. It is responsible for 50% of miscarriages in this group. A less common chromosomal disorder is trisomy-21. In this group, all miscarriages occur before the 12th week. In the treatment of disorders due to chromosomal reasons, preimplantation genetic diagnosis (PGD) is performed by in vitro fertilization and the healthy child is transferred.
2-Factors of the mother and father:In case both of them are translocation carriers, pregnancy is performed. ends in miscarriage. Additionally, if the pregnant mother uses a drug called Acutane for acne treatment, the pregnancy will again end in miscarriage. These medications must be stopped 6 months before getting pregnant. Treatment for translocation carriers is donor egg or donor sperm. (egg donation)
3-Factors related to the uterus:If there is a septum (curtain) in the uterus or cervical laxity, it causes miscarriage, especially between the 14th and 20th weeks. In its treatment, the septum (curtain) must be removed by hysteroscopic surgery. In case of loose cervix, purse string stitching operation is performed between the 12th and 14th weeks.
How Does Miscarriage Happen?
First, bleeding foci appear in the placenta and desudua in the uterus. . With the contraction of the vessels, blood flow to the fetus (child) stops. The death of the child occurs. Following this, miscarriage occurs within 10-15 days.
What is an empty gestational sac?
In cases of miscarriage, the fetus is not seen, only the amniotic sac is seen. In this case, it is called empty gestational sac (blighted ovum). Here, the child is dead and the pregnancy must be eliminated by abortion.
What is Missed Abortion (dead fetus)?
Miscarriage occurs when bleeding does not start even though the fetus dies in the sac. This name is given to the absence of . In this case, miscarriage is performed by vacuum curettage in the first 3 months, and by initiating labor pains between the 14th and 20th weeks.
WHAT ARE THE TYPES OF MISMISSION?
1-Miscarriage. Threat: Spotting bleeding occurs in 25% of cases in the first 3 months of pregnancy. Here the cervix is not opened (closed). There is no cramp-like pain. Bleeding is less. Treatment: sexual intercourse is prohibited, rest is recommended. Follow-up: 1- Observation of the baby's heartbeat and the growth of the gestational sac in ultrasonography indicate the progress is getting better. BHCG follow-ups every 2-3 days. If BHCG increases during these follow-ups (50% increase every 3 days), it is an indicator of fetal viability. If no heartbeat is seen and BHCG levels are decreasing, the fetus is not alive. In order to eliminate the risks of infection and bleeding, the pregnancy is terminated by vacuum curettage.
2-Inevitable and incomplete miscarriage:The cervix is opened. There is cramp-like painful and clotted bleeding. Fetal and placental waste may be seen in the cervix or vagina. Treatment: vacuum curettage in the first 3 months, and if it is older than the 14th week, induction of labor pains and complete miscarriage followed by sharp curettage. . There is no bleeding or pain. If the gestational age is not large, there is no need for abortion. If there is bleeding, a mild curettage is performed to clean the dead uterine inner wall cells (decidua).
4-Dead Fetus (missed abortus):There is no fetal heartbeat in the gestational sac. The fetus (child) is dead. However, there is no bleeding. If progesterone is used mostly in the first 3 months, the rate of missed abortion increases. Miscarriage does not occur spontaneously. Treatment: It is cleaned with vacuum curettage in the early weeks. In older weeks, hospitalization is necessary. Because the risk of bleeding is high in these patients due to deterioration of the clotting factor. It may be necessary to donate blood. First, labor pains are initiated. Abortion is performed after the fetus is expelled.
5-Septic miscarriage:These are miscarriages accompanied by infection. In countries where abortion is legal, the rate of septic abortion is low. However, in prohibited countries The septic tank rate is higher in the surrounding areas. Fever is over 38 degrees. There is severe pain and bleeding. Broad-spectrum combined antibiotic treatment is started before the abortion. It continues for 10 days after the abortion. Patients should be monitored very closely for septic shock.
REPEAT (HABITUAL) ABORTIONS
Having 3 miscarriages in a row is called recurrent miscarriage.
What are the causes of recurrent miscarriage?
1- Structural disorders of the uterus (uterine anatomy disorders): In cases of müllerian duct disorders during the formation of the uterus, such as septate uterus It is possible. Treatment: The septum (curtain) is surgically removed and the inside of the uterus is expanded. Thus, 70% of pregnancies that continue until term can be achieved.
2-Hormonal disorders:The most important hormonal disorder that causes miscarriage is progesterone failure (luteal phase failure). Diagnosis includes basal body temperature radiography, date determination with endometrial biopsy, and progesterone determination. If there is luteal phase insufficiency, progesterone is given orally, vaginally, rectally or intramuscularly to these pregnant women until the 8th week.
3-Chromosome disorders:trosomies of the baby occur in cases of translocation carriers of the mother and father. . In this case, in vitro fertilization with PGD is recommended in case of chromosomal abnormality, and egg donation is recommended in cases of translocation carriers.
4-Antiphospholipid antibodies and thrombophilia:In the presence of lupus anticoagulant and anti-cardiolipin and in thrombophilia diseases, excessive coagulation is recommended. Miscarriages due to miscarriage are very common.
5-Cervical insufficiency:It is responsible for miscarriages between the 14th and 20th weeks, which we call the second trimester. These miscarriages are painless sudden water breaking and a very rapid miscarriage. In this case, a purse string stitch (Mc Donald operation) is placed on the cervix between the 12th and 14th weeks of pregnancy. With this stitch, 80% of successful miscarriages are prevented and full-term babies are delivered. This stitch is not placed if there is bleeding during pregnancy. If bleeding occurs after the stitch is placed, it is necessary to undo the stitch.
WHAT SHOULD BE DONE AFTER A MISMISSION?
AFTER A MISMISSION. THINGS TO CONSIDER LATER
1-First of all, do not be discouraged. Do not forget that; 50 to 80% of fetuses that spontaneously abort in the first 3 months are abnormal fetuses. It is mostly due to chromosomal disorders.
2-After miscarriage and abortion, use medications such as antibiotics and painkillers prescribed by your doctor in accordance with the recommendations.
3-After the miscarriage, you can take a bath as soon as you want.
4-Bleeding may continue for up to 1 week after the miscarriage, do not be afraid. However, call your doctor in case of clotted and painful bleeding that lasts more than 10 days.
5-If your blood type is Rh (-) Negative and your partner is Rh (+) positive, get your blood incompatibility injection within 72 hours. .
6-After miscarriage, sexual intercourse is allowed after 10 days.
7-Pregnancy after miscarriage: 20th. After the day ovulation begins, protection must be used.
8-When can you get pregnant after a miscarriage?: It is necessary to menstruate at least 3 times (3 cycles). After that, pregnancy (pregnancy) can be planned. As soon as you find out that you are pregnant, go to your doctor as soon as possible and get the necessary advice and take your medications to prevent your pregnancy from ending in miscarriage. Avoid sexual intercourse during this pregnancy. (It is necessary to avoid sexual intercourse during pregnancy after miscarriage.)
9-If you have had your first miscarriage; After 40 days, go to your doctor or hospital to investigate the reasons for the miscarriage.
10-If you had a voluntary miscarriage (if you had a voluntary abortion), do not be afraid because you aborted your child, you will not be infertile. You can get pregnant whenever you want.
11-Tests to be done after miscarriage: For those who have had more than 3 spontaneous miscarriages (habitual miscarriage), genetic research and thrombophilia (excessive blood clotting) tests must be done. they should have it done. Additionally, in cases of miscarriage greater than 14 weeks, a medicated uterine x-ray should be taken and cervical laxity should be evaluated.
When does menstruation occur after a miscarriage?
20 days after a miscarriage. ovulation (ovulation) around the day llama) may occur. And after miscarriage, menstruation occurs on the 35th day. In case of major miscarriages, this period may extend up to 2 months. Therefore, protection is necessary to avoid pregnancy after the 20th day.
Miscarriage bleeding and bleeding after miscarriage?
Miscarriage bleeding is less in the threat of miscarriage. There are no pieces or clots. The cervix is closed. In case of incomplete miscarriage; There may be loose, fragmented or clotted bleeding. If it is completely low; There is no bleeding or pain. Bleeding after a miscarriage may be spotting for up to 7 days.
When can you get pregnant after a miscarriage? (pregnancy after miscarriage)
You can get pregnant 3 months after the miscarriage. Three menstrual periods is the time required for the uterus and hormonal balance to be restored.
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