Miscarriage (abortion)

At a Miscarriage or a Abortion it is an unintended termination of pregnancy within the first 23 weeks of pregnancy. The child shows no signs of life such as umbilical cord pulse, heartbeat or breathing and his weight is less than 500 grams.

What is a miscarriage?

A miscarriage occurs when there is an unwanted termination of pregnancy before the fetus is viable. It is classified according to the cause or the time of occurrence.

A spontaneous abortion is used when the abortion has a natural cause. There is also the artificial abortion caused by chemicals, drugs or an abortion. An early abortion is usually caused by genetic damage and often occurs together with the expected menstruation.

Sometimes the woman doesn't even know at that moment that she was pregnant. She only wonders about a delayed menstruation and possibly a stronger blood flow. If the abortion occurs before the 12th week of pregnancy, it is called an early abortion. A miscarriage after the 13th week of pregnancy is called a late abortion.

causes

The reasons for a miscarriage can be varied and can rarely be uncovered. A basic distinction is made between fetal, maternal and paternal causes.

Typical fetal causes of an abortion are chromosome mutation, infection of the unborn child, and exposure to drugs or X-rays. The maternal causes include a malformation of the uterus, an incorrect development of the placenta, mechanical trauma such as a fall, infections of the mother, tumors, hormonal disorders, Rh intolerance, heavy caffeine consumption and drug consumption.

However, a miscarriage can also be due to the father. These include different types of semen abnormalities and genetic disorders. In addition to the causes mentioned, there are also pregnancy-specific hormonal disorders in the mother or child, which can lead to an endocrine miscarriage.

In general, the causes can be divided into six groups:

• fetoplacental causes (pharynx by the fetus): e.g. Genetic disorders, umbilical cord abnormalities, placenta disorders

• Causes by the mother: e.g. Uterine rupture (ruptured uterus), premature placental detachment or inflammation of the cervix

• hormonal disorders

• trauma

• Infectious diseases: e.g. rubella

• Poisoning: e.g. Lead poisoning

Symptoms, ailments & signs

A miscarriage is usually indicated by very strong and labor-like pain. The pregnant woman feels increasingly strong contractions in the abdomen, which are usually spasmodic. In contrast to normal labor, which starts out weakly and then slowly increases, the contractions that induce a miscarriage usually begin very suddenly and violently.

If such severe contractions occur even though the due date has not yet been reached, you should go to a hospital as quickly as possible or call an emergency doctor. Bleeding may be another sign of an impending miscarriage. These can vary in strength. Not every bleeding is directly associated with a miscarriage, but the symptoms should also be clarified by a doctor.

If the pregnancy has progressed beyond the 15th to 20th week, the mother-to-be can usually feel the child's movements. Strongly changing child movements can also be a sign of an impending miscarriage. Most of the time, the children's movements are significantly weaker or do not occur at all.

The expectant mother usually has a very good sense of whether the child is just resting or sleeping in her stomach, or whether something is actually wrong. The mother's state of health also usually changes before a miscarriage. She feels bad and sick, exhausted and especially tired. In some cases there is also a fever.

diagnosis

If the miscarriage occurs in the first few weeks of pregnancy, some women do not even notice it, as it is similar to menstrual bleeding. Depending on the week of pregnancy, in addition to vaginal bleeding, the onset of labor is a sign of an abortion.

With the help of an ultrasound scan, the doctor can see whether the fetus is still alive or not. If the heartbeat can still be heard, a miscarriage can still be prevented with the help of contraceptive agents, magnesium and strict bed rest. If this is no longer possible, the birth will be ended as quickly as possible with medication to promote labor and by scraping the uterus.

With the help of another ultrasound examination, the doctor can determine to what extent parts of the pregnancy are still present in the uterus after the miscarriage.

Complications

A miscarriage can have a number of complications. After an abortion, menstrual disorders and severe physical discomfort can occur. Temporary indigestion and gastrointestinal disorders can also occur. Often, psychological and emotional complaints also arise as a result of the child's death.

Affected women often suffer from the loss of their child for years and have difficulty saying goodbye because the procedure is usually carried out quickly. Children who have already been born often suffer from this. Restlessness and sadness as well as insomnia are typical consequences for the immediate family.

Physical complaints can also occur. In Asherman's syndrome, there is adhesions of the anterior and posterior walls of the uterus, which can lead to menstrual cramps, premature births and secondary sterility. Miscarriage generally increases the risk of premature birth during the next pregnancy.

If an unnoticed miscarriage occurs, circulatory disorders and life-threatening thromboses can occur. The longer the abortion goes unnoticed, the greater the risk of serious complications. Pregnancy and especially a miscarriage should therefore always be discussed with a gynecologist and psychological counseling.

When should you go to the doctor?

Often women do not realize they have had a miscarriage. But if it does, a visit to the gynecologist is advisable. In addition, a doctor should always be consulted in the event of a miscarriage if the patient suffers from psychological complaints or from depression. The life partner or relatives can also be affected and then also need treatment. Visiting a therapist or a psychologist is particularly suitable, although conversations with other women can also be helpful.

However, direct treatment of the miscarriage cannot take place. A doctor should also be seen if the person has sudden vaginal bleeding during pregnancy. This usually occurs unexpectedly and relatively severely.

The discomfort is accompanied by severe pain in the abdomen or vagina. This pain also suggests a miscarriage. An open cervix can also indicate a complaint. In the event of these complaints, a doctor must usually be consulted immediately. If the pain is very severe, call an emergency doctor.

Doctors & therapists in your area

Treatment & Therapy

The treatment of a miscarriage is primarily based on the stage of the abortion and the possibility of maintaining pregnancy. Medical advice is always advisable.

An important medical therapy is the scraping of the womb which died too early as well as the remaining placenta. After the 12th week of pregnancy, the womb should usually be born naturally, with the presence of a midwife or nurse required. This natural birth is more painful, but is usually preferred to scraping for psychological reasons.

Both treatment options have low risks. Which option is chosen is up to the woman. In addition to medical treatment, psychotherapeutic advice can be useful. This can also be done in the form of a self-help group. This makes the work of grief easier and makes it easier to come to terms with the traumatic experience.

If the woman suffers from various unintended miscarriages, genetic counseling can be the solution. As part of this, the causes are explored. If possible, not only should both parents be examined, but also the dead child of the miscarriage.

Outlook & forecast

If scraping is not performed, chorionic carcinoma or a mole of bladder may develop. Furthermore, a uterus with remains of the fetus and blood is an ideal breeding ground for bacteria and germs.

In this context, there is also a possible uterine inflammation. In the worst case, even the peritoneum can be affected. Even sepsis is conceivable in this case. Further adhesions and possibly sterility are the result.

In the event of a miscarriage, the unborn child dies. This leads to emotional and psychological problems for most mothers, but also for fathers-to-be. Depending on the personality of the parents, the miscarriage is processed individually. Accordingly, the prognosis must also be assessed according to the personal circumstances of those affected.

The previous history, the age of the parents, the intensity of the desire for children and the circumstances that led to the miscarriage must also be taken into account. If the desire to have children is not very pronounced, processing what has happened is often easier.Parents who have tried everything over the course of several years to have children often have greater difficulty in looking optimistically and confidently into future developments.

If the miscarriage occurred as a result of an accident, fall or the use of external violence, the trigger must be processed at the same time. This process usually leads to a deterioration in the general condition and prolongs the healing process.

The prognosis improves if the support of a therapist is used and at the same time other areas of the parents' life play an important role. If, for health reasons, nothing speaks against a new pregnancy, a miscarriage is usually better processed. The situation is unfavorable if the woman is sterile after the abortion and there is a desire to have children.

prevention

The main way to prevent miscarriage is through a healthy lifestyle. Furthermore, the administration of hormones can be useful. Furthermore, reducing stress during pregnancy is important, which is why relaxation exercises are recommended. Occasionally, however, a miscarriage cannot be prevented, as some causes cannot be influenced.

Aftercare

The follow-up care for a miscarriage depends on the type of abortion. Scraping the uterus (curettage) is often not necessary. It is advisable to wait a few days before such an operation. Those affected can often accept the situation better. Often the tissue is shed naturally.

The progress of the exit should be monitored medically. Even after curettage, a check-up should be carried out to ensure that all tissue remains have been removed and excreted. Basically, at least one ultrasound examination is carried out about two weeks later. The hCG value is often also checked, which those affected can determine themselves using a pregnancy test.

In any case, the woman concerned is entitled to the care of a midwife. This can not only accompany the physical process, but also help to deal with the grief. It is still possible and customary to consult a midwife months after the abortion. Many sufferers perceive the miscarriage as a great psychological burden.

It is therefore sometimes advisable to seek psychological help. The next ovulation after the miscarriage occurs two to eight weeks after the miscarriage. If those affected do not feel ready for a new pregnancy, it is advisable to take appropriate contraceptive measures.

You can do that yourself

A miscarriage (abortion) is a crucial experience in a woman's life. In many cases, this event cannot be influenced. Nevertheless, there are a few things that a woman can do in everyday life as part of self-help to either avoid a miscarriage or to regain physical and mental strength as quickly as possible after an abortion.

Avoiding an impending miscarriage is often associated with calm and protection. In addition to visiting the doctor at the first signs and any drug treatment, the pregnant woman is best to relax for a large part of the day in a lying or sitting position.

Physical exertion such as carrying heavy objects, cycling and sexual contact should be avoided. Hot baths and alcohol are also not recommended. A sufficient amount of water to drink and food rich in fiber support digestion and help to avoid heavy pressing in the toilet.

After a miscarriage, women are often physically resilient again quickly. Due to medical advice, bathing or sexual intercourse may be avoided for a few days. An abortion that was associated with heavy bleeding can lead to a significant deterioration in iron levels, so an iron cure is helpful here.

Drinking a sufficient amount of water helps to stabilize the circulation. Herbal tranquilizers, talks with a therapist or confidante, dosed exercise in the great outdoors or yoga are all suitable for psychological processing of the miscarriage.