Early pregnancy loss (miscarriage)

Symptoms and cause

Early pregnancy loss is an unsuccessful pregnancy up to the 12th week of pregnancy, which occurs in 15 - 20% of identified pregnancies, ie roughly every fifth pregnancy ends unsuccessfully. The main symptoms are bleeding, spotting and abdominal pain. The most common causes of unsuccessful pregnancy are chromosomal abnormalities (genetic error), which are uncontrollable. For a successful pregnancy, the fetus must have 46 chromosomes, if their number is lower or higher, very often the pregnancy will end spontaneously. This means that such a pregnancy cannot be treated - e.g. if the doctor prescribed me some medication, it might work out well or if I came earlier and so on. There is no reason to blame yourself or those around you in these cases, as the exact reason for the end of the pregnancy will not be established. However, risk factors such as blood clotting disorders, diabetes, thyroid disease, age, smoking and overall lifestyle may also contribute to a failed pregnancy. Some of them are examined only after 2-3 unsuccessful pregnancies, as most of the subsequent pregnancies after a miscarriage will take place without complications.

Course

The course of a failed pregnancy can be associated with pain and bleeding (even very severe), but it can also be without difficulties. Pain and bleeding are associated with an ongoing abortion (abortus spontaneus in cursu), when the fetal egg is expelled from the uterus, either completely (no part of the fetal egg remains in the uterus) or incompletely (abortion remains in the uterus). We are talking about abortus spontaneus completus resp. incomplete. The so-called missed abortion. It is a situation where the fetus has died in the womb, but the uterus has not yet expelled it (therefore there is no pain and bleeding). Probably this situation precedes the one described above - that is, the fetus dies first, the female body recognizes that it is no longer developing and is subsequently expelled from the uterus. However, with abortion, this period without expulsion may be different for each woman.

Solution options

We can solve miscarriage in Slovakia in two ways - by waiting or surgically (so-called cleaning, curettage, emptying - evacuation of the uterine cavity). Each procedure has its advantages and disadvantages.

The advantage of the waiting procedure is that the woman can avoid being in the hospital and undergoing surgery. However, he must go for inspections 1-2 times in 14 days until the condition is resolved. The principle is waiting for the uterus to empty spontaneously (usually within 3 weeks), which is usually associated with manageable bleeding and pain. The disadvantage is that the procedure may not always be successful (even after a long time, the uterus will not be emptied) or the emptying may be accompanied by heavy bleeding and pain requiring surgery (so-called cleansing). The risk of infection with this procedure is very low. The waiting procedure is successful in 90% of cases with an incomplete abortion. With abortion, it is successful in half of the cases. A waiting procedure in which a woman is checked by a healthcare professional is not dangerous for a woman. The risks associated with this procedure are minimal.

The surgical approach requires a hospital stay, administration of an anesthetic, and removal of the fetus (or its remnants) from the uterus with instruments. The situation is usually resolved faster in terms of time than with the waiting procedure. Complications are also rare. However, it is important to realize that every surgical procedure has its risks that can never be completely eliminated or predicted. Incomplete emptying of the uterus (so-called residues - remnants of the operation) can most often occur and then it is necessary to repeat it. However, uterine injury, infection, allergic reactions, anesthesia-related complications, and the like can also occur.

The waiting procedure does not replace surgery, but is a possible alternative for some patients who agree to it. However, every woman should be informed about this possible solution. He must agree to its use and, in the event of complications such as heavy bleeding, pain, fever, etc., immediately go to the admission clinic of the Gynecology and Obstetrics Clinic of the Trenčín University Hospital. In some cases, the patient can recognize the expelled remnants of the fetal egg and then bring them for histological examination. If the material is not sent for histological examination, the level of pregnancy hormone (HCG) is monitored to a negative value (it can take up to 6 weeks after abortion) to rule out a rare disease (mole hydatidosis).

Consequences and other pregnancies

Every desired unsuccessful pregnancy is an unpleasant event in the life of a woman and her partner. More common than physical consequences (eg abdominal pain, irregular bleeding, uterine growth, infection, ...) are psychological consequences, namely depression and anxiety. In most cases, these resolve within 3 months of the abortion. psychiatrist. According to studies, women who have had the opportunity to decide which procedure (waiting or surgical) will deal with a failed pregnancy are better able to deal with this situation mentally than those who have been strictly prescribed by a doctor. Subsequent pregnancy in most cases will take place without complications and it is recommended to plan it after the first menstruation since abortion, respectively. if the woman (partner couple) is mentally ready for another pregnancy. After possible 2-3 unsuccessful pregnancies in a row, some examinations are indicated, such as genetic testing, blood clotting disorders, thyroid disease and other hormonal diseases and disorders.