Unintention( spontaneous interruption) of pregnancy - Causes, symptoms and treatment. MF.

Miscarriage of pregnancy is a spontaneous abortion until 37 weeks. Interruption of pregnancy can occur at any time of pregnancy, but more often it occurs in the first trimester. If the pregnancy is interrupted until 28 weeks, it is referred to as spontaneous miscarriage or abortion. If after 28 weeks of pregnancy, then it is a question of premature birth.

Causes of miscarriage

Genetic causes of miscarriage

There are many reasons that lead to this pathology. Approximately 10% of cases of pregnancy are interrupted due to chromosomal abnormalities of the fetus. In other words, the fetus has genetic developmental defects that are incompatible with life, which leads to its death, that is, to a spontaneous miscarriage. Thus, according to geneticists, nature conducts natural selection.

Spontaneous miscarriages due to chromosomal abnormalities are more common in families in which there have already been cases of miscarriage or lack of experience, and also if in the family some parents already had children with congenital malformations or children with mental retardation.

Valuable information for the diagnosis of chromosome abnormalities of the fetus is cytogenetic analysis of the abortus, i.e. Study of the remains of the fetal egg removed from the uterus during miscarriage.

To determine whether the genetic factor is the main cause of miscarriage - it is necessary to study the karyotype of both parents. In case of detection of pathology in a karyotype of a married couple, consultation of a geneticist is necessary.

In the presence of a pathological karyotype, at least one parent has a several times increased risk of congenital anomalies in the fetus. Therefore, geneticists recommend such pairs of perinatal diagnostics( chorion biopsy, amniocentesis, cordocentesis).

Endocrine causes of miscarriage

Other common causes of miscarriage include endocrine disorders, to be more precise, luteal phase deficiency, androgen excess, hyperprolactinemia, thyroid dysfunction and diabetes mellitus. Endocrine disorders in 25% of cases are the cause of spontaneous miscarriages in the early stages of pregnancy.

The inadequacy of the luteal phase of is due to a decreased level of progesterone - the hormone "pregnancy", without which the normal course of pregnancy is impossible. The level of progesterone is of fundamental importance in the first trimester of pregnancy, since it is progesterone that takes part in the implantation and retention of the fetal egg in the uterus. Accordingly, an insufficient level of progesterone in the body can lead to infertility and miscarriage.

To correct the level of progesterone in the first trimester of pregnancy, gestagens are used - Dyufaston, Utrozhestan. If a deficiency of progesterone is combined with an excess of androgens, then appoint glucocorticoids( Metipred, Dexamethasone).

Excess androgen or scientifically " hyperandrogenia " is also a common cause of miscarriage. Hyperandrogenism can be caused by excessive production of testosterone by the adrenal glands, ovaries or both.

Hyperandrogenism of adrenal origin arises from hereditary diseases caused by genetic defects of steroidogenesis enzymes( adrenogenital syndrome, congenital hyperplasia of the adrenal cortex).

Hyperandrogenia of ovarian genesis occurs with polycystic ovary syndrome.

An excess of androgens of mixed genesis is observed when the hypothalamic-pituitary function is disturbed( with neuro-exchange-endocrine and hypothalamic syndrome).

Hyperprolactinemia is caused by diseases of the hypothalamic-pituitary system( trauma, infection, brain tumor).In addition, hyperprolactinaemia can be caused by the intake of certain medications( antidepressants, birth control pills).

Of thyroid diseases , thyroiditis and iodine deficiency are a great danger for pregnancy. The fact is that with thyroiditis and with a deficiency of iodine, the thyroid gland produces less thyroid hormones than is necessary to maintain and normal development of pregnancy and fetus. Accordingly, in order for pregnancy to proceed normally, a woman is prescribed hormone replacement therapy and / or iodine preparations.

Diabetes mellitus can also lead to miscarriage due to a decrease in tissue sensitivity to insulin. Therefore, during pregnancy, correction of insulin doses is necessary.

When endocrine disorders are detected, hormone treatment is indicated not only during pregnancy but also in some cases before pregnancy, therefore it is very important to undergo a gynecologist's examination before pregnancy planning. If any deviations are found, the doctor will refer you to the endocrinologist.

Anatomical causes of miscarriage

The next reason for miscarriage is anatomical abnormalities. In a percentage of this cause, 10-16% of the total number of miscarriages occur. Anatomical abnormalities include the developmental defects of the uterus: doubling of the uterus;a two-horned, one-horned or saddle-shaped uterus;presence of an intrauterine septum. In addition to the developmental defects of the uterus, anatomical abnormalities include acquired defects of the uterus, such as intrauterine synechia, uterine fibroids with a submucous site of the node. The latter is more common than the rest.

Asthmic-cervical insufficiency

An ischemic-cervical insufficiency( ICI) approximately in 10% of cases causes a miscarriage. What it is? This shortening of the cervix with the subsequent opening. Most often, the ICI develops in the second and third trimester of pregnancy. To reduce the likelihood of preterm labor until 33 weeks of pregnancy, pregnant women with this pathology are cervical. Out of pregnancy, often carry out the plastic of the cervix.

Infectious causes of miscarriage

Infectious and viral diseases of the genital area( chlamydia, ureaplasmosis, mycoplasmosis, trichomoniasis, HPV, HSV, CMV), as well as TORh infections( herpes, rubella, toxoplasmosis, cytomegalovirus) have a negative effect on pregnancy. According to research, more than 40% of miscarriages and premature births are caused by infectious or viral genesis. In this regard, women with these diseases during pregnancy are immunoglobulin therapy, depending on the type of pathogen in the second and third trimester, antibiotics and antiviral drugs are administered.

It should be noted that even if there is any of these infections, pregnancy is not interrupted by everyone and not always. Therefore, in most cases, miscarriage due to infections or viruses is associated with the weakness of the immune system during pregnancy.

Immunological causes of miscarriage

Finally, the most mysterious causes of miscarriage are immunological. If the other reasons for miscarriage mentioned above are excluded during the survey, then, as a rule, the cause of miscarriage is "attributed" to immunological ones. What do they mean by immunological disorders? Kind of - this is an inadequate aggressive reaction of immunity against foreign fetal tissues( alloimmune disorders) or against the mother's own tissues( autoimmune disorders).In autoimmune disorders in the blood, a woman has antinuclear, antithyroid and antiphospholipid antibodies. With alloimmune disorders in the pregnant woman's blood, antibodies to hCG are present.

Therapy, aimed at preserving pregnancy in immunological disorders, is carried out for a long time, sometimes throughout the entire pregnancy. For the treatment of similar pathologies, anticoagulants, glucocorticoids, antiaggregants, gestagens, etc. are used. Throughout pregnancy, careful monitoring of the fetus is carried out.

It should be noted that physical activity, including sexual contact, despite the widespread opinion, does not have any negative impact on the bearing of pregnancy. The causes of miscarriage are more serious.

All pregnant women who have had a pregnancy with a spontaneous abortion are recommended to undergo an out-patient examination at the gynecologist for an explanation of the cause of the miscarriage, which includes:

- ultrasound of the pelvic organs in both phases of the menstrual cycle;
- cytogenetic examination of the remains of the fetal egg;
- examination for urogenital infections: chlamydia, ureaplasmosis, mycoplasmosis, trichomoniasis, HPV, HSV, CMV;
- blood test for TORCH infection: rubella, herpes, toxoplasmosis, cytomegalovirus infection;
- blood test for hormones: estradiol, LH, FSH, cortisol, testosterone, DHEA, prolactin, progesterone, 17-OH progesterone;
- blood test for thyroid hormones: TTG, st. T3, over T4;
- coagulogram, hemostasiogram;
- study of karyotype of both partners;
- consultation of the endocrinologist and genetics;
- spermogram of the husband;
- a blood test for antibodies to hCG, for antinuclear, antithyroid and antiphospholipid antibodies.

The volume of diagnostic tests is determined individually.

After a miscarriage, a woman is recommended to be protected from pregnancy within 6 months for restoration, examination and treatment of the revealed pathology. To protect against pregnancy, oral contraceptives with a curative effect are prescribed( Janine, Yarina, Jess), which should be used from 3 to 6 months according to the contraceptive scheme.

Treatment for miscarriage

Treatment is determined by the cause that caused miscarriage and is reduced to its elimination and prevention.

Complications of miscarriage:

- abortion;
- profuse bleeding can lead to hemorrhagic shock;
- the spread of infection in the abdominal cavity, which can cause peritonitis;
- purulent infection of blood or sepsis;
- premature delivery of a premature fetus, intrauterine fetal death, fetal death immediately after birth.

Prevention of miscarriage:

- examination by a gynecologist before planning a pregnancy;
- timely treatment of gynecological and endocrine diseases before pregnancy;
- abortion;
- healthy lifestyle-rejection of bad habits, regular exercise.

Consultation of a obstetrician-gynecologist for the topic of miscarriage:

1. Can I get pregnant immediately after a miscarriage?
It is possible, but it is better to go through the examination at the gynecologist first and then try to become pregnant.

2. Do I need to drink oral contraceptives after miscarriage?
Not necessarily. Everything depends on the cause of miscarriage. But in most cases, oral contraceptives are prescribed to treat and restore the body after miscarriage.

3. I have a uterine myoma. Will I be able to bear the child out?
It all depends on the size of the myomatous nodes and on their location. If the nodes are small and there is no contact of the node with the placenta, in most cases the pregnancy proceeds favorably.

4. Can there be a miscarriage due to erosion of the cervix?
No. Erosion of the cervix does not affect the bearing of pregnancy.

5. Can there be a miscarriage due to frequent ultrasound?
No.

6. I already had four miscarriages. Doctors did not find out the reason. What to do, I'm afraid of becoming pregnant again?
You and your spouse need to have a consultation with a geneticist.

7. The gynecologist has found out from me ureaplasmosis. But I did not manage to treat it, I immediately became pregnant. How will ureaplasmosis affect pregnancy?
Ureaplasmosis can lead to miscarriage and fetal infection. But fortunately, it does not always happen. During pregnancy, ureaplasmosis is treated with antibiotics at 20-22 weeks of gestation.

8. Can an orgasm cause premature birth?
No. According to some reports, orgasm opposite, is useful for the health of the fetus. But 2-3 weeks before the birth of sex is better to give up.

Obstetrician-gynecologist, Dr. Christina Frambos

* Miscarriages associated with family history of heart disease

The results of a new study( February 2011) suggested that there may be a link between heart disease in parents and the risk of miscarriage in their adultdaughter.

UK scientists found that women who had two miscarriages before the birth of their first child had a higher than average risk of having parents with heart disease. This risk was even higher in women who had suffered three miscarriages before the birth of the first child, write Dr. Gordon Smith( Cambridge University) and his colleagues.

In a previous study involving almost 130,000 Scottish women, scientists showed that women with frequent miscarriages are more likely to have heart problems as their age increases. This prompted the question of whether such women - already at risk of heart disease - will also have a more likely family history of heart disease, which suggests a genetic link.

Thus, the authors examined the data of nearly 75,000 women who gave birth to the first child between 1992 and 2006, along with medical information about the parents of about two-thirds of the women.

Compared to women who gave birth without any previous miscarriages, women who had two miscarriages 25% more likely to be parents who died or were hospitalized because of heart disease. When a woman had three miscarriages before birth, she is 56% more likely to have parents with severe heart disease.

Factors such as income, education and smoking, did not explain the relationship between heart disease in parents and miscarriages in their grown-up daughters.