Spontaneous abortion: symptoms and causes of a widespread phenomenon
Spontaneous abortion is the spontaneous termination of pregnancy before the 22nd week of gestation. Unfortunately, it is a very frequent phenomenon, affecting 31 to 35 percent of total pregnancies, and can be occasional, if it happens only once, repeated, if a woman suffers two consecutive spontaneous abortions, or even recurrent, if a woman suffers at least three consecutive miscarriages. Fortunately, the most frequent cases are those of occasional spontaneous abortions. What Happens During a Miscarriage? What are the symptoms? And the causes? Find out what the doctor says about the main causes of the majority of miscarriages.
Everything there is to know about miscarriage
In this video, Dr. Canevisio tells everything there is to know about miscarriage. The risk of miscarriage tends to decrease as the pregnancy progresses: if the risk is highest in the first weeks, it begins to decrease from the 12th week, up to the 22nd week when you can feel safer.
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Symptoms of miscarriage
Spontaneous abortion presents as typical symptoms blood loss, cramps and pains similar to menstrual ones, vomiting. Not all blood loss is a symptom of abortion, but in any case should be checked with the doctor, especially if there have been threats of "abortion earlier and the doctor declared the presence of a pregnancy at risk. Slight intermittent bleeding (coming from the cervix and placenta) may be normal. On the other hand, more abundant or continuous blood loss, and the presence of clots in them, are often symptomatic of an onset of spontaneous abortion.Sometimes it is the disappearance of pregnancy symptoms (breasts deflate, nausea decreases) that raises the alarm.
The causes of miscarriage
Spontaneous abortion can have different causes, which can be divided into two large groups: genetic causes and non-genetic causes. The former concern possible anomalies in the genetic product, which prevent the normal evolution of the embryo after conception. Non-genetic causes, including uterine malformations, diseases such as gestational diabetes and hypertension, malformations of the fetus, are however the most frequent.
For different reasons (and a combination of factors) two types of abortions can occur
- early abortions: often due to problems with the ovum, a non-viable embryo carrying chromosomal abnormalities, which is often aborted as it fails to develop properly.
- late abortions: mainly due to "mechanical" problems, such as a dilated cervix, the presence of placenta previa, bacterial infections and malformations of the uterus (septum, bicornuate, or too small uterus)
Abortions linked to the fetus:
- Genetic anomalies are among the most frequent causes of the most frequent causes. It concerns 2 out of 3 abortions.
- Severe malformations of the fetus: they are significant malformations, cardiac, digestive or nervous.
- Multiple pregnancies increase the risk of miscarriage: the uterus is undergoing too fast growth.
- In some cases, CVS and amniocentesis can cause an abortion.
Maternal-related abortions:
- Uterine malformations.
- They are often responsible for late miscarriages. They are rare anomalies and occur in 0.1 - 0.5% of women.
- The uterine cavity is too small.
- Polyps or fibroids, which exist in 20% of women, can be an obstacle to pregnancy, but it all depends on their size and where they are located.
- Infections: an abortion can have a "bacteriological, viral or parasitic origin. Mycorplasms (STD), listeria (a germ present in cow's milk, above all), some antibiotics, the hepatitis B virus, herpes" are responsible for this. , chicken pox, toxoplasmosis and some tropical parasites.
- Some hormonal disturbances make the uterine mucosa unsuitable for nesting.
- The advanced age of the mother influences the quality of the oocytes and therefore the occurrence of an abortion.
- Smoking and alcohol are factors that negatively affect the quality of the oocytes, the nesting and in general the progress of pregnancy, thus increasing the risk of spontaneous abortion.
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Male causes of miscarriage:
- The quality of the sperm can sometimes be at the origin of repeated spontaneous abortions. A spermogram will then allow to diagnose the anomalies in the partner's sperm.
A woman is considered to be subject to repeat miscarriages when she undergoes at least 3 subsequent miscarriages. This situation affects between 0.4 and "1% of women. According to statistics after 2 successive miscarriages, the risk of a new abortion is estimated at 30%, and becomes 40% after 3 abortions."
What Happens During a Miscarriage?
If a miscarriage occurs, or if you have symptoms that suggest this possibility, you should immediately consult your doctor or gynecologist, who will immediately perform an "ultrasound:"
- if the expulsion is spontaneous and complete, there is no need for any medical intervention
- if the expulsion is incomplete, you will be given prostaglandin tablets, hormones that cause contractions and allow you to evacuate what is left in the uterus. Or it is possible to wait 1-2 weeks to see if the uterus can clean itself by further bleeding. However, if the losses become very abundant (more than three sanitary pads in an hour), and in the presence of strong pain and / or fever, it will be essential to go to the emergency room.
If necessary, the doctor can resort to aspiration carried out through a straw connected to a device that allows the uterus to be emptied (similar to the procedure performed during voluntary abortions) or to curettage, to smooth the uterine mucosa, under general anesthesia. This surgery is often followed by a short hospitalization. In the case of a late miscarriage, hospitalization is necessary due to the risks of bleeding. Removal of the fetus is done under epidural or general anesthesia.
Losses after a miscarriage
After a miscarriage, the losses have a very variable duration, ranging from a few days to several weeks (sometimes until the following menstruation). Losses can be large and short-lived or short and long-lasting, or they can stop and resume a few days later. All these situations are normal, even if they are not always easy to manage, especially when you want to "turn the page" as soon as possible.
Usually a gynecological checkup with ultrasound is prescribed after the next menstruation, to check that everything is completely normal again.
Spontaneous abortion: the consequences
Spontaneous abortions are perhaps more difficult to live with today than in past centuries, given that we increasingly have the illusion of being able to control life, and, moreover, pregnancy is diagnosed earlier and earlier. Not to mention the fact that there are far fewer children than in the past.
Be that as it may, the consequences of a miscarriage should not be underestimated.
After an abortion there is always a period of mourning: to the pain of the loss of the fetus, we must add the mother's sense of guilt. The abortion refers to a feeling of failure and a sense of guilt. Even if women are cautious and wait a few months before announcing the pregnancy, the abortion is like "a bolt from the blue", although most abortions spontaneous is caused by a "chromosomal abnormality, the sense of guilt remains inevitable. Women blame themselves for not having been able to carry the pregnancy to term. The abortion also calls into question a part of their femininity. Some women rebel, try to find a culprit (themselves, the doctors, the stress ...) and sink into grief and depression before starting to mourn indispensable. Depending on the women and the history of their pregnancy, the time it takes to mourn will be more or less long.
Psychological help may be needed, and often a single session is sufficient. In any case, the role of those close to the woman is essential. Talking with your partner and family can be of great help in not feeling lonely. Support must be continuous. Because, over time, there are dates that will inevitably remind us of the past: the day the baby was supposed to be born, the anniversary of the abortion. Sadness can resurface. The important it is to remember that a spontaneous abortion is very frequent, which in the majority of cases does not preclude future pregnancies.
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When is there another pregnancy?
Most doctors recommend waiting two or three cycles before trying to start a new pregnancy. But for many doctors there is no evidence that a break should be respected before trying to get pregnant again. A pregnancy that begins in the cycle following the spontaneous abortion, especially if it is an early abortion, has as many chances of being completed as a pregnancy that begins months later. This period of time is recommended above all for the psychological impact of abortion.
However, the important thing is to remember that a spontaneous abortion is very frequent, which in most cases does not preclude future pregnancies.
How to cope with a new pregnancy?
Getting pregnant after a miscarriage usually awakens some fears. The fear of failing again often prevents the mother from investing her emotions in the new pregnancy for the first few weeks. These fears diminish long after the moment when the abortion took place in the previous pregnancy. If the anguish is too strong, it is advisable to seek help from a psychologist.
For more useful information on spontaneous abortion, you can view the article by Dr. Alessandra Graziottin, Director of the Center for Gynecology and Medical Sexology H. San Raffaele Resnati, Milan.
