Miscarriage (Abortion, Abandonment): Loss of a not yet viable child during pregnancy. We speak of early abortion up to and including the 16th week of pregnancy. week of pregnancy, from late abortion up to and including 23. SSW and from the 24. SSW from a stillbirth.
The end of a pregnancy due to a miscarriage is more common than you think. If you add the cases of silent miscarriages, where the woman experiences the miscarriage "only" as a particularly painful and delayed menstruation, at least every 3. Pregnancy this way.
Guide complaints
- Moderate to heavy bleeding from the vagina, with discharge of blood clots and tissue fragments
- Drawing, contraction-like lower abdominal pain
- Possibly slight fever (up to 38 °C)
- Leakage of amniotic fluid (in late pregnancy).
When to see a doctor
The next day, when already light, painless bleeding occurs – if there is no clear trigger for the light bleeding (z. B. after intercourse) gives.
Immediately, when I felt pain in my lower abdomen or did not feel any childbearing movements for a long period of time.
Show background information
The disease
A miscarriage is when the pregnancy is terminated by expulsion of the embryo before it reaches 500 g in weight, i.e. it is not yet viable. As mentioned above, this is the case in at least every third pregnancy. Most miscarriages occur by 10. In the 16th week of pregnancy, the psychologically particularly stressful late abortions after the 16th week of pregnancy can be avoided. SSW are rather rare in comparison.
Left: Impending miscarriage (abortus imminens) with light bleeding from the (still) almost closed cervix. Middle: Unstoppable miscarriage (Abortus incipiens): the cervix has opened, the bleeding is heavier. Right: Incomplete miscarriage (abortus incompletus): remnants of the child or placenta are still in the uterus.
Georg Thieme Publishing House, Stuttgart
It is now known that premature abortions can be traced back to severe damage to the fetal genome in around 60% of cases. These early miscarriages are therefore a kind of "emergency brake" of the body, which ensures that no child is carried that is not viable.
Especially in early pregnancy, infections also cause miscarriages. (If the pregnancy is more advanced, infections such as rubella or toxoplasmosis cause malformations in the unborn child.) Other causes include:
- Rejection reactions of the maternal body (immunological sterility)
- malformations, z. B. an additional partition wall in the uterine cavity (uterine septum) , benign lumps of the uterus
- Hormonal imbalances and drugs that damage fertility.
- Hypothyroidism. To detect hypothyroidism, which is often asymptomatic, the doctor can determine how much thyroid-stimulating hormone (TSH) is in the blood. Until a few years ago, TSH values of four to five milliunits (mU) per liter were considered normal. A recent study shows that levels above 2.5 mU per liter in early pregnancy almost double the risk of miscarriage.
What the doctor does
To find out if there is a miscarriage, the doctor not only carefully checks the condition of the uterus, but also whether the cervix is open, and assesses the amount of bleeding. Ultrasound is used to check the size of the child and whether the child’s heart is still beating. As a rule, the course of the pregnancy hormone beta-HCG in the blood of the pregnant woman is also determined. If it drops continuously in early pregnancy, this indicates a miscarriage.
If the doctor is sure that a miscarriage has occurred, he gives prostaglandin as a drug to promote labor, which helps the uterus to remove any remnants of the amniotic sac.
This is usually followed by a scraping of the inner wall of the uterus (instrumental curettage) under short anesthesia to remove any residual tissue. Because the uterine muscles are quite loose at this stage, the doctor must be very careful not to injure or perforate the uterine muscle. The procedure is performed in a hospital on an outpatient basis.
Until 8. In the second week of pregnancy, regular checks of the beta-HCG level may mean that abortion is not necessary. Cervical curettage is obligatory
- To prevent life-threatening blood poisoning (septic abortion), which can occur if residual amniotic tissue remains in the uterus.
- In an incomplete miscarriage (abortus incompletus), when the embryo was not completely expelled.
- In a restrained miscarriage (missed abortion), when the embryo has died but the miscarriage has not occurred.
A special form is the threatened miscarriage (abortus imminens). The child is alive and the cervix is closed, but (light) bleeding from the vagina indicates a danger. The mother should be taken to the hospital and given bed rest, as the miscarriage can often still be averted with consistent bed rest and medication. Later, when there is no more bleeding, restricted bed rest applies, d. h. only a short walk to the toilet or to get tea is allowed.
Your pharmacy recommends
The most important advice after a miscarriage is: take your time, grieve, but at some point also look forward again.
If you wish to have a child, you should wait at least three months until the next pregnancy so that the uterus can recover. Otherwise you risk another miscarriage.
After that you can hope for a new and this time successful pregnancy. Hundreds of thousands of women have experienced that it works the second, sometimes even the third time. Even after three miscarriages, more than 50% of the affected women still carry a healthy pregnancy to term, almost always without any special therapy. This should encourage those affected. No additional restrictions apply to the new pregnancy – unless explicitly advised otherwise by the attending gynecologist. B. a move) and unusual sexual practices should, however, be better avoided.