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Today I would like to talk to you about the sad topic of miscarriages.
As some of you may know, my first pregnancy unfortunately ended in October with an abortion at 9.Week of pregnancy due to a wind egg / a missed abortion.
If the pregnancy test is positive, the joy is first of all very great and hardly any woman likes to think about the fact that now everything is still far from being "safe".
Unfortunately it is so that Miscarriages in early pregnancy are very common.
However, because it is still a "taboo" subject, many women don’t talk about their experiences and so often you don’t know of anyone who has also had a miscarriage. I have also had two miscarriages and am therefore in the new miscarriages course "letting go" of stork whispers* I was there myself as an expert/doctor and as a person affected – I can only recommend the course to you wholeheartedly!
✓ 20+ interviews with affected women
✓ Medical knowledge and naturopathy
✓ Yoga, Meditation and Grief Recovery
✓ From renowned doctors and experts in childbearing
This fertility course is especially close to my heart. I have experienced two miscarriages myself – and in this course I and other childbirth experts explain everything you need to know about miscarriages in 40+ videos. In addition, I have interviewed more than 20 women with miscarriages – and these women also have very valuable tips for you. If you have had a miscarriage, then I can wholeheartedly recommend this course to you! And with my code BABYBAUCH you get 10€ discount – so the course costs only 19,90€!
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In this article I would like to explain everything you need to know about miscarriages – from diagnosis and symptoms to treatment and consequences. And I’ll explain to you what it is about the restrained miscarriage (Missed Abortion) and how wind eggs differ from bladder moles.
I have also added my personal experiences in italics – I hope they help you as well!
A spontaneous miscarriage is when the embryo or fetus is not born before the 24.tenth week of pregnancy under 500g dies and the pregnancy ends naturally (i.e. there is bleeding and rejection of the pregnancy tissue).
The majority of miscarriages involve early miscarriages – miscarriages before the 12th week.Week of pregnancy (1.trimester). Late abortions / miscarriages In 2.Trimesters, on the other hand, are much rarer.
From 24.When the baby reaches the third week of pregnancy or weighs 500g, it is no longer called a miscarriage, but an stillbirth. From 500g fetuses are considered as persons in the Federal Republic and are therefore buried and also registered in the family register. However, since 2013 it has also been possible to have stillborn children under 500g entered into the family register if you wish to do so.
In a Missed Abortion (also: restrained miscarriage / delayed miscarriage) there is also a death of the embryo.
In contrast to spontaneous miscarriage, the Pregnancy tissue, however, not rejected by the body and there is no or incomplete bleeding.
In a large-scale study in London in an Early Pregnancy Unit, 24% of patients were admitted due to a Missed Abortion – so it is a relatively common form of early miscarriage.
Although the terms "wind egg" and "bladder mole" are often used interchangeably, they are two very different diagnoses!
In the case of a wind egg, a visible embryo never develops, or. is reabsorbed by the body. However, the placenta and amniotic cavity often develop normally. The cause is thought to be early embryonic death, but the trophoblast forms other structures.
However, since the body continues to maintain the pregnancy, a wind egg is therefore a special form of Missed Abortion / restrained miscarriage. However, restrained miscarriages can still become spontaneous miscarriages in the course (see therapy options). The American Pregancy Association estimates that blighted ovum is present in as many as 50% of all early miscarriages, so it is common!
My first pregnancy was also such a wind egg: the amniotic cavity and the placenta were well formed – only one embryo was missing in the 9th week.week still. However, my HCG level corresponded to 9.week – in Missed Abortions the HCG level is usually lower. I was therefore admitted to the clinic with suspicion of missed abortion or bladder mole. Fortunately, there were no further indications of a blighted ovum and it was "only" a normal wind egg – the histological confirmation is still pending.
In the case of a complete bladder mole, this is a Rare diagnosis, which is only about 1:1.500 to 1:2.000 pregnancies in Europe. Partial mole pregnancies also occur in only about 1:700 pregnancies.
In case of a Complete bladder mole an egg cell that does not contain a maternal nucleus is fertilized by one or two sperm cells. The chromosome set of the sperm can be doubled in the process.
From one partial / incomplete mole pregnancy is said to occur when a "normal" female egg is fertilized by one or two sperm and the male chromosome set is doubled – therefore a triple (rarely: quadruple) set of chromosomes is present.
Due to the defective chromosome set the developing placenta forms vesicle-like structures and no embryo develops. In an incomplete mole, embryonic structures may partially develop – but the embryo is severely malformed and not viable.
On ultrasound, the distended, bubble-like uterine tissue can be seen, there is a lot of blood flow ("snowflakes") and the uterus is enlarged overall. Also, in cases of complete bladder moles, blister-like uterine very high HCG levels measured (several hundred thousand to>1.000.000).
However, partial bladder moles in particular are visible on ultrasound before 3.Month difficult to diagnose – ultrasound is often only borderline abnormal and HCG levels are less "suspicious" than complete bladder moles. Experts assume that partial bladder moles are often overlooked in early abortions – a histological examination of the abortion material can therefore be helpful. In a retrospective study of abortions, only 17% of partial moles were actually previously suspected on ultrasound – all others were referred as "anembryonic pregnancy" (nappy egg)/Missed Abortion.
bladder mole should treated immediately with curettage The embryos, which can become invasive and have a risk of degeneration, are lost again. Approximately 10-15% of mole pregnancies turn into a invasive form about – and in about 2-3% of all (complete) bladder moles even the malignant chorionic carcinoma.
How often are miscarriages?
At least 30% of all early pregnancies are lost again.
A good proportion of early miscarriages occur so early that they are only noticed by women who use early pregnancy tests – otherwise the miscarriage is often just interpreted as a "late period". These are so-called biochemical pregnancies (HCG increase without ultrasound confirmation)
Often you can find information in the literature about a miscarriage rate of 20-25% – however, this usually refers to Clinically confirmed pregnancies (i.e. embryonic anlagen/ amniotic cavities visible on ultrasound).
The Implantation rate of fertilized eggs, on the other hand, is estimated to be as low as 50% estimated! Here, however, no really reliable figures can be found – after all, these discarded fertilized eggs cannot be measured!
What are the causes of miscarriages?
In 50% of all miscarriages a Chromosomal disorder before. Trisomy is most common (52%), followed by polyploid chromosome set (21%) or monosomy X (Turner syndrome, 13%).
In the case of diaper eggs, non-viable trisomy 16 and Turner syndrome (45,X0) are also found particularly often.
Other possible causes of miscarriage are:
- Coagulation disorders
- Autoimmune diseases
- Infections in early pregnancy (z.B. CMV, toxoplasmosis, listeriosis)
- Toxic substances and drugs (rarely)
Especially after multiple premature births, a clarification of the coagulation situation, a genetic examination and possibly also autoimmune diagnostics are recommended.
What are the symptoms of a miscarriage??
In the case of a spontaneous miscarriage there are often vaginal bleeding and pain. Also contractions cramps can occur. In the blood test a falling or not adequately rising HCG is found.
Due to the decreasing HCG level, it is also possible that early pregnancy symptoms such as Nausea and breast tenderness tend to become weaker again or disappear completely.
A special case is the Missed abortion – often there are no symptoms at all. Even with wind eggs, the HCG level can rise adequately and thus continue to cause pregnancy symptoms. (This was also the case with me – I had no bleeding at all and continued to have a high HCG and associated, pregnancy symptoms).
The diagnosis is usually not made until the Interaction of blood test and ultrasound made. In ultrasound no heart activity (more) is visible and Embryo appears too small for its gestational age.
In contrast, in the case of wind eggs, an amniotic cavity can be seen, but despite sufficient size (28mm is considered the limit for the diagnosis), there is no embryonic cavity no embryo and no yolk sac.
Sometimes one hopes for a so-called "corner stool" (a poorly sound embryonic system), which is why mostly until about 8.week waited before the definitive diagnosis of "Windei / Missed Abortion" is made. At the latest from an HCG value of 10.000, an embryonic anlage should be visible (this was with me with a HCG of 58.000 not the case at my first ultrasound appointment on 8+3).
Therapy options in case of (restrained) miscarriage
An early spontaneous abortion cannot be stopped – unfortunately, the pregnancy can no longer be saved!
In the case of spontaneous miscarriages often no therapy is necessary and therefore the miscarriage is observed in a waiting manner. Medical intervention may be necessary only in case of heavy bleeding.
The HCG level should be checked after the end of bleeding and ultrasound should be used to look for remaining residues in the uterus. In the case of an incomplete abortion, the same treatment options exist as in the case of a missed abortion.
In general, there are three options for dealing with a missed abortion. a wind egg can be dealt with:
- Waiting for a spontaneous abortion
- Medicinal abortion (Cytotec)
- Curettage / Scraping
A special case is the bladder mole. Because of the risk of degeneration, a fast action required. In most cases a complete curettage takes place on the day of diagnosis or the next day.
Waiting for a spontaneous abortion
In principle, even in the case of restrained miscarriages, it is possible to wait for a spontaneous abortion to occur. In general "Success rate" of wait-and-see behavior in a missed abortion significantly lower than in the case of an incipient spontaneous miscarriage – depending on the study, a "successful" spontaneous abortion occurs in 16-76% of cases.
This can however up to 6 weeks take a long time or even not get going at all. There is a risk that Infection and thus a septic abortion This in turn can be life-threatening and permanently damage fertility.
In addition Risk of incomplete abortion in which then still medicamentous or by means of scraping must be intervened.
Nevertheless, many women decide to wait and see – and under control, this is also medically justifiable!
Alternatively to a wait-and-see approach, a drug abortion may also be an option.
In Germany, this is actually almost always Cytotec (misoprostol) used. It should be noted that Cytotec not approved for use in obstetrics is – it is an "off-label" use. However, this has more to do with the fact that Cytotec is very inexpensive and the manufacturer could therefore hardly earn money with such an approval.
Cytotec tablets are used for medication abortion in cases of Missed Abortion
Cytotec can be taken orally or vaginally in this case, the Success rate in Missed Abortion is about 75-85%.
As a result of the ingestion it may severe pain and bleeding come. Gastrointestinal side effects (diarrhea, vomiting, stomach pain, constipation) are also common. On the Internet you can find everything from "horror reports" to positive experiences.
In 10-15% of cases, a medical abortion with Cytotec starts, but is not "sufficiently strong" and there remain Remains in the uterus back. In these cases a curettage has to be performed after all.
Whether a medication abortion or a surgical intervention is the best solution also depends on what you feel best with!
Personally, I would not have been able to stand emotionally seeing the amniotic cavity (it has to come out!) and therefore decided against this option. However, since my HCG did not drop sufficiently after curettage at first, I took an additional round of Cytotec: nothing happened with me except for clear side effects.
curettage / scraping
Curettage in cases of missed abortion is nowadays mostly a suction curettage and thus, strictly speaking, not a scraping at all (in which blunt instruments are used).
This surgical procedure is actually a "routine procedure", which is usually performed by a physician <10 minutes needed and either in general anesthesia or under spinal anesthesia can be performed.
After the curettage there is usually only a short, light bleeding (most of it is already out!) and the HCG level drops again relatively quickly. Also for these reasons I have decided for a curettage myself.
A curettage is in >95% of cases successful – only very rarely must be scraped/sucked again. However there are risks, as with any surgical procedure – from complications of anesthesia to injuries and infections.
However, curettage probably increases the Risk of premature birth in subsequent pregnancies moderate. Another (although very rare!) complication represents the Asherman syndrome is a problem: As a result of too deep a scraping, scarring and adhesions of the uterus can occur, thus complicating subsequent pregnancies.
In spite of the risks I have decided for a curettage and I am very happy about it. I did not have any pain and there were no complications. I was very scared on the day of the procedure – but I felt much better immediately afterwards! In Miscarriage course of stork whispering* I report on my personal experiences with my two miscarriages – both from the Kurretage and from my spontaneous miscarriage