Center of Excellence in Gynecology informs: Abortion, miscarriage
Definition of miscarriage
Specialists in gynecology speak of a miscarriage when the pregnancy is terminated before the 24th week of pregnancy. week of pregnancy ends, and the embryo or fetus (lat. Fetus) weighed less than 500 grams. Often manifested by vaginal bleeding or pain in the lower abdomen. At a later stage of pregnancy, amniotic fluid may also be shed.
Gynecologists distinguish different types and processes of miscarriage:
- Imminent miscarriage (abortus imminens): Despite vaginal bleeding or. Despite pain in the lower abdomen, the cervix remains closed and the pregnancy can continue.
- Abortion in progress: the cervix is open, bleeding is heavy, the miscarriage can no longer be stopped by the gynecologist.
- Incomplete miscarriage (abortus incompletus): the embryo or. Fetus is usually expelled, but part of the placenta remains in the uterus.
- Complete miscarriage (abortus completus): the pregnancy tissue is completely expelled, there are no remnants left in the uterus.
- Septic miscarriage: Together with the miscarriage (abortion), an infection occurs in the uterus. Pain, nausea, fever, chills, vaginal bleeding or discharge may occur.
- Behavioral miscarriage (Missed Abortion): the fruit has died but is not spontaneously expelled by vaginal bleeding.
- Repeated miscarriage (abortus habitualis): This is referred to from the third miscarriage onwards.
The most common cause of miscarriage, according to gynecologists, is a defect in the child’s genetic makeup. This includes in particular a trisomy. The child has a triple set of chromosomes instead of a double set.
Synonyms and related terms
Synonyms: Abortion, abortus
English: miscarriage, abortus, abortion
Miscarriage is a dramatic and terrible event for those affected by it. It is very common and occurs mainly in the first 12 weeks of pregnancy. The clinically recognized rate is between 10 and 15 percent. However, the number of abortions is probably much higher because most of them go unnoticed. The women had not yet noticed their pregnancy and perceive the bleeding triggered by the miscarriage as delayed menstruation. As the pregnancy progresses, the risk of the embryo or fetus dying and being rejected continues to decrease.
Not infrequently, no embryo has developed at all. Early abortions in the first eight weeks of pregnancy are in most cases a so-called abortive fruit or "wind egg". Although the placenta and amniotic cavity indicate pregnancy, the gynecologist cannot recognize a child in the amniotic sac. The egg has migrated to the uterus after fertilization and has nested there, but the fetal body cells do not continue to grow, organs and extremities do not form. The fruit eventually dies. If pregnancy has already been established, vaginal bleeding should be taken very seriously and should definitely be clarified by a specialist in gynecology. They may have been caused by an abortion, but do not necessarily mean that the embryo or fetus has died.
Causes of abortion, miscarriage
Specialists in gynecology identify many different causes of miscarriage (abortion). This includes:
- Chromosomal defects of the parents
- Numerical aberration or chromosomal mutation
- Malformations of the uterus
- Blood clotting disorders
- hormonal disorders
- Rejection reactions of the mother
- age of the woman
Specialists in gynecology suspect that external influences, such as ionizing radiation (X-rays), but also alcohol, drugs and medications, can also promote abnormal development of the unborn child, or. can trigger. A deficiency of the corpus luteum hormone progesterone, which is necessary for maintaining pregnancy, can also lead to miscarriage (abortion). An older age of the woman as well as extreme psychological stress are further risk factors. Often there are several causes that lead to a miscarriage (abortion).
What you can do yourself in case of miscarriage (abortion)?
If you experience bleeding during pregnancy, you should see your gynecologist immediately. It is also advisable to consult a gynecologist if there is pain in the lower abdomen or if the typical signs of pregnancy, such as nausea and tightness in the breasts, suddenly disappear. Through a physical examination and through an ultrasound examination, he can determine:
- Whether the pregnancy still exists
- Whether the pregnancy can be maintained
- Whether the fruit is already dead
- What type of miscarriage (abortion) is involved
- Whether medication needs to be given to stop the miscarriage (abortion)
- Whether a curettage is necessary
Affected couples and women should consult a gynecologist in detail after an abortion. Often need individual emotional and psychological support. Your specialist in gynecology can provide you with contacts where you can find further help.
Help from the specialist
Depending on the specificity of the symptoms, further detailed diagnostics can be carried out by various medical specialists on the basis of a discussion with your doctor. These include:
What to expect from your gynecologist doctor?
Before your gynecologist begins an examination, there will be an introductory discussion (medical history) about your current symptoms. As part of this, he will also ask you about past complaints and any existing diseases.
You can expect the following questions:
- How long have the symptoms existed?
- Can you make a precise characterization and, if necessary, localization?
- Have there been changes in the course of the symptoms?
- Do you suffer from additional symptoms, such as shortness of breath, chest pain, dizziness
- Have you suffered from this condition before and do these signs run in your family?
- Are there currently pre-existing conditions or hereditary diseases and are these being treated?
- Are you currently taking medication?
- Are you aware of any allergies?
- Do you suffer from stressful conditions in everyday life?
What medications you take regularly?
Your gynecologist will need an overview of the medications you regularly take. Even before you visit your gynecologist, compile an overview of the medications you take in a table. You can find a template for the overview here.
Examinations (diagnostics) by the gynecologist
Based on the symptom characteristics obtained in the previous anamnesis and the current condition, the specialist in gynecology can now apply the following diagnostics:
- Physical examination
- Ultrasound examination (sonography)
- Determination of the beta-HCG level
Through the ultrasound examination, the gynecologist will determine whether the embryo or. Fetus is still alive or has already died. After a complete miscarriage (abortion), the uterus is empty and has often already contracted again. In the case of an incomplete miscarriage (abortion), on the other hand, parts of the placenta may still be present in the uterus. These are then removed by the gynecology specialist.
If the miscarriage has been diagnosed, the gynecologist will discuss with you whether further treatment (therapy) is necessary. If the pregnancy tissue has been completely shed, it is often sufficient to wait until the beta-HCG serum level is back at zero. Beta-HCG is a hormone produced by a part of the placenta during pregnancy. It can be detected in the urine and blood.
If pregnancy tissue is still present, the gynecology specialist will complete the miscarriage as soon as possible to avoid complications for the woman. Questioning:
- Drug treatment (therapy) over several days
- small surgical procedure, a scraping (curettage)
During curettage the remaining pregnancy tissue is removed from the uterus under general anesthesia. Usually a teat or spoon is used for this purpose.
If the cervix is still closed and the heart sounds of the unborn child can be heard, the gynecologist will do everything possible to preserve the pregnancy. Bed rest and an inpatient stay in a clinic are then required. Magnesium tablets can be prescribed to suppress labor activity. Threatens an abortion after the 22. week of pregnancy, labor-inhibiting drugs are administered by the gynecologist. If the fruit has died but not been rejected, the abortion must be induced with medication. Curettage is then performed.
Prevention (prophylaxis, prevention)
A miscarriage is usually caused by many factors. Often the gynecologist cannot determine an exact cause. To reduce the risk of miscarriage, make sure you eat a healthy balanced diet during pregnancy. Avoid stress, don’t drink alcohol, don’t smoke and keep caffeine intake low.
Many women who have had an abortion have a desire to get pregnant again quickly. The risk of losing the unborn child again increases the more often the pregnancy ends prematurely. After three miscarriages, the risk is about 45%. Talk to your gynecologist about how to avoid possible risks.