Spontaneous abortion

Spontaneous abortion, by definition, is the death of the fetus; it may increase the risk of spontaneous abortion in subsequent pregnancies.

Fetal death and premature delivery are classified as follows:

Miscarriage: death of the fetus or a shedding of the pregnancy product (fetus and placenta) prior to 20. SSW

Threatening or inevitable

Incomplete or complete

Between 20-30% of all women with a proven pregnancy bleed during the first 20 weeks of gravidity; half of these women suffer a spontaneous abortion. Thus, the incidence of spontaneous abortion is up to 20% of all proven pregnancies. For all pregnancies, the incidence is probably higher because some very early miscarriages are misinterpreted as late menstrual bleeding.

Etiology

Isolated spontaneous abortions can be caused by some viruses-particularly cytomegalovirus, herpes virus, parvo virus, and rubella virus-or by diseases that cause sporadic abortions or repeated miscarriages (z. B. chromosomal or Mendelian anomalies, luteal phase disorders), can be triggered. Other causes include immune disorders, severe trauma, and uterine abnormalities (z. B. fibroids, adhesions). In most cases, the cause is unknown.

Risk factors for spontaneous abortion include

Age> 35 years

Spontaneous abortion in the anamnesis

The use of certain substances (z. B. cocaine, alcohol, large amounts of caffeine)

A poorly controlled chronic disease (z. B. Diabetes, hypertension, manifest thyroid disease) in the mother

Subclinical thyroid disease, a retroverted uterus and minor trauma could not be verified as possible causes of spontaneous abortions.

Symptoms and complaints

Symptoms of spontaneous abortion include cramping lower abdominal pain, bleeding and eventual expulsion of tissue. A late spontaneous abortion can start with a gush of fluid when your water breaks. The bleeding is rarely heavy. An open cervix shows that the birth can no longer be stopped.

If remnants of the pregnancy remain in the uterus after a spontaneous abortion, bleeding may occur, occasionally with a delay of hours or days. In some cases, an infection also develops, causing fever, pain, and occasionally sepsis (called septic abortion Septic abortion Septic abortion is a threatening uterine infection during, just before, or after an abortion. Septic abortions often result from induced abortions caused by inexperienced physicians under. Learn more ).

Diagnosis

Usually sonography and quantitative determination of the beta subunit of human chorionic gonadotropin (beta-hCG)

Usually both a sonography and a quantitative determination of beta-hCG are performed not only to exclude an ectopic pregnancy, but also to clarify whether remnants of the pregnancy have remained in the uterus (which would speak for an incomplete rather than a complete abortion). Nevertheless, the findings, especially during an early pregnancy, are not necessarily conclusive.

A restrained abortion Must be assumed if uterus is not continuously enlarging in a timely manner, or if quantitative beta -hCG is too low as measured by gestational age or does not double within 48-72 hours. A restrained abortion is proven if any of the following circumstances are detected on ultrasound:

Disappearance of previously seen embryonic heart activity

Absence of cardiac activity at a crown-rump length> 7 mm

Absence of an embryonic shield (detected by transvaginal sonography) when the mean diameter of the gestational sac (average of 3 diameters measured in orthogonal planes)> 25 mm is

Treatment

Observation when abortion is imminent

Emptying the uterus when abortion has started, is incomplete or restrained

At threatened abortion the treatment consists of observation. However, it has not been proven that the risk of a subsequent complete abortion can be reduced by bed rest.

The therapy of the started, incomplete or restrained abortion is emptying of the uterus or waiting for spontaneous expulsion of the pregnancy product. Procedures for emptying the uterus include a suction curettage 12. Week of gestation, a cervical dilatation along with suction curettage from the 12. to 23. Week of gestation or drug induction Induced abortion IIn the United States, abortion of a previa fetus is legal, although there are state-specific restrictions (e.g. B. Mandatory waiting periods, gestational age restrictions) gives. Approximately. Learn more of the abortion in the> 16. up to 23. week of pregnancy (z. B. with misoprostol). The later the uterus is emptied, the greater the likelihood of placental hemorrhage, uterine perforation by the long bones of the fetus, and difficult cervical dilation. These complications can be prevented by preoperative use of an osmotically active cervical dilator (z. B. Laminaria pen) of misoprostol or mifepristone (RU 486) decrease.

In cases of suspected complete abortion Uterine emptying does not need to be performed routinely. Uterine emptying may occur if bleeding and/or other signs develop as an indication of restrained pregnancy components.

After a induced or spontaneous abortion parents may experience grief and guilt. They should receive psychological support, and in the event of a spontaneous abortion, they will be told that it was not their behavior that caused it. Psychotherapy is rarely indicated, but should be provided.

Important points

Spontaneous abortion is likely to occur in approximately 10-15% of pregnancies.

The cause of an isolated spontaneous abortion is usually unknown.

An open cervix indicates that the abortion is unstoppable.

Spontaneous abortion must be confirmed and its type determined by clinical criteria, sonography, and quantitative beta-hCG measurement.

Uterine evacuation is ultimately necessary when abortion has begun, is incomplete, or is restrained.

Often, emptying of the uterus is not required in cases of threatened or complete abortion.

After spontaneous abortion, psychological support should be offered to the parents.

Repeated miscarriages

Etiology

Causes of recurrent miscarriages may be maternal, fetal, or in the placenta.

Common Maternal Causes are

Uterine or cervical abnormalities (e.g. B. polyps, fibroids, adhesions, cervical insufficiency)

Maternal (or paternal) chromosomal abnormalities (z. B. balanced translocations)

Manifest and poorly controlled chronic disease (z. B. hypothyroidism, hyperthyroidism, diabetes mellitus)

Placental Causes are preexisting chronic diseases that are poorly controlled (z. B. systemic lupus erythematosus, chronic hypertension).

Fetal Causes are usually

Chromosomal or genetic abnormalities

Whether repeated history of miscarriage increases the risk of fetal growth retardation and preterm delivery in subsequent pregnancies depends on the cause of the miscarriages.

Diagnosis

Tests to identify the cause

The diagnosis of repeated miscarriages is clinical

To determine the cause of recurrent pregnancy loss, the following tests should be performed:

Genetic workup Genetic workup Genetic workup is part of routine prenatal care and is ideally done before conception. The extent of genetic testing desired by a woman. Learn more (karyotyping) of both parents and all pregnancy products as clinically indicated to rule out possible genetic causes

Screening for acquired thrombotic disease: Anticardiolipin antibody (IgG and IgM), anti-beta2-glycoprotein I (IgG and IgM), and lupus anticoagulant

Hysterosalpingography or sonohysterography to investigate structural uterine abnormalities

However, in up to 50% of cases, the cause cannot be determined. Screening for hereditary thrombotic disease is no longer routinely recommended unless monitored by a prenatal medicine specialist.

Treatment

Treatment of the cause, if possible

Some causes of recurrent pregnancy loss can be treated. If the cause is not found out, the chance of a live birth in the next pregnancy is 35-85%.

Key points

Causes of repeated miscarriages may be maternal, fetal, or placental.

Chromosomal abnormalities (especially aneuploidy) can cause 50% of recurrent pregnancy losses.

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