The term “miscarriage” refers to a termination of pregnancy that occurs spontaneously within the first 180 days of pregnancy

In the majority of cases, however, miscarriage occurs during the first trimester of pregnancy.

It is a much more common condition than is generally believed: it is estimated that it can affect up to 30% of pregnancies.

What is miscarriage?

Miscarriage can be “complete” (characterised by the complete spontaneous expulsion of the lifeless embryo or foetus); or “incomplete” or “retained” (when the pregnancy is still partially or completely present in the uterine cavity, but there is no cardiac activity of the embryo or foetus).

What are the causes of miscarriage?

There are many different causes of miscarriage.

These include

• chromosomal abnormalities (this is certainly the most frequent cause of miscarriage. The frequency increases with maternal age);
• congenital malformations (septum, unicorn, etc.) or acquired malformations (polyps, fibroids) of the uterus;
• cervical incontinence (the cervix tends to dilate at a very early stage of pregnancy, even in the absence of contractions, leading to expulsion of the foetus);
• autoimmune or thrombophilic diseases (i.e. where there is an increase in blood clotting);
• infectious diseases such as toxoplasmosis, rubella, cytomegalovirus infection that can infect the foetus and cause it to suffer and then die;
• untreated vaginal infections;
• insufficiency of the corpus luteum, which does not produce enough progesterone, the hormone that promotes implantation and maintenance of pregnancy in the first trimester.

What are the symptoms of miscarriage?

There are silent miscarriages, i.e. without any symptoms (in this case, the diagnosis is clinical, through the obstetric ultrasound scan).

In other cases, however, the abortion is manifested by blood loss or uterine contractions.

The symptoms of a miscarriage can be very different from each other and vary according to the different clinical situations.

How can a miscarriage be prevented?

Preventive treatments for miscarriage differ greatly depending on the cause of the miscarriage.

Rest is generally the first and foremost treatment that is recommended if a miscarriage is threatened.

Progesterone-based preventive therapy can be effective in cases where corpus luteum insufficiency is suspected.

In cases of autoimmune diseases (such as antiphospholipid syndrome) or excessive thrombophilia, heparin or acetyl salicylic acid may be prescribed.

In cases of cervical incompetence, cerclage of the cervix will be performed.

Diseases such as diabetes or thyroid disease should be treated before pregnancy.

Diagnosis

The diagnosis of miscarriage is generally based on:

• gynaecological examination;
• ultrasound examination.

The following may also be prescribed:

• pregnancy test;
• plasma dosage of the beta fraction of the pregnancy hormone (HCG). HCG is produced from implantation in the uterus and increases steadily until the third month of pregnancy. Its changes are useful for understanding whether or not a pregnancy is developing.

Treatments

Once a miscarriage has been diagnosed, there are generally two possible courses of action:

1) surgical treatment: this is known as “curettage” by hysterosuction. In practice, the abortion material retained in the uterine cavity is sucked out through a cannula inserted through the cervical canal.

2) in some cases it may be decided to wait for the spontaneous expulsion of the abortive material from the uterus or to facilitate its expulsion by administering drugs that facilitate uterine contraction. This is known as ‘wait-and-see behaviour’, which is applied mainly in cases of incomplete abortion (more rarely in the case of internal abortions), and especially if the abortion occurred in the initial weeks of pregnancy.

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Source:

Humanitas