Threatened miscarriage - how to detect and treat it?

Pregnancy is a special period in a woman’s life However, namely during pregnancy, the body loses the major part of its protective qualities becoming more vulnerable to adverse factors, especially in the case of existing health problems. According to sad statistics, about 15% of all clinically confirmed pregnancies result in the loss of a baby and every second expectant mother is familiar with the diagnosis of “threatened miscarriage”.

Short information about threatened miscarriage

What is a miscarriage?

Miscarriage is an involuntary ending of pregnancy occurring before the 20th week of pregnancy when the fetus's weight is less than 500 g (1.1 lbs). More than 80% of miscarriages happen before the 12th week of pregnancy. This is a term during which the initial development of the fetus’ organs occurs so any impact can have a negative effect. Frequently, at this early term, a woman is unaware of pregnancy and can think of bleeding as a period. It is a dangerous situation that can cause serious health damage if the fetus is not completely removed from the body.

If a threatened miscarriage occurs after 22nd week of pregnancy, then it is premature birth, and babies weighing over 650 g (1.4 lbs) can be successfully nurtured thanks to the achievements of modern medicine and experienced doctors.

Symptoms that must not be ignored

The main symptom of threatened miscarriage is vaginal bleeding. Regardless of its intensity, duration, and blood color, it is a cause to seek emergency help from a specialist.

Another worrisome symptom is the occurrence of nagging pain in the lower abdomen spreading to the back or genitalia. Such painful sensations indicate hypertonicity of the uterus and the body's attempt to get rid of the developing fetus.

It can turn out that the causes of bleeding and unpleasant sensations are far less dangerous but these symptoms must not be neglected.
In the case a disappointing diagnosis is made to the expectant mother, the task of the doctors is to do everything possible to extend the pregnancy up to a safe period.

The main reasons for the threat of early termination of pregnancy

The threat of miscarriage can be triggered by a number of reasons and not in every case it is possible to establish the true problem.

Nevertheless, every woman should be aware of the factors that can lead to it:

- Any inflammatory and infectious diseases in which the body temperature rises above 38 C (100.4 F) is a serious threat to the pregnancy. The leaders on this list are rubella, chlamydia, hepatitis, toxoplasmosis, and syphilis. Even the sore throat familiar to everyone at the initial stage can be fatal. Progesterone, a hormone produced initially by the yellow egg and subsequently by the placenta, is needed to maintain pregnancy and fetal development. Lack of progesterone can lead to the rejection of an already fertilized egg.
- High levels of male hormones is another reason for termination of pregnancy since it suppresses the production of female hormones.
- Severe stress, along with hard physical labor and an unhealthy lifestyle, deplete the body of the expectant mother, making it unable to bear the fetus for the required period. In case of excessive emotional stress, the doctor decides on the need to prescribe sedatives.
- Various gynecological problems such as the presence of stitches or abnormal development of the uterus pose a serious threat to the bearing of the fetus. The non-standard shape (two-horned, saddle-shaped) does not allow the fertilized egg to gain a foothold and stay in the endometrium.
- Uncontrolled use of a variety of medications during pregnancy can trigger a miscarriage. Even herbs that seem safe at first glance should only be consumed only if your doctor approves.
- Genetic malformations of the fetus are the main reason why there is a threat of miscarriage. Pathology is the result of a single mutation, in which the development of the embryo stops, which leads to its subsequent death. The development of such pathologies is perhaps the only one of the factors listed above, in which medicine is powerless.

Who is at additional risk?

Not a single woman is insured against involuntary termination of pregnancy, and yet there are a number of factors that increase the risk and require more attention from the expectant mother and additional control from the observing doctor:

- If the age of the expectant mother exceeds 35 years, the threat of miscarriage increases significantly. After conducting a number of studies, doctors argue that the risk of termination of pregnancy after 30 years increases 2 times, after 40 years the probability of bearing a child decreases to 20%. Doctors associate a similar problem with the aging of eggs, which nature endows a woman with and birth and losing their vitality as they grow older. Postponed diseases, accumulation of toxic substances negatively affect the ability of eggs to conceive.
- It is necessary to inform the supervising doctor about the presence of chronic gynecologic and endocrine diseases even before the pregnancy occurs. Often, such a problem as diabetes mellitus develops in parallel with the growth of the fetus. Being under the constant supervision of a specialist, a woman increases the chances of delivering a child.
- A new pregnancy shortly after a recent birth is a serious factor that can lead to the inability of the body to bear the baby. According to doctors, a new pregnancy should be avoided for at least three months after giving birth.
- If a woman has previously faced the problem of spontaneous abortion, the threat of miscarriage will also be present during the subsequent conception. According to the observations of specialists, in the case of two consecutive miscarriages, almost every new pregnancy cannot be saved to the end, if the necessary examination has not been previously carried out and the appropriate treatment has not been received.
- Medicine knows many cases when the genetic incompatibility of the father and mother led to the rejection of the fetus. Parents who do not have the same rhesus factor (Rh factor) in their blood are at the greatest risk zone. If the mother has a negative, and the father has a positive Rh factor, a situation may arise in which the female body, perceiving the developing fetus as a foreign body, tries, by all means, to get rid of it.
- Modern women prefer to lead an active lifestyle and work until late pregnancy term. On the one hand, such activity can only be welcomed, since physical mobility helps the expectant mother to easily endure the rather difficult process of the upcoming birth. However, if a woman has to constantly experience excessive loads, lift weights, then this is a serious reason to think about changing jobs or going on maternity leave as soon as possible.

What to do if you suspect a threatened miscarriage?

Even with the slightest suspicion, you should immediately contact a specialist. It is very important to do not panic. Your peace of mind and timely medical care in most cases help to maintain the pregnancy.

Noticing bloody discharge, indicating a possible detachment of the chorion the membranes of the embryo, with which it is held on the walls of the uterus, you should lie down and call an ambulance. Trying to get to a medical facility on your own in such a state is not worth it.

If the doctor suspects the threat of miscarriage, a number of tests and examinations will help to clarify the situation and identify the degree of danger. First of all, the specialist will check the heartbeat of the developing fetus. Ultrasound examination will help to find out about the state of the placenta and embryo, and also show possible pathologies of the structure of the uterus. Examination by a gynecologist will determine the presence of excessive tone.

Treatment methods

After a thorough examination and determining the level of danger, the doctor will prescribe conserving therapy. In the case when the risk of termination of pregnancy is especially high, the expectant mother is left for treatment in the hospital until her condition stabilizes and the threat of miscarriage is eliminated. If the condition does not cause serious concern, a woman can undergo treatment at home, provided that the doctor's orders are followed and complete calmness is maintained, for which she will be prescribed sedatives on a natural basis.

Treatment aimed at maintaining pregnancy includes the following steps:

1. Hormone therapy. If the threat of miscarriage was caused by hormonal disorders, the pregnant woman will be prescribed treatment with the main hormone necessary during this period progesterone. Taking drugs (usually Utrogestan or Duphaston) is prescribed according to a special scheme and is used until 16 weeks of pregnancy are reached. By this time, the mature placenta begins to produce the necessary hormones on its own and there is no need to obtain hormones artificially, but it is very important to know that abrupt cessation of progesterone use can cause spontaneous abortion. Cancellation of the drug should occur in stages, by reducing the dose entering the body on a weekly basis.
2. Medicines to decrease tone. The appointment of antispasmodics can reduce the tone of the uterus and reduce pain. The most common drugs that can be used until the pain disappears completely: papaverine (suppositories) and drotaverine (tablets).
3. Vitamin support. In any case, the expectant mother will be prescribed vitamins, which will not only strengthen the body as a whole but also contribute to the fact that the threat of miscarriage will be minimized. The use of folic acid during the first trimester as a separate drug or as part of a vitamin complex will prevent the development of neural tube defects in the embryo.

How to avoid the threat of miscarriage: preventive measures

Given the number of factors that affect the course of pregnancy, it is impossible to find a magic formula in which the threat of miscarriage is reduced to zero. And yet, some preventive measures will help reduce the risk of complications to the minimum possible:

- A comprehensive examination, which is desirable for both the expectant mother and the father, will allow identifying possible genetic incompatibility and beginning measures to preserve pregnancy at the earliest stage if the problem is confirmed.
- Timely visits to the gynecologist and the delivery of the necessary tests will help to detect and prevent the development of vaginal infection in time.
- In case of existing hereditary diseases transmitted through the maternal line, be sure to inform your supervising doctor about this.
- Every pregnant woman should pay double attention to the consumed food. Before use, all the ingredients that make up the menu of the expectant mother should be subjected to the necessary processing to avoid food infections that can lead to fetal death.
- You should stop using alcohol, cigarettes, and drugs for several months before planning a pregnancy.
- Do not overestimate your strength. Do not refuse the offered help with chores. If your work is connected with great physical and emotional stress, take a sick leave to undergo a course of supportive therapy.
- Tune in to a positive course of pregnancy, even if earlier in your life there was a threat of miscarriage, and the previous pregnancy could not be saved. Talking to a psychologist and consulting a doctor will help you to survive the bitterness of loss until the onset of a new pregnancy.

The time you expect your baby is the moment when neglecting the advice of a specialist can become a fatal mistake. You should not self-medicate, if you suspect you should consult with your doctor.

Post by Karen Willson, gynecologist at Mother and Baby Centre, London, UK