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Threatened and Recurrent Spontaneous Abortions
Spontaneous abortion, or miscarriage, refers to the unplanned evacuation of the fetus from the uterus (womb). Almost 20% of all pregnancies end in spontaneous abortion. About 75% of all spontaneous abortions occur in the first trimester of pregnancy, generally between the 4th and 10th weeks.
Reasons for miscarriage can be variable and include fetal genetic abnormality (most common), structural defect in the uterus, or a maternal hormonal imbalance. Maternal stress, or infection (i.e. syphilis ) can also result in miscarriage. Heavy smoking, alcohol use, drug abuse, and/or poor nutrition also contribute to the possibility of miscarriage. Those women who have had three or more spontaneous abortions (in a row) should have tests done to determine the cause.
Situations where women have pain and/or vaginal bleeding without documented abortion, are referred to as threatened abortion. This group will have an increased risk of spontaneous abortion, however, up to 40% of all pregnant females will have some degree of bleeding in the first trimester of pregnancy.
Symptoms of Spontaneous Abortions
Common symptoms of spontaneous abortion include severe, cramping abdominal pain that is often accompanied by vaginal bleeding. The patient may complain of passing blood clots. Care should be given to the inspection of the clots to be certain they are not fetal tissue. A clot should dissolve (or at least breakup) in water, however, fetal tissue will remain whole. Bring any expelled tissue to your physician for evaluation.
Evaluation and Treatment of Spontaneous Abortions
Evaluation will include history and physical examination. The patient will have a pelvic examination performed to see if the cervix is open or closed. An open cervix indicates a miscarriage is in progress. Occasionally, the abortion can be diagnosed at the time of examination. In cases where there is a question of fetal survival, pregnancy ultrasound can be used to judge fetal viability.
In some early pregnancies (less than 5 weeks) fetal viability may be indeterminate, secondary to the limitation of ultrasounds accuracy in the early stages of pregnancy. In these cases, ultrasound and blood pregnancy testing should be repeated in 2-3 weeks to look for a change in the absolute level of human chorionic gonadotropin (HCG).
Treatment for threatened abortion is conservative. Bed rest, plenty of fluids, avoidance of exertion (no intercourse), and avoidance of aspirin or anti-inflammatory agents is suggested. Most women may resume regular work and activities one full day after bleeding or pain has stopped.
Treatment for some complete abortions, and all incomplete abortions, requires D and C (dilatation and currettage). In this procedure, the endometrial lining (inner lining) is cleared out and allowed to recycle making a future pregnancy possible. Complete abortions do not always require D and C. The OB-GYN physician is the expert in the treatment of this problem.
Patients inevitably feel guilty after the miscarriage. Grief and anger are common reactions. Patients will feel guilty for engaging in too much exercise, frequency of intercourse, or for another aspect of self care. It must be stressed that most often these factors ARE NOT RESPONSIBLE for the miscarriage. Family and physician support are helpful.
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