Miscarriage - Causes and prevention

Miscarriage is the cessation of pregnancy by itself while still pregnant (before the gestational age reaches 20 weeks). The causes of miscarriage vary from person to person, for example due to illness suffered by pregnant women or due to the fetus not developing normally.

Miscarriage can be characterized by bleeding from the vagina, as well as pain or cramping in the abdomen and lower back. When symptoms or signs of danger of pregnancy appear, pregnant women are advised to immediately contact a doctor to get treatment as soon as possible.

There are no specific steps to prevent miscarriage. In general, the prevention of miscarriage is done by keeping the condition of pregnant women healthy.

Miscarriage Characteristics

The main characteristic of a miscarriage is bleeding from the vagina during early pregnancy, either in the form of spotting or flowing. These symptoms may be accompanied by abdominal pain or cramping, and lower back pain. In addition to blood, thick fluid or blood clots and tissue can also come out.

The characteristics of miscarriage in pregnant women vary according to the stages of the miscarriage, including:

  • Miscarriage unavoidable (abortion insipiens)

    In abortus insipiens, the fetus has not come out of the womb. However, pregnant women have experienced bleeding and the opening of the birth canal (cervix), so miscarriage cannot be avoided.

  • Miscarriage no complete (incomplete abortion)

    In the incomplete abortion stage, the fetal tissue has been expelled but only partially.

  • Complete miscarriage (complete abortion)

    It is said to be a complete abortion, when all the fetal tissue has been expelled from the uterus.

Sometimes, a miscarriage can also occur without bleeding. This condition is called missed abortion.

When to go to the doctor

It should be noted that not all vaginal bleeding during early pregnancy is a sign of miscarriage. Normal pregnant women experience spotting of blood from the vagina 6-12 days after conception, which is when the fetus attaches to the uterine wall. This bleeding is called implantation bleeding. But it is usually at this time, a woman has not realized that she is pregnant.

Although it can be normal, bleeding from the vagina in the first trimester of pregnancy should be suspected of a threat of miscarriage (abortion imminens), so it is necessary to immediately consult a gynecologist. If indeed a miscarriage has not occurred, the doctor can take treatment to prevent it.

In addition, pregnant women also need to immediately see a doctor if they experience the following complaints in the first trimester of pregnancy:

  • Fever
  • Vomiting until you can't eat and drink
  • vaginal discharge
  • Pain when urinating

Causes of Miscarriage

The causes of miscarriage are very diverse, and sometimes can not always be determined with certainty. In general, miscarriages occur due to abnormal fetal development due to genetic disorders or problems in the placenta.

In addition, miscarriage can also be caused by:

  • Chronic illness, such as diabetes or kidney disease.
  • Autoimmune diseases, eg lupus and antiphospholipid syndrome.
  • Infectious diseases, such as toxoplasmosis, rubella, syphilis, malaria, HIV, and gonorrhea.
  • Hormonal disorders, such as thyroid disease or PCOS.
  • Abnormalities of the uterus, such as a weak cervix (cervical incompetence) and fibroids.
  • Medications taken, such as non-steroidal anti-inflammatory drugs, methotrexate, and retinoids.
  • Abnormalities in the uterus, such as the cervix.

There are a number of factors that make a pregnant woman more at risk of having a miscarriage, including:

  • Pregnant over the age of 35 years
  • Have had a miscarriage before
  • Smoke
  • Consuming alcoholic beverages
  • Abusing drugs
  • Excessive stress

Not the Cause of Miscarriage

There are many myths or misconceptions about miscarriage. Therefore, not a few pregnant women are reluctant to do certain things because they are worried that it can cause miscarriage. It should be reiterated, the following conditions do not cause miscarriage:

  • Sports, but can be discussed again with the obstetrician regarding the appropriate exercise.
  • Eat spicy food.
  • On a plane.
  • Have sex.
  • Work, except for jobs where there is a risk of exposure to chemicals or radiation.

Miscarriage Diagnosis

When pregnant women experience symptoms of miscarriage, the obstetrician will perform a physical examination, including an internal examination. In addition to asking for symptoms and checking the physical condition of the pregnant woman, the doctor will perform an ultrasound examination to determine whether the pregnant woman has miscarried or not.

In addition to ultrasound, blood tests are also done to check levels of the hormone HCG, which should increase during pregnancy.

Repeated Miscarriage

If a pregnant woman experiences repeated miscarriages (habitual abortion) it is necessary to find out the factors that could be the cause. For that, the obstetrician will perform the following examinations:

  • Transvaginal ultrasound examination

    Through transvaginal ultrasound, doctors can examine the condition of the uterus in more detail, to detect abnormalities.

  • Gene check

    This examination aims to check whether there are genetic abnormalities in the patient or his partner.

  • blood test

    This test is done to check for certain disorders that can cause a miscarriage, such as hormonal disorders, blood clots or coagulation, and infections.

Miscarriage Management

Treatment for miscarriage varies depending on the stage of the miscarriage. The main principle of treatment is to prevent bleeding or infection. The following are some of the treatments for miscarriage according to the stages experienced:

Threat of miscarriage

If the miscarriage has not occurred, but there is a threat in that direction, the doctor will advise pregnant women to rest completely in bed. Ask your obstetrician clearly, how long you need to rest completely in bed and what things you should avoid.

Even so, pregnant women still have the risk of having a miscarriage. That is why, sometimes doctors also give hormone drugs to strengthen the womb.

Miscarriage that tno dapat davoid and kmiscarriage tno lcomplete

If a pregnant woman has been declared to have had a miscarriage, whether the fetus has not come out at all or has been partially expelled, the rest of the fetus can come out naturally from the uterus within 1-2 weeks. But this waiting process has the potential to cause emotional stress for the mother. Therefore, doctors tend to recommend treatment with drugs or surgery.

The drugs given aim to speed up the process of removing the remaining tissue from the uterus, which is within 24 hours. This medicine can be taken by mouth or directly inserted into the vagina. In addition to drugs to help deliver the fetus, obstetricians can also give antibiotics to prevent infection and anti-bleeding drugs to reduce bleeding.

In addition to drugs, doctors can perform a curettage in dealing with miscarriage. This minor operation is performed by dilating the cervix (neck of the womb) and using a special tool to remove the tissue from the uterus and the fetus. Curettage needs to be done as soon as possible if the pregnant woman experiences heavy bleeding or signs of infection appear.

Miscarriage lcomplete

In miscarriages with all fetal tissue expelled, no further treatment is required. Medicines may be given by the doctor to overcome other complaints that the patient feels.

Post Miscarriage Recovery

The time it takes for recovery after a miscarriage is a few days to a week. However, many times pregnant women who have just had a miscarriage experience emotional shock, or even depression after a miscarriage. This condition takes longer to recover. Therefore, it is very necessary support from spouse and family.

A woman will get her period again 1 to 1.5 months after the miscarriage, and can get pregnant again in a healthy way.

Miscarriage Leave

According to the Law of the Republic of Indonesia Number 13 of 2003 concerning Manpower, Article 82 paragraph 2, a female worker is entitled to 1.5 months leave or according to a doctor's certificate, if she has a miscarriage.

This is to give a woman time to rest until her physical and emotional condition recovers.

Miscarriage Prevention

Because miscarriage is affected by a variety of factors, it is difficult to determine the specific steps that need to be taken to prevent miscarriage. But in general, there are several ways that can be done to prevent miscarriage, namely:

  • Implementing a healthy diet with balanced nutrition, especially increasing the consumption of foods that contain fiber.
  • Maintain a normal weight.
  • Do not smoke, do not consume alcoholic beverages, and do not abuse drugs.
  • Receive vaccines as recommended by doctors to prevent infectious diseases.
  • Treating causes of miscarriage that have been detected, for example injecting blood-thinning drugs if you have antiphospholipid syndrome.

Miscarriage Complications

Miscarriage risks causing infection due to the rest of the fetal body tissue that is still left in the uterus. This condition is called a septic abortion. Symptoms to watch out for from septic abortion are fever, chills, vaginal discharge, and hardening of the lower abdomen.

In addition, placental tissue that is still left in the uterus is also at risk of causing bleeding, which can lead to anemia or even shock.