Understanding and How to Handle Miscarriage During Pregnancy

Miscarriage

Miscarriage is a condition where the pregnancy stops automatically while still pregnant or the fetus dies in the womb before the gestational age reaches 20 weeks. The causes of miscarriage vary from person to person, for example due to illness suffered by the pregnant woman or due to the fetus not developing normally. Miscarriage can be characterized by bleeding from the vagina, as well as pain or cramps in the stomach and lower back. Miscarriage is a risk that can occur in every pregnancy. However, this condition can be prevented by detecting signs of miscarriage as early as possible. In this way, pregnant women can receive immediate treatment so that the risk of fetal death can be reduced. Actually there are no specific steps to prevent miscarriage. In general, miscarriage prevention is done by keeping pregnant women healthy.

Signs of miscarriage

The following are several signs of miscarriage that pregnant women should be aware of and should immediately take to the hospital to get medical help:

1. Bleeding.
   Bleeding or spotting of blood is an early sign of miscarriage. But not all bleeding will end in miscarriage. Light bleeding with pink or brown spots is usually nothing to worry about. Light bleeding also generally lasts for 1-2 weeks. However, if what comes out is bright red blood with a large volume or pink clots, it could be that the bleeding indicates a miscarriage. Contact a doctor immediately if you experience bleeding, whether light or heavy.
2. Painful.
   If bleeding is accompanied by pain, you should be wary of it as a sign of miscarriage. The parts of the body that feel pain are usually the pelvis, stomach and back. This pain usually feels more intense than menstrual pain and can appear continuously or occasionally.
3. Baby’s movements decrease.
   In general, miscarriage occurs when the gestational age has not reached 20 weeks. However, late miscarriage can occur at 12–24 weeks of gestation. One sign of late miscarriage is a decrease in the baby’s movement. Therefore, pregnant women need to be alert if the fetus does not move for several days and immediately have the pregnancy checked by a doctor.
4. Changes in pregnancy symptoms.
   Changes in pregnancy symptoms, such as no longer feeling nauseous or vomiting, can be a sign of miscarriage. However, keep in mind that these changes can also occur due to other factors, such as pregnancy hormones. Therefore, consult a doctor if pregnant women feel changes in pregnancy symptoms.
5. Discharge of fluid or tissue from the vagina.
   Fluid or tissue coming out of the vagina can be a sign of miscarriage. If a pregnant woman experiences this condition, place the tissue in a clean container, then take it to the doctor for further analysis. Bleeding in the early trimester is not always related to miscarriage, because many pregnant women are still able to continue the pregnancy and give birth to a healthy baby.

The following are various types of miscarriage (abortion) that you need to know:

1. Imminent abortion
   Imminent abortion/threat of abortion is vaginal bleeding with or without abdominal pain, the cervix is ​​still closed, and the fetus is still alive and in the uterus (viable). Symptoms include bleeding and lower abdominal cramps, but the cervix is ​​still closed. In this type of abortion, the fetus has not actually aborted. Symptoms of threatened abortion can come and go over several days or weeks. Some pregnant women can get through this phase and continue their pregnancy healthily and safely, although others cannot. However, pregnant women should regularly check with their doctor so that undesirable things don’t happen. The doctor will advise pregnant women to rest completely in bed. Ask your obstetrician clearly, how long pregnant women need to rest completely in bed and what things should be avoided. Even so, pregnant women still have the risk of having a miscarriage. That is why, sometimes doctors also give hormone medication to strengthen the womb.
2. Complete abortion
   A pregnant woman is said to have experienced a complete abortion if all fetal tissue or products of conception have exited the uterus. This type of miscarriage is usually characterized by the cervix opening wide and bleeding from the vagina which looks like clotted menstruation, but is accompanied by severe abdominal pain and cramps. Symptoms of complete abortion appear because the uterus tries to empty its contents from damaged tissue. Usually, complete abortion occurs at less than 12 weeks of gestation. In a miscarriage where all the fetal tissue has been expelled, no further treatment is needed. The doctor may give medication to treat other complaints that the patient is experiencing.
3. Incomplete abortion
   Incomplete abortion occurs when some fetal tissue remains in the uterus. The symptoms of one type of miscarriage are not much different from a complete abortion, namely bleeding and cramps in the lower abdomen. The remaining tissue in the mother’s stomach must be removed completely to prevent complications.
   If a pregnant woman has been declared to have had a miscarriage, whether the fetus has not come out at all or has come out partially, the remaining fetus can come out naturally from the uterus within 1-2 weeks. However, this waiting process has the potential to cause emotional stress for the mother. Therefore, doctors tend to recommend treatment with medication or surgery. The medication given aims to speed up the process of removing remaining tissue from the uterus, within 24 hours. This medication can be taken orally or directly inserted into the vagina. Apart from medication to help expel the fetus, obstetricians can also prescribe antibiotics to prevent infection and anti-bleeding medications to reduce bleeding.
   Apart from medication, doctors can perform curettage to treat miscarriages. This small operation is carried out by widening the cervix (cervix) and using special tools to remove the placenta tissue and fetus from the uterus. Curettage needs to be done immediately if a pregnant woman experiences heavy bleeding or symptoms of infection appear.
4. Incipient abortion
   Incipient abortion (unavoidable abortion) is one of the types of miscarriage with a flat cervix. With the products of conception still intact in the womb. Signs of this type of abortion are bleeding, cramps, and opening of the cervix. Even though the fetal tissue is intact, miscarriage still occurs because the cervix has opened. If a pregnant woman experiences these symptoms, it is certain that the fetus in her womb has aborted. If the gestational age is less than 12 weeks, the action that the obstetrician can take is to carry out curettage.
5. Repeated abortion
   Recurrent abortion is a diagnosis for pregnant women who have miscarried 3 or more times in a row. The possibility of recurrent abortion is very small. Therefore, consult your obstetrician about this incident to find out the cause.
   If a pregnant woman experiences repeated miscarriages (habitual abortion), it is necessary to find out the factors that could be the cause. For this reason, the obstetrician will carry out the following examinations:
   1. Transvaginal ultrasound examination.
      Through transvaginal ultrasound, the doctor can examine the condition of the uterus in more detail, to detect any abnormalities.
   2. Gene examination.
      This examination aims to check whether there are genetic abnormalities in the patient or his partner.
   3. Blood test.
      This test is carried out to check for certain disorders that can cause miscarriage, for example hormonal disorders, blood clots or thickening, and infections.
6. Missed miscarriage/Missed abortion
   Missed miscarriage occurs when the fetus has died, but the placenta and embryonic tissue are still in the uterus. The fetus usually dies at 20 weeks of gestation. This condition can be without symptoms. Therefore, pregnant women do not realize that their baby has died. Others experience symptoms in the form of brown vaginal discharge and normal pregnancy symptoms such as nausea and weakness, which have disappeared. This condition is usually only realized when the mother goes to the doctor and the fetal heart rate is not visible on ultrasonography.

   Immediate medical care and treatment is required by a doctor to treat missed abortion. All treatment methods will usually be adjusted to the condition of the pregnancy and the health of the pregnant woman’s own body. Often the embryo tissue will come out by itself and the mother will experience a miscarriage naturally. However, if this doesn’t work, the mother may need medication or surgery to remove the embryonic tissue and placenta. For medicine, avoid taking medicine carelessly without a doctor’s prescription because it can pose a high risk to the mother’s health.

   Recovery time after experiencing a missed abortion can vary for each woman, it can be a matter of weeks or months. Most likely the mother’s menstruation will return within 4-6 weeks. Apart from physical healing is emotional recovery. Look for a new atmosphere to recover your mother’s feelings of sadness and involve your husband and family to express your feelings. After experiencing a missed abortion, the mother may be able to get pregnant again after having a normal menstrual cycle. However, most experts say it is best to give yourself a gap of at least three months to return to the pregnancy program. After experiencing a miscarriage or missed abortion, usually the chance of experiencing it again is not very big. However, if the mother has had more than one miscarriage, including missed abortion, it is better to consult further with a doctor. The doctor will carry out further examinations to see what causes this.

Not all blood discharge from the vagina during early pregnancy is definitely a sign of miscarriage. Normal pregnant women experience blood spots coming out of the vagina 6-12 days after fertilization, which is when the fetus attaches to the uterine wall. This bleeding is called implantation bleeding. However, usually at this time, a woman does not realize that she is pregnant. Even though it can normally occur, bleeding from the vagina in the first trimester of pregnancy needs to be suspected of a threat of miscarriage (imminent abortion), so it needs to be immediately checked by a gynecologist. If a miscarriage has not occurred, a doctor can carry out treatment to prevent it.

Several causes and risk factors for miscarriage

The following are several things that can increase the risk of miscarriage:

1. The age of pregnant women is considered old or above 35 years.
2. Have a history of previous miscarriage.
3. Unhealthy lifestyles during pregnancy, such as smoking, consuming alcoholic drinks, or abusing drugs.
4. Exposure to radiation or toxins either in the workplace or living environment.
5. Premature opening of the cervix without signs of labor.
6. Too fat and too thin.
7. There are anatomical abnormalities in the uterus.

Most miscarriages occur in the first trimester and are generally caused by chromosomal disorders in the fetus. Chromosomal disorders prevent the fetus from developing normally, causing miscarriage. This chromosomal disorder generally does not come from the parents’ genetics. Miscarriage in the first trimester can also be caused by disruption of the development of the placenta which connects the mother to the fetus.

Meanwhile, miscarriage in the second trimester is usually caused by the health condition of the pregnant woman. There are several medical conditions that can increase the risk of miscarriage, including:

1. Chronic diseases, such as diabetes, high blood pressure or kidney disease.
2. Autoimmune diseases, for example lupus and antiphospholipid syndrome.
3. Infectious diseases, such as toxoplasmosis, rubella, syphilis, malaria, HIV, and gonorrhea.
4. Hormonal disorders, for example thyroid disease or PCOS.
5. Uterine abnormalities, for example a weak cervix (cervical incompetence) and myoma.
6. Medicines consumed, such as non-steroidal anti-inflammatory drugs, methotrexate, and retinoids.
7. Abnormalities in the uterus, for example the cervix.

Miscarriages that occur in the second trimester can also be caused by infections in the baby, consumption of certain medications, food poisoning, or a weak cervix. Every pregnant woman must understand the signs of miscarriage in order to dispel various erroneous views regarding the causes of miscarriage. It should be remembered that miscarriage is not caused by sports activities (but you can discuss with your obstetrician about suitable sports), sexual relations, work (as long as you are not exposed to radiation or toxins), traveling by plane, spicy food, or stress.

If a pregnant woman experiences the signs of miscarriage mentioned above, immediately check her pregnancy condition with a doctor so that appropriate examination and treatment can be carried out. Therefore, don’t forget to always check your pregnancy condition regularly to maintain the health of the mother and fetus.

Miscarriage diagnosis

If a pregnant woman experiences symptoms of miscarriage, the obstetrician will perform a physical examination, including an internal examination. Apart from asking about symptoms and checking the physical condition of the pregnant woman, the doctor will perform an ultrasound examination to determine whether the pregnant woman has had a miscarriage or not. Apart from ultrasound, blood tests are also carried out to check levels of the HCG hormone which should increase during pregnancy.

Recovery after miscarriage

The time required for recovery after a miscarriage is several days to a week. However, often pregnant women who have just experienced a miscarriage experience emotional shock, or even depression after the miscarriage. This condition takes longer to recover. Therefore, support from partners and family is very necessary. A woman will get her period again 1 to 1.5 months after a miscarriage, and can get pregnant again healthily.

Complications of miscarriage

Miscarriage carries the risk of causing infection due to the remaining fetal body tissue remaining in the uterus. This condition is called septic abortion. Symptoms to watch out for from septic abortion are fever, chills, vaginal discharge, and hardening of the lower abdomen. Apart from that, placental tissue remaining in the uterus is also at risk of causing bleeding, which can result in anemia or even shock.

Prevention of miscarriage

Because miscarriage is influenced by various factors, it is difficult to determine the specific steps that need to be taken to prevent miscarriage. However, in general, there are several ways you can prevent miscarriage, namely:

1. Implement a healthy diet with balanced nutrition, especially increasing consumption of foods that contain fiber.
2. Maintain normal body weight.
3. Don’t smoke, don’t consume alcoholic drinks, and don’t abuse drugs.
4. Receive vaccines as recommended by your doctor to prevent infectious diseases.
5. Treating causes of miscarriage that have been detected, for example injecting blood thinners if you experience antiphospholipid syndrome.