A miscarriage is considered to occur before the 20th weekof pregnancy . If the pregnancy ends after the 20th week, this is premature labor. If the signs of the miscarriage are seen before it occurs, it is called a threatened miscarriage or a risk of miscarriage. Pregnant women usually receive this diagnosis after vaginal bleeding. However, sometimes a bleeding area can be seen on an ultrasound during a routine check-up without any bleeding. In this case, the pregnant woman is diagnosed with a threatened miscarriage and the necessary precautions are taken.
25% of women who become pregnant experience clinically detectable miscarriages. However, 50% of all pregnancies are lost in the first three months, and many of these occur undetected. Approximately 40% of pregnant women are at risk of miscarriage. This risk increases in multiple pregnancies. Since adequate supportive care is applied in pregnancies that occur with treatment, this risk is not considered to be higher. The main reason for most miscarriages is genetic reasons. In other words, a pregnancy product with a genetic disorder cannot pass the quality control mechanisms in the first three months and results in miscarriage. The development of genetically disordered embryos is higher in older pregnancies. This is the main reason for the increased risk of miscarriage in older pregnancies.
Until how many months does the risk of miscarriage continue?
Pregnant women with a threatened miscarriage are kept under close observation. Sometimes, the gestational sac and fetal heart rate are monitored with weekly checks. Sometimes, the risk of miscarriage is observed by measuring the length of the cervix (neck of the womb). Although things usually return to normal within the first three months, that is, by the end of 12 weeks, sometimes the pathology that poses the risk (for example, untreated urinary tract infections) may continue until it disappears.
What are the causes of miscarriage and how can it be prevented?
Although miscarriages are defined as pregnancies that end in the first 20 weeks, they usually occur in the first three months, that is, the first 12-week period. The causes of miscarriages that occur before and after 12 weeks differ from each other.
The most important reason in the early period is genetic reasons. Approximately 70% of all miscarriages occur for these reasons. Chromosomal abnormalities or disorders related to a single gene can also cause miscarriages. Advanced age is a risk factor. Those who have had a previous birth with a chromosomal abnormality or are carriers of a known genetic disease are also in the risk group.
The second most common cause of miscarriage is congenital deformities of the expectant mother's uterus. In these deformities called Mullerian Anomalies, the space inside the uterus is not sufficient. The intrauterine space, which should be triangular, is heart-shaped or completely divided into two by a septum. Even if pregnancy occurs, the rapidly growing gestational sac cannot fit into the insufficient intrauterine space and miscarriage occurs. Such anatomical disorders usually occur with recurrent pregnancy losses. With the widespread use of fiber optic camera systems in medicine, such problems can be easily overcome. Operations performed with a system called hysteroscopy, which allows observation of the inside of the uterus, have become the gold standard in the treatment of Mullerian Anomalies. The results are very satisfactory.
Another early cause is disorders in the clotting mechanisms of the pregnant woman. Many of these can be detected and revealed by tests performed on pregnant women with a history of previous miscarriages. Treatment is the use of blood thinners during the risky period.
Early-term infections, exposure to radiation, environmental factors, and excessive stress can cause miscarriages. In late-term losses, the cause may be cervical insufficiency.
Bed rest is recommended for patients who are experiencing a threatened miscarriage. Although it is not medically proven, resting will psychologically relax the pregnant woman. Apart from this, although there are medical treatment options that prevent the uterus from contracting, in some cases, such as miscarriages due to genetic disorders, it is impossible to prevent the outcome.
What is the meaning of cervical stitching during pregnancy and in what cases is it done?
The normal structure of the cervix is tight and prevents the uterus from opening until birth. Sometimes this structure is observed to be loose and shorter than it should be. This can cause pregnancy loss, which is usually seen after the 16th week. The baby is healthy, but the structure it is in cannot hold it and causes it to somehow slip out. If this condition is detected early, it can be treated by stitching the cervix (cerclage). If a previous pregnancy ended like this, a cerclage in the 13th week of pregnancy will be life-saving.
The success of cerclage depends on the week it is performed and whether it is performed as an emergency or a precaution. The success of cerclage performed as a precaution is high. Emergency cerclages are successful if they are performed before the cervix becomes too short and amniotic fluid is not released.
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