Patient's question:
I had a natural miscarriage just two months into my pregnancy and I don't know what factors or causes it could be. I was very careful during that time. Did I get angry over household matters at the beginning of my pregnancy, which affected it? After the miscarriage, I had a D&C procedure. Could you please tell me what I should pay special attention to after the surgery? It's summer now, can I take a bath every day? How long should I wait before trying to get pregnant again? What should I pay attention to next time? Could this lead to habitual miscarriage? I'm afraid my parents will worry, but I don't dare ask them. I sincerely request help from any kind-hearted doctor!Doctor's answer:
Factors or causes leading to natural miscarriage are numerous, with the main ones being:1. Genetic gene defects: Chromosomal abnormalities in either partner of a couple can be passed on to offspring. Chromosomal abnormal embryos have a 50%-60% chance of early natural miscarriage. Chromosomal abnormalities include: ① numerical abnormalities: commonly trisomy, X monosomy, triploidy, etc. ② structural abnormalities: mostly chromosomal breaks, inversions, deletions, and translocations. Even if some chromosomal abnormal embryos reach full term, they will be born with deformities or functional defects. If miscarriage occurs, the pregnancy products may only be an empty gestational sac or a degenerated embryo.
2. Maternal factors
(1) Systemic diseases: Systemic infections during pregnancy with high fever can cause uterine contractions leading to miscarriage. Bacterial toxins and viruses (such as herpes simplex virus, cytomegalovirus, etc.) enter the fetal bloodstream through the placenta, causing fetal death and leading to miscarriage. Severe anemia or heart failure in pregnant women can cause fetal hypoxia, also leading to miscarriage. Chronic nephritis or hypertension in pregnant women can also cause placental infarction, leading to miscarriage.
(2) Reproductive organ abnormalities: Uterine malformations (such as uterine hypoplasia, double uterus, uterine septum, etc.), uterine tumors (such as submucous myomas, etc.) can all affect embryo implantation and development, leading to miscarriage. Severe cervical laceration or cervical canal relaxation can lead to premature rupture of membranes and late natural miscarriage.
(3) Endocrine abnormalities: Hypothyroidism, uncontrolled severe diabetes, and luteal phase deficiency can all lead to miscarriage.
(4) Unhealthy habits: Excessive smoking, alcohol abuse, excessive coffee consumption, heroin, and other drug use can all cause miscarriage.
(5) Trauma and stimulation: Severe shock, uterine trauma (such as surgery, direct impact, excessive sexual activity) can also lead to miscarriage. Excessive tension, anxiety, fear, and grief can also cause miscarriage.
3. Immune function abnormalities: Pregnancy is similar to allogeneic transplantation, with complex and special immunological relationships between the embryo and the mother to prevent rejection. If there is an immunological incompatibility between the mother and child, the mother may reject the embryo, leading to miscarriage. Immune factors related to miscarriage include paternal histocompatibility antigens (HLA), fetal antigens, blood group antigens (ABO and Rh), insufficient maternal during pregnancy, insufficient maternal cytotoxic antibodies against paternal lymphocytes, excessive production of maternal antiphospholipid antibodies, and the presence of antisperm antibodies, etc.
4. Environmental factors: Excessive exposure to chemicals such as arsenic, lead, formaldehyde, benzene, butadiene, and ethylene oxide can all cause miscarriage.
Clinical types of natural miscarriage are divided according to different stages of development:
1. Threatened miscarriage refers to vaginal bleeding before 28 weeks of gestation, often dark red or bloody leukorrhea without pregnancy products being expelled, followed by cramping lower abdominal pain or back pain. Gynecological examination shows an unopen cervical os, intact membranes, and a uterus of appropriate size for gestational age. Rest and treatment can lead to symptom resolution and continuation of pregnancy; if vaginal bleeding increases or lower abdominal pain worsens, it may progress to inevitable miscarriage.
2. Inevitable miscarriage refers to miscarriage that is unavoidable. On the basis of threatened miscarriage, vaginal bleeding increases, cramping lower abdominal pain intensifies, or vaginal discharge (rupture of membranes) occurs. Gynecological examination shows an open cervical os, sometimes with embryonic tissue or a gestational sac obstructing the cervical os, and a uterus of appropriate size for gestational age or slightly smaller.
3. Incomplete miscarriage refers to the continuation of inevitable miscarriage, with part of the pregnancy products expelled outside the body, while some remain in the uterine cavity or become lodged at the cervical os, affecting uterine contractions and causing heavy bleeding, even shock. Gynecological examination shows an open cervical os, with pregnancy products obstructing the cervical os and persistent blood flow, and a uterus smaller than the gestational age.
4. Complete miscarriage refers to the complete expulsion of pregnancy products, with vaginal bleeding gradually stopping and abdominal pain gradually disappearing. Gynecological examination shows a closed cervical os and a uterus close to normal size.
Additionally, there are three special cases of miscarriage:
1. Incomplete abortion refers to the death of an embryo or fetus that remains in the uterine cavity and has not been naturally expelled. After the death of the embryo or fetus, the uterus no longer enlarges but instead shrinks, and early pregnancy symptoms disappear. If it is in the second trimester of pregnancy, the pregnant woman's abdomen does not enlarge, and fetal movement disappears. Gynecological examination shows an unopen cervical os, a uterus smaller than the gestational age, firm texture, and no fetal heartbeat heard.
2. Habitual abortion refers to three or more consecutive natural miscarriages. Internationally, recurrent abortion has replaced habitual abortion, referring to two consecutive natural miscarriages. Each miscarriage usually occurs at the same gestational age, with a clinical course similar to general miscarriage. Early miscarriage is commonly caused by factors such as chromosomal abnormalities in the embryo, abnormal immune factors, luteal phase deficiency, and hypothyroidism. Late miscarriage is commonly caused by factors such as uterine malformations or hypoplasia, cervical canal relaxation, and uterine myomas. In cases of cervical canal relaxation, after pregnancy, the fetal sac protrudes from the cervical os as the fetus grows and amniotic fluid increases, increasing intrauterine pressure. The cervical canal gradually shortens and dilates. Patients usually have no symptoms, but once the membranes rupture, the fetus is rapidly expelled.
3. Abortion infection refers to the possibility of intrauterine infection during the process of miscarriage, with prolonged vaginal bleeding, residual tissue in the uterine cavity, or illegal induced abortion. Severe infection can spread to the pelvic cavity, abdominal cavity, or even the entire body, leading to pelvic inflammatory disease, peritonitis, sepsis, and septic shock.
Post-abortion precautions:
1) Abstinence from sexual activity: Some people have prolonged bleeding after medication abortion, while others have short bleeding periods, and some have intermittent bleeding. In any case, sexual activity should be avoided before menstruation. During medication abortion, the cervical os is in a relaxed state, reducing the ability to prevent bacteria from entering the uterine cavity. During sexual activity, bacteria hidden in the male foreskin and bacteria in the female external genitalia, vagina, and cervix can ascend and infect the uterine cavity. At the same time, after the embryonic tissue is stripped, blood sinuses open and are easily infected.
(2) No tub baths or vaginal douches for one month after medication abortion, and no swimming.
(3) Use qualified products for sanitary napkins and toilet paper; change sanitary napkins frequently; do not wear synthetic fiber underwear; change underwear daily.
(4) If vaginal bleeding exceeds 7 days, take antibiotics under medical guidance to prevent infection. If bleeding persists for more than two weeks, go to the hospital to determine the cause and may require uterine aspiration if necessary.
(5) If uterine aspiration is performed due to medication abortion failure, incomplete abortion, or heavy bleeding, antibiotics must be taken postoperatively.
(6) Rest and avoid fatigue after medication abortion. Taking herbs such as motherwort can promote uterine contractions, expel embryonic tissue, reduce vaginal bleeding, and shorten bleeding time.
(7) Pay attention to dietary supplements. Eat more high-quality protein to enhance the body's resistance, but avoid excessive greasy food to prevent indigestion.
Medication abortion should not be done secretly
The introduction and use of abortion drugs in the 1990s undoubtedly brought great blessings to women with unintended pregnancies. "Now things are better, it's just like having a cold," so taking anti-pregnancy medication became fashionable. With demand comes market, and signs of "early pregnancy specialties" appeared everywhere, not only in hospitals but also in the hands of wandering quacks.
Are abortion drugs really that good? Let the doctor give you the "lowdown" - in fact, medication abortion is not as easy and optimistic as it seems. Due to individual differences in pregnant women or non-standard medication use, coupled with the limitations of the drugs themselves, if used improperly, it may fail to achieve the purpose of abortion or even lead to the loss of youth and life.
Medication abortion done right
In recent years, mifepristone (Mifeprex) combined with carboprost has been widely used in clinical practice, achieving relatively satisfactory results. Without "surgery," the dream of stopping pregnancy can become a reality, which is truly exciting. Compared to surgical abortion, medication abortion avoids damage to the reproductive organs from surgical instruments, has less pain, fewer side effects, fewer sequelae, and less psychological stress for the patient, making it more acceptable. With modern medical technology "backing you up," life is worry-free, carefree, and without worry. What is there to be afraid of? Naturally, medication abortion became fashionable. Due to the influence of traditional thought, many women who became pregnant did not dare to speak up and tried to use medication secretly at home, while some "experienced" women paid no attention to it and used medication themselves. All of these are extremely dangerous.
Another name for anti-pregnancy drugs is "menstruation-inducing abortion drugs." From the literal meaning, one can see the thoughtfulness of the developers - women with a history of sexual activity may become pregnant as soon as several days after their period. At this time, when they are "not yet firmly established," medication is used to induce menstruation to "expel the unwelcome guest" and achieve the purpose of terminating pregnancy. However, most people's understanding still the level of checking if they are pregnant before considering choosing an abortion method. By then, "the boat has sailed" and the gestational sac has already "settled in," and the decidua has also grown "luxuriantly." Under the action of medication, although the gestational sac can be expelled, the decidua may not be completely shed. The decidua remaining in the uterus "" and may "stir up trouble" in the future, threatening the health and life of the medication user.
Medicine is a "double-edged sword," protecting you while also potentially cutting you behind your back. Anti-pregnancy drugs are no exception. What is suitable for others may not be suitable for you. Blindly following the trend can only hurt yourself. Even if you regret it later, it means little to you personally, but rather a lesson for others to learn. Moreover, whether it is surgical or medication abortion, there is some damage to health, after all, it is a makeshift measure at the cost of health. For this reason, gynecological and obstetric experts have repeatedly warned: once you choose medication abortion, remember the following two points: first, strictly control the length of pregnancy, the shorter the better; second, it is best to have medication abortion in a hospital with emergency treatment capabilities and use medication under the guidance of a doctor to prevent unexpected events. Never have the of secretly "flowing"!
There are also taboos for medication abortion
Because surgical abortion often brings great physical and mental pain, many people choose medication abortion.
Medication abortion, as the name suggests, is a method of terminating early pregnancy by taking oral medication. It avoids some problems brought by surgical abortion, with a complete abortion rate of 90%-95%. Moreover, if abortion fails, surgical uterine aspiration is less painful because the cervical os is already open and does not require dilation. However, medication abortion also has its scope of application, and women must first determine if they are within this scope before undergoing medication abortion.
Indications:
1. Termination of pregnancy due to various factors or causes without contraindications;
2. Suitable for high-risk pregnancy within 8 weeks of gestation, where vacuum aspiration is difficult or high-risk and requires termination of pregnancy, and also suitable for women with concerns or fear of surgical abortion.
Contraindications:
1. Glaucoma, asthma;
2. Heart, liver, kidney disease, and adrenal insufficiency;
3. Intrauterine contraceptive device, pregnancy, and suspected ectopic pregnancy;
4. Those who cannot promptly seek medical attention after medication should preferably not use medication abortion to avoid delaying the condition in case of an emergency.
If you have decided to have medication abortion, you should also be aware of some precautions: First, medication abortion is only used for terminating intrauterine pregnancy. It is essential to do a B before medication to confirm intrauterine pregnancy, and the gestational sac size should be about 1.0CM-2.5CM before taking medication. Second, after the gestational sac is expelled, taking yìmǔcǎochōng can reduce bleeding caused by decidua residue. Additionally, oral antibiotics should be taken to prevent infection.
Common knowledge
1. Sexual activity is not allowed for one month after abortion. Ovulation function of the ovaries generally recovers within 22 days after surgical abortion.
2. Withdrawal before ejaculation is the easiest way to cause accidental pregnancy.
3. Abstinence from sexual activity for one week after surgical abortion, then use condoms or vaginal barriers for contraception. If using birth control pills, start on the fifth day of the next menstrual period. Do not take birth control pills before this time; use condoms or other methods.
4. Pay attention to hygiene after abortion. Change underwear daily. My girlfriend helped me wash clothes every day after medication abortion, just for hygiene. Also, buy good quality sanitary napkins and toilet paper, do not be stingy, and avoid strenuous exercise.
5. Rest well and do not go out. Illnesses contracted during the postpartum period are difficult to treat. Also, eat supplements.
What to pay attention to after abortion?
After the surgery, it is important to rest appropriately. The first three days are best spent lying down. Because the endometrium leaves a wound after surgical abortion, premature activity can prolong vaginal bleeding. Generally, avoid physical labor and exercise for half a month after the surgery.
Appropriate nutrition should be increased because the surgery causes a small amount of bleeding, which damages the body. Therefore, it is necessary to promptly supplement some foods rich in protein and vitamins, such as lean meat, fresh fish, eggs, milk, or soy products.
After abortion, the body's resistance decreases, so personal hygiene should be paid more attention. Due to the remaining wound on the endometrium, vaginal discharge increases, making it a breeding ground for bacterial infection and proliferation. Therefore, it is necessary to pay special attention to the cleanliness of the external genitalia, take a shower to clean the external genitalia, disinfect and frequently change toilet paper; avoid tub baths for half a month, change underwear frequently; and absolutely avoid sexual activity for one month to prevent bacterial infection. Additionally, it is necessary to further strengthen contraception. Under the guidance of a doctor, adopt appropriate contraception methods or sterilization measures to prevent pregnancy again. After the surgery, it is also necessary to pay attention to the condition of vaginal discharge. Generally, there will be red or light red discharge for one week after the surgery, with the amount gradually decreasing and no obvious odor. If there is still bleeding or more discharge one week later, especially if the discharge has an odor and is accompanied by fever and abdominal pain, it is necessary to seek medical attention promptly.
Self-care after abortion
Abortion is something women do not want to face but often have to face in reality. Almost every woman will have at least one abortion experience during their childbearing age. Since it is unavoidable, you must better protect yourself because it is, after all, an injury to your body.
1. Rest and strengthen nutrition. After abortion, lie down for 2-3 days, then gradually increase activity time. Avoid heavy physical labor and cold water labor for half a month after abortion. Pay attention to increasing nutrition to enhance the body's resistance to disease and promote the early repair of damaged organs. After abortion, eat more protein-rich foods such as fish, meat, eggs, and soy products, as well as fresh vegetables rich in vitamins, to speed up recovery.
2. Maintain external genital cleanliness and strictly avoid sexual activity. The cervical os has not completely closed after abortion, and the endometrium also has a repair process. During this period, pay special attention to maintaining the cleanliness of the external genitalia. Frequently change sanitary napkins and underwear, and avoid tub baths for half a month to prevent dirty water from entering the vagina and causing infection. If sexual activity occurs too early after abortion, it can cause acute endometritis, pelvic inflammation, and even secondary infertility. Therefore, strictly avoid sexual activity for one month after abortion.
3. Observe bleeding. If vaginal bleeding exceeds one week after abortion and is accompanied by lower abdominal pain, fever, cloudy discharge with an odor, or other abnormal symptoms, seek medical attention promptly.
4. Adhere to contraception. The ovarian and uterine functions gradually recover after abortion, and the ovaries ovulate regularly. If contraception is not adhered to, pregnancy may occur again very soon. Therefore, after abortion, it is necessary to choose a reliable contraception method as soon as possible. Abortion surgery can only be used as a last resort when contraception fails and must be based on contraception as the main measure, not using abortion surgery as a method of contraception.