A spontaneous abortion is the non-induced embryonic or fetal death or departure of the pregnancy product before the 20th week. A threatened abortion is a vaginal bleeding without opening of the cervix that occurs during this period, indicating that a spontaneous abortion in a woman can occur with a confirmed intrauterine pregnancy living product. Diagnosis is based on clinical criteria and sonography. The therapy consists in threatened abortion mostly in wait-and observing when it come to spontaneous abortion or such can not be stopped, in the observation or the emptying of the uterus.
Fetal death and premature birth are divided as follows:
A spontaneous abortion is the non-induced embryonic or fetal death or departure of the pregnancy product before the 20th week. A threatened abortion is a vaginal bleeding without opening of the cervix that occurs during this period, indicating that a spontaneous abortion in a woman can occur with a confirmed intrauterine pregnancy living product. Diagnosis is based on clinical criteria and sonography. The therapy consists in threatened abortion mostly in wait-and observing when it come to spontaneous abortion or such can not be stopped, in the observation or the emptying of the uterus. Fetal death and premature birth are classified as follows: miscarriage, death of the fetus or a disposal of the pregnancy product (fetus and placenta) before the 20th week of fetal death (stillbirth): fetal death after 20 weeks premature birth: Withdrawal of a living fetus between the 20th and 37th SSW (Preterm labor) abortions are divided into early or late, spontaneous or therapeutic or elective reasons initiated (induced abortion) threatening (abortion imminens) or beginning (abortion incipiens), incomplete or complete, recurrent ( also referred to as repeated miscarriages, repeated miscarriages), restrained or septic abortion (see Table: classification of abortions). Classification of abortions type definition early abortion before the 12th week of pregnancy late abortion 12 to 20 SSW spontaneous non induced abortion induced termination of pregnancy for medical reasons or elective Therapeutic Termination of pregnancy to protect the life or health of the woman or not to be agreed malformations of the fetus (note due to death or to life. d. Red .: In Germany, the procedure follows § 218a of the Criminal Code) Threatening a vaginal bleeding before 20 weeks without opening the cervix, heralding an spontaneous abortion Starting vaginal bleeding or rupture of membranes by dilation of the cervix accompanied Incomplete expulsion of some products conception complete expulsion of the whole pregnancy product Repeated or habitual ? 3 consecutive spontaneous abortions response Not detected death of the embryo or fetus, which was not ejected and no bleeding caused (d. H. Windei, pregnancy without embryo or death of the fetus) Septic-threatening infection of the uterine contents during, just before or after an abortion Between 20-30% of women with confirmed pregnancy bleeding during the first 20 weeks of pregnancy; half of these women suffer a spontaneous abortion. Thus, the incidence of spontaneous abortion is 10-15% of all substantiated pregnancies. For all pregnancies, the incidence is probably higher, since some very early abortions are wrongly interpreted as a late menstrual bleeding. Etiology Isolated spontaneous abortions, by some viruses – especially cytomegalovirus, herpes, parvo virus and rubella – or by disease, sporadic abortions or repeated miscarriages cause (such as chromosomal or Mendelian anomalies Lutealphasestörungen.), Are triggered. Other causes include immune disorders, severe trauma and uterine abnormalities (eg. As fibroids, adhesions). In most cases the cause is unknown. Risk factors include age> 35 years Spontaneous abortion history of cigarette smoking, the use of certain substances (eg. As cocaine, alcohol, large amounts of caffeine) Faulty chronic disease (eg. As diabetes, hypertension, overt thyroid disease) in the mother Subclinical thyroid disease, a retroverted uterus and minor trauma could not be verified as potential causes of spontaneous abortion. Symptoms and discomfort symptoms are crampy abdominal pain, bleeding and finally the expulsion of tissue. A later spontaneous abortion, when the amniotic sac jumps to start with a gush of fluid. The bleeding is rare strong. An open cervix shows that the birth is unstoppable. If, after a spontaneous abortion radicals of pregnancy in uterine remain, there may be a blood flow, occasionally with a delay of hours or days. In some cases, even an infection, fever, pain and sometimes causes a sepsis developed. Diagnosis Clinical criteria Usually ultrasound and quantitative determination of the ?-subunit of human chorionic gonadotropin (?-hCG) The diagnosis of an imminent, started, complete or incomplete abortion can often be based on clinical criteria (see table: Characteristic symptoms and findings of spontaneous abortion) together with make a positive pregnancy test. Usually, however, both ultrasound and quantitative determination of ?-hCG are performed to exclude not only an ectopic pregnancy, but also to clarify whether remnants of the pregnancy have remained in the uterus (which might argue more for a incomplete as for a complete abortion ). Nevertheless, the findings are not necessarily conclusive, especially during early pregnancy. Characteristic symptoms and findings of spontaneous abortion type of abortion Vaginal bleeding Zervixöffnung * expulsion of the pregnancy product Threatening Yes No No Yes No Yes Starting Incomplete Yes Yes Y Complete Yes or No Demeanor Yes or No No No * The inner cervix is ??opened throughout in the vaginal examination for a finger. The pregnancy material may be visible in the vagina. To distinguish blood clots from pregnancy material, in some cases, tissue examination is required. Prior to the investigation but pregnancy material may already have been expelled unnoticed by the patient. A restrained abortion must be accepted if the uterus does not increase continuously in time or when the quantitative ?-hCG measured at the gestational age is too low or not doubled in 48-72 hours. A restrained Abort is proved if one of the following conditions is detected in the ultrasound: disappearance of a previously viewed embryonic heart activity absence of cardiac activity at a crown-rump length> 5 mm (as measured by transvaginal sonography) absence of a Embryonalschilds (determined by transvaginal sonography ), when the average diameter of the gestational (average of 3 measured in orthogonal planes diameters)> 18 mm is the case of repeated miscarriages to clarify the cause of abortion is required (repeated miscarriages). Treatment Observation for threatened abortion evacuation of the uterus in begonnenem, incomplete or restrained abortion Psychological Support If threatened abortion treatment in the observation is made. However, it is not proven that can be reduced by bed rest, the risk for a subsequent complete abortion. The treatment of begun, incomplete or restrained abortion is the emptying of the uterus or waiting for the spontaneous expulsion of the pregnancy product. Method for emptying the uterus are a suction curettage <12th week of pregnancy, a cervical dilation with suction curettage 12 to 23 SSW or drug initiation of abortion (in pregnant women without previous uterine surgery)> 16 to 23 weeks (for the treatment of late intrauterine Fruchttods, stillbirth). The later the uterus is emptied, the greater the likelihood of placental bleeding, uterine perforation through the long bones of the fetus and a difficult cervical dilation. These complications can be reduced by the preoperative application of an osmotically effective Zervixdilatators (z. B. Laminaria-pin) of misoprostol or mifepristone (RU 486). On suspicion of complete abortion an emptying of the uterus does not have to be performed routinely. An evacuation of the uterus may occur when a blood flow and / or other characters develop as an indication of pregnancy subdued shares. After an induced or spontaneous abortion, parents can feel sorrow and guilt. You should receive psychological support, and in the case of spontaneous abortion they are told that it is not their behavior was the cause. Psychotherapy is rarely indicated, but should be made available. Summary In about 10-15% of pregnancies is likely to result in spontaneous abortion. The cause of an isolated spontaneous abortion is usually unknown. An open cervix indicates that abortion is unstoppable. The spontaneous abortion must be confirmed and its type is determined by clinical criteria, sonography and quantitative ?-hCG measurement. The emptying of the uterus is finally necessary for begonnenem, incomplete or restrained abortion. Often the evacuation of the uterus is not in case of imminent or complete abortion is required. After spontaneous abortion parents a psychological support should be offered. Repeated miscarriages (Repeated or habitual abortion) is called recurrent miscarriages when ? 3 spontaneous abortions follow each other. Some causes are to be treated successfully. The cause out requires a thorough investigation of both parents. Some causes can be treated. Etiology causes of recurrent pregnancy loss may be maternal or fetal conditions or lie in the placenta. Common causes include maternal uterine or cervical abnormalities (eg. As polyps, fibroids, adhesions, cervical incompetence) Maternal (or paternal) chromosomal abnormalities (eg. As balanced translocations) luteal phase defect (especially <6 weeks) manifestos and poorly controlled endocrine diseases (z. B. hypothyroidism, hyperthyroidism, diabetes mellitus) Chronic kidney disease Acquired thrombotic diseases (for. example, in terms of anti-phospholipid antibody syndrome with lupus anticoagulant, anticardiolipin [IgG or IgM] or anti-?2-glycoprotein I [IgG or IgM]) are associated with recurrent miscarriage after the 10th week of pregnancy. The reference to hereditary thrombotic diseases is less clear, but seems not to be pronounced, except perhaps in the case of Factor V Leiden. Placental causes are chronic underlying diseases that are poorly controlled (eg. As SLE, chronic hypertension). Fetal causes are usually chromosomal or genetic abnormalities Anatomic abnormalities chromosomal abnormalities may be responsible for 50% of recurrent miscarriages; Abortions due to chromosomal abnormalities occur more frequently during early pregnancy. Aneuploidy is involved in up to 80% of all miscarriages <10th week of pregnancy, but in ? <15% of abortions 20 weeks. Whether repeated miscarriages in the history increases the risk of fetal growth and preterm birth in subsequent pregnancies, depends on the cause of abortions ab.Diagnose to determine the cause of the following tests should be performed: Genetic evaluation (karyotyping) of both parents and all pregnancy products as clinically indicated to exclude possible genetic causes (genetic study) screening of acquired thrombotic diseases: anticardiolipin antibody (IgG and IgM), anti-?2-glycoprotein I (IgG and IgM) and lupus anticoagulant thyroid-stimulating hormone diabetes tests validation of the health ovarian including determination of the FSH values ??on day 3 of the menstrual cycle or hysterosalpingography Sonohysterographie to study structural uterine abnormalities in up to but 50% of cases can not be determined the cause. Screening for hereditary thrombotic diseases is no longer routinely recommended, unless it is by a specialist in prenatal überwacht.Behandlung Some disorders underlying can be treated. If the cause is not found, there is the chance of a live birth in the next pregnancy at 35-85%.