What are the conditions of early miscarriage?
Pre-eclampsia is a term that is often used in clinical practice to refer to a condition in which there is combined bleeding or abdominal pain.
If the doctor finds that the cervix is dilated during the vaginal examination, then the miscarriage is inevitable and is also called “inevitable miscarriage”.
An incomplete miscarriage is one in which a small amount of tissue has been expelled, but some tissue remains in the uterus.
Subchorionic hemorrhage is usually diagnosed by the presence of vaginal bleeding and the presence of a blood clot between the embryo and the uterine wall on ultrasound.
Empty egg is a sign of embryonic abortion in which a gestational sac is found on ultrasound but no embryo is present.
Some miscarriages occur early, before there are any visible tissues of the pregnancy, and they are just like a menstrual period, except that the hCG is elevated in the blood or urine.
Recurrent miscarriage (used to be called “habitual miscarriage”, but now it is not used) refers to the occurrence of more than 2 miscarriages.
Why does early miscarriage occur?
In most cases, miscarriage is a kind of eugenics process. More than 70% of the embryos are not well developed, and when they reach a certain level of development, the embryos can no longer develop, and then they are expelled because they die. In some cases, chromosomal abnormalities can be detected by chromosomal examination, but genetic defects cannot be detected by chromosomal examination, so the fact is that the majority of early miscarriages cannot be found. Other causes of early miscarriage include uterine malformation, infection, exposure to toxic and harmful substances, radiation exposure, advanced maternal age, and luteal insufficiency.
[How to determine if the embryo has stopped developing].
It is a common clinical process that the embryo stops developing and the pregnancy tissue is expelled after the embryo dies. In the early stages, blood beta hCG (human chorionic gonadotropin beta), progesterone and ultrasound can be used to assist in the diagnosis of embryonic arrest.
In the case of normal intrauterine pregnancy, at 4 to 8 weeks after menopause, if blood is drawn for beta hCG, it will appear to double every 2 to 3 days, and if beta hCG remains the same or decreases during follow-up, then it suggests an abnormal pregnancy outcome. Progesterone, on the other hand, is relatively stable, with >25ng/dl indicating a normal intrauterine pregnancy and <5ng/dl a higher likelihood of abnormal pregnancy (miscarriage or ectopic pregnancy).
If the ultrasound reveals a gestational sac of more than 18 mm, but no gestational buds are present, it may indicate embryonic abortion. 5mm or more gestational buds should be visible on the ultrasound, but if not, it also indicates the possibility of embryonic abortion. If the ultrasound result is not clear, you can also follow the change of the sac and the germ through a series of tests. Normally, the embryo should grow 1mm per day.
Does medication help]
Progesterone is now commonly used in China for fetal preservation treatment and has been somewhat abused. Previously, I had written a popular science article “What to do with low early pregnancy progesterone” for reference, the first occurrence of preterm miscarriage is very common and treatment with progesterone does not improve the prognosis, the miscarriage will still be aborted, using progesterone is more like a placebo. Modern medicine places great emphasis on evidence-based medicine, and medication without evidence is not supported. It is because of the lack of valid evidence that the WHO (World Health Organization) does not recommend the use of progesterone for the treatment of early miscarriage, but for recurrent miscarriage, it is supported.
Many domestic hospitals use a variety of “birth control pills” are the result of a lack of rigorous controlled trials, so there is no need to use them.
Is surgery necessary for incomplete miscarriage or embryonic abortion?
My advice for first-time preterm miscarriage patients is usually to “let nature take its course”, because we cannot improve the outcome of the pregnancy, and embryonic abortion is a natural process of elimination.
In the past, most cases of embryonic abortion required surgical evacuation to complete the treatment, which carries risks and can cause psychological fear for the patient.
Medicine is changing and in recent years there has been a lot of research that is changing this traditional clinical practice. Recent studies have found that it is simply waiting that can result in 91% of incomplete miscarriages and 28% of complete miscarriages in patients with embryonic abortion. A study published in the New England Journal of Medicine found that some medications used vaginally with misoprostol assisted in the expulsion of 84% of embryos, a rate that allows most cases of early pregnancy failure to be treated without surgery, which is certainly a less invasive approach for patients.
Of course, non-surgical options are not suitable for every patient; those with heavy bleeding, those at risk of infection, and those with an unclear diagnosis are not suitable for non-surgical options.
[What is the special attention for the next pregnancy].
Generally speaking, there is no need for any special tests. After 3 months of contraception, you can try for another pregnancy, and generally most pregnancies will be normal, and the chance of another miscarriage will still be between 15-20%, and two consecutive miscarriages will of course exist, with about 1 to 3% of the population. For patients with more than 2 recurrent miscarriages, it is necessary to seek the help of a doctor.
Do you need any special tests?
As mentioned earlier, blood tests for beta hCG and progesterone and ultrasound can help determine the outcome of this pregnancy and are helpful in the diagnosis of ectopic pregnancy, but they usually do not change the outcome of the pregnancy.