Miscarriage is always the most worrying issue for mothers-to-be, and whether they must keep the baby after miscarriage, whether it is necessary to do progesterone test, whether the baby can be kept with progesterone, and whether they must take bed rest after miscarriage are also the most concerned and confusing issues for mothers-to-be. Here I will talk to you about this issue.
1.What is miscarriage?
Miscarriage refers to the termination of pregnancy before 28 weeks of pregnancy for some reason. Miscarriage is further divided into two categories: spontaneous abortion and induced abortion. Those who terminate pregnancy by artificial factors such as mechanical or medication are called induced abortion, while those who terminate by natural factors are called spontaneous abortion. Here we are mainly talking about spontaneous abortion.
2.What is the incidence of miscarriage?
The process of conception is an extremely complicated and delicate one, from the development and maturation of sperm and egg, to the union of billions of sperm with an egg after fierce competition to form a fertilized egg, to the implantation and development of the fertilized egg, any one of which can lead to abnormalities during pregnancy, which may cause mild abnormalities in the development of the embryo in mild cases, or embryonic abortion and miscarriage in severe cases. The total clinical pregnancy miscarriage rate is about 15% among women of reproductive age, and the total embryo loss rate is as high as 60% to 70% if biochemical pregnancies are included.
It is evident that only about 1/3 of all fertilized eggs that are formed develop normally and are born, and most of them are eclipsed by natural selection. The so-called biochemical pregnancy refers to the very early stage of pregnancy, when the fertilized egg is still in the cellular stage, and the miscarriage occurs before the embryo is formed, without even the woman herself knowing it. Pregnancy is actually a process of trial and error, as well as a process of natural selection and natural elimination.
3.Why does miscarriage occur?
At present, embryonic abortion or miscarriage is more common in early pregnancy (within 3 months of menopause from the last menstrual period), and many mothers-to-be are very worried about it. The main cause of spontaneous miscarriage is chromosomal abnormality of the embryo, the proportion is about 50%; other causes are maternal factors, including anatomical abnormalities of reproductive organs, autoimmune factors, infectious factors, endocrine factors, unexplained factors (including thrombotic tendencies, etc.), the real luteal insufficiency caused by the lack of progesterone levels resulting in miscarriage accounted for a small proportion; in addition, there are environmental factors. Nowadays, environmental pollution exists everywhere, and hazy weather often occurs, so the food we eat, the air we breathe, and the harmful substances we are exposed to cannot be avoided.
It is clear that most of the early miscarriages are due to genetic problems in the development of the embryo, that is, genetic problems in the embryo, resulting in serious problems such as the absence of certain enzymes or abnormalities in the vital organs of the embryo during the development process, which makes it impossible for the child to survive and will stop developing at some stage (note that embryo development is a dynamic process, and for embryos with serious problems, stopping development is not a one-time event. For embryos with serious problems, the cessation of development does not occur at the beginning, but at some point during the development process, and this point cannot be determined, so it is not possible to say that if the embryo develops normally through one test, it will be fine in the future), and it will manifest itself as death.
This kind of early miscarriage, we know that most of them are due to the result of nature’s superiority and inferiority, the eliminated children are bad and unhealthy children, so there is no need to feel special regret and worry. As for what causes problems with the embryo, according to the above mentioned, there are many reasons that are not very good to check, so usually it is not necessary or possible to conduct a detailed investigation to determine the cause of the miscarriage.
There is also a condition called habitual miscarriage, which refers to a situation where there have been 3 or more spontaneous miscarriages, but as soon as 2 spontaneous miscarriages occur in a row, it is time to pay attention. In this case, you need to look for the cause carefully, the doctor may check the cause of multiple miscarriages from chromosomal, endocrine, immune function, reproductive tract morphology and so on, but may not always be able to find the cause, it will be a bit complicated and long process of medical treatment, but as long as you have confidence and patience, most of them can eventually give birth to a healthy baby as they wish.
4.Do I have to use progesterone to keep my baby after a miscarriage?
Some mothers-to-be visit the hospital for vaginal bleeding in early pregnancy, and after the doctor diagnoses pre-eclampsia, they will usually be given progesterone to protect the fetus, if the doctor does not prescribe progesterone, or even some patients themselves strongly request the doctor to prescribe progesterone to protect the fetus. Let’s look at the most authoritative evidence-based medicine, the latest Cochrane review on progesterone (i.e. progesterone) for miscarriage prevention published in 2013 concluded that the application of progesterone (either intramuscular or oral) is ineffective in preventing miscarriage; for three or more consecutive spontaneous abortions, empirical progesterone supplementation may be beneficial, but this requires large sample multicenter studies to further confirm.
In addition, the World Health Organization does not recommend the use of progesterone for fetal preservation; see the WHO website for detailed instructions. It is clear that progesterone is ineffective in most cases of miscarriage, especially in first pregnancies, and is not recommended. Personally, I believe that a small number of pregnant women have a strong dependency on progesterone for fetal preservation. Giving progesterone for fetal preservation in appropriate amounts to such women may relieve their psychological anxiety and does not affect the pregnancy outcome. However, progesterone supplementation is needed in a few cases, including patients who have had their corpus luteum surgically removed during early pregnancy or whose progesterone levels have dropped, patients who can be diagnosed with luteal insufficiency, and patients who have conceived through in vitro fertilization.
5. Is it necessary to check progesterone in early pregnancy?
Nowadays, some doctors are used to routinely check the progesterone level of pregnant women in early pregnancy, and even in the absence of any abnormality, they give unnecessary progesterone level check to pregnant women, and often misinterpret their test results, and start injecting progesterone or taking oral progestin to protect the fetus as soon as the test result is low, which is actually a typical over-diagnosis and treatment, resulting in some abuse of progesterone and other drugs. In fact, progesterone is only effective in preserving fetuses in pregnant women with luteal insufficiency, and as mentioned before, most miscarriages in early pregnancy are due to problems with the child itself, with low progesterone being the result, and miscarriages cannot be avoided even with progesterone.
The reason why some doctors are used to aggressively testing progesterone levels is that they consider that one of the causes of miscarriage is luteal insufficiency (which accounts for a very small percentage of miscarriage etiology), which can lead to low progesterone levels, further leading to miscarriage. If detected in time, progesterone can be supplemented to prevent miscarriage from occurring. The gold standard for the diagnosis of luteal insufficiency is endometrial biopsy at mid-luteal phase, but since two consecutive endometrial biopsies are required to diagnose luteal insufficiency, it is almost impossible to use the gold standard for diagnosis in clinical practice. Therefore, testing progesterone levels to determine luteal function has been proposed, but this method is not reliable for the following reasons.
(i) progesterone levels in normal pregnancy fluctuate widely, and it is not possible to determine how much progesterone level below a certain pregnancy time point is considered abnormal.
(ii) Low progesterone levels are more likely to be the result of poor embryonic development rather than the cause of the intended miscarriage.
(iii) Half of the patients diagnosed with luteal insufficiency have normal progesterone levels.
④In early pregnancy, there are two sources of progesterone: one is secreted by the corpus luteum of the ovary and the other is secreted by the trophoblast after embryo implantation. We cannot tell which cause of low levels is responsible. Therefore, routine measurement of progesterone levels to guide fertility preservation is not recommended. Of course, the usefulness of progesterone testing cannot be dismissed in general. After a positive HCG (human chorionic gonadotropin) test, when ultrasound does not reveal evidence of pregnancy, progesterone testing is still helpful in determining the prognosis of pregnancy. -A progesterone level between 5 and 20 ng/mL indicates the possibility of miscarriage and ectopic pregnancy. But the purpose of progesterone testing is definitely not to supplement progesterone.
6. Do I have to rest in bed after miscarriage?
After the doctor diagnoses pre-miscarriage to a pregnant woman, he or she will usually suggest to pay attention to rest, meaning to move appropriately and avoid exertion so as not to induce more physical discomfort. However, it is often interpreted by many mothers-to-be, especially their mothers and mothers-in-law, as absolute bed rest. One of the most bizarre cases I’ve seen on the Internet is that of a daughter who had a spontaneous miscarriage in her first pregnancy, and after her second pregnancy, her mother forced her daughter to take absolute bed rest, eating, drinking, pooping, and scattering all in bed, and was not allowed to go down to the floor for six months. By the time the mother brought her daughter to the clinic, she was already walking wobbly and the examination revealed that the muscles of her lower limbs had atrophied significantly. This practice is simply outrageous.
Scientifically speaking, there is no evidence-based medical evidence that bed rest can reduce the incidence of miscarriage. But in fact, without evidence-based medical evidence, common sense should be able to determine that bed rest to protect the fetus is not useful, look at those lower mammals than humans, never seen which animals need to lie still all the time when pregnant, are normal activities for food. Of course, it is necessary to avoid strenuous exercise during pregnancy, and proper rest is necessary in case of preterm abortion, not absolute bed rest.
As mentioned earlier, nearly half of the miscarriages are caused by chromosomal abnormalities of the embryo, and this situation is doomed to miscarriage no matter what you do, not to mention bed rest, even if it is not useful to play progesterone every day. Will it be good to keep the fetus that falls off when walking or sneezing? If the fetus will fall off when you walk, the hospital’s family planning clinic can be closed and no more abortions will be needed, so that people can walk or even run instead of having an abortion.