Miscarriage is the spontaneous termination of pregnancy when the gestational age has not reached 20 weeks. Most miscarriages occur early in pregnancy, sometimes before a woman even knows she is pregnant.
It should be noted that light bleeding or spotting of blood from the vagina during young pregnancy is not always a sign of miscarriage. This generally occurs within 6–12 days after conception, when the fetus attaches to the uterine wall and occurs for a maximum of 3 days. This bleeding is called implantation bleeding .
Bleeding can be a sign of miscarriage if it is accompanied by severe pain in the lower abdomen and is accompanied by discharge of tissue or clots from the vagina. If you experience this condition, pregnant women are advised to immediately go to the nearest health service center to get treatment as soon as possible.
Causes of Miscarriage
The most common cause of miscarriage is chromosomal abnormalities that prevent the baby from developing normally, or even an empty pregnancy ( blighted ovum ). These chromosomal abnormalities can occur unexpectedly, or due to genetic disorders inherited from parents. Problems with the placenta can also cause a miscarriage.
In addition, there are factors that can increase the risk of miscarriage , including:
- Infectious diseases, such as toxoplasmosis , rubella, syphilis, malaria, HIV, gonorrhea , or sepsis
- Autoimmune diseases, such as lupus and antiphospholipid syndrome
- Chronic illness, such as diabetes or kidney disease
- Hormone disorders, such as thyroid disease or PCOS
- Abnormalities in the shape of the uterus or cervix
- Use of drugs, such as non-steroidal anti-inflammatory drugs , methotrexate, and retinoids
- Pregnant at the age of more than 35 years
- History of miscarriage more than 2 times
- Unhealthy lifestyle, such as alcohol addiction, smoking, or drug abuse
- Underweight or overweight (obesity)
- Exposure to toxic substances and high levels of radiation
Conditions that do not cause miscarriage
It should be noted that there are still many people who believe that some of the conditions below can cause miscarriages, even though they are not. These conditions include:
- Light exercise
- Have sex
- Consumption of spicy food
- On a plane
- Work, except work that is at risk of exposure to chemicals or radiation
Symptoms of Miscarriage
Signs or symptoms of miscarriage experienced by pregnant women can vary, depending on the type. The following is an explanation of each type of miscarriage and its symptoms:
Unavoidable miscarriage (insipiens abortion) Insipiens
abortion is characterized by bleeding, abdominal cramps, and the opening of the birth canal. Even so, the decayed fetus has not come out of the womb.
Incomplete miscarriage (incomplete abortion)
Incomplete abortion is characterized by heavy vaginal bleeding, severe cramps, accompanied by expulsion of the placenta or a decayed fetus. In this type of miscarriage, some tissue or placenta is still left in the uterus.
Complete miscarriage (complete abortion)
As the name implies, this miscarriage is characterized by all the tissues or the fetus dropping out of the uterus. After experiencing a complete miscarriage, the pain and bleeding that occurs will be significantly reduced.
Missed miscarriage ( missed abortion )
Unlike other types, missed abortion occurs because the fetus does not develop or the pregnancy is empty ( blighted ovum ). Missed abortion does not cause symptoms like a miscarriage in general, so mothers who experience it are often not aware that they are pregnant.
Recurrent miscarriage occurs when a pregnant woman
has had two or more miscarriages in a row. The most common cause is genetic disorders in the mother, for example antiphospholipid syndrome .
When to see a doctor
As previously mentioned, pregnant women can experience implantation bleeding. However, pregnant women need to be vigilant if there is bleeding from the vagina during the first trimester, which is suspected of being a threat of miscarriage ( abortion imminens ).
Imminent abortion can be in the form of brown spots accompanied by blood clots and pain in the lower abdomen, but the birth canal has not yet opened. If this happens, pregnant women are advised to immediately go to the emergency room at the nearest hospital or medical service, so that doctors can take preventive measures.
Pregnant women also need to see a doctor immediately if they experience the following complaints in the first trimester of pregnancy, especially if there is a history of previous miscarriages:
- Vomiting until unable to eat and drink
- vaginal discharge
- Pain when urinating
The obstetrician will do a pelvic examination and pregnancy ultrasound to determine whether a miscarriage has occurred or not. The doctor will also measure the level of the hCG hormone which should increase during pregnancy.
If pregnant women experience more than two miscarriages in a row, the doctor may recommend further tests in the form of:
- transvaginal ultrasound , to examine the uterus, ovaries, cervix, and pelvic area
- Genetic tests, to check if there are genetic disorders in pregnant women or their partners
- Blood tests, to detect the causes of miscarriage due to hormonal disorders, blood clots or coagulation, and infection
Management of Miscarriage
If the patient is declared to have had a complete miscarriage, special treatment, including curettage , is not necessary. However, if the patient experiences a condition of threatening miscarriage or is declared to have had a miscarriage, there are several types of treatment that doctors can do, namely:
Pregnancy care is carried out when the patient experiences a threat of miscarriage. The doctor will suggest complete bed rest until the bleeding or pain subsides.
Patients are also advised not to exercise and have sex for several weeks. If necessary, the doctor will give content-strengthening drugs .
If the patient is declared to have had a miscarriage, whether the fetus has not come out at all or has partially come out, the doctor will prescribe medicine to speed up the cleaning process. The drug can be taken by mouth, injected, or inserted into the vagina. Examples of drugs are oxytocin or misoprostol.
In addition to drugs to help expel the fetus, doctors can give antibiotics and anti-bleeding drugs. Immunoglobulin injections can also be done to prevent health problems in subsequent pregnancies.
Curette is done by dilating the cervix (cervix) using a special tool, to remove the placental tissue or the rest of the body of the fetus in the uterus. A curettage needs to be done as soon as possible if the patient has a miscarriage accompanied by heavy bleeding or signs of infection.
Miscarriage is at risk of causing infection due to remaining fetal body tissue that is still left in the uterus. This condition, called septic abortion, is characterized by complaints of fever, chills, vaginal discharge, and pain in the lower abdomen.
Placental tissue that is still left in the uterus is also at risk of causing bleeding which can result in anemia or even shock.
Post-abortion Mental Recovery of Parents
Losing a future baby certainly causes feelings of sadness, anger, and regret. Parents may also experience sleep disturbances, cry often, or be weak.
Therefore, parents who have lost their future baby due to miscarriage can share their grief with family, friends or other people who have experienced it. This is useful for reducing stress due to the event.
Some women also experience milk loss after a miscarriage. This can add to the sadness for some mothers. If this makes mental recovery more difficult, there are ways to stop milk production after a miscarriage. One of them is by taking the drug bromocriptine . However, this drug has a number of side effects, so its use must be based on the direction of the doctor.
If these efforts don't help, consult a psychologist or psychiatrist. This method is expected to help suppress feelings of depression, loss, or guilt.
According to the Law of the Republic of Indonesia Number 13 of 2003 concerning Manpower, Article 82 paragraph 2, a female worker who has a miscarriage has the right to get 1.5 months of leave or according to a doctor's certificate.
These regulations are to give women time to rest until their physical and emotional conditions recover.
Miscarriages caused by genetic disorders are difficult to prevent. However, miscarriages that occur due to other factors can be prevented by taking the following steps:
- Consume a minimum of 400 mcg of folic acid daily, at least 1-2 months during pregnancy
- Maintain ideal body weight
- Eat a balanced nutritious diet
- Manage stress well
- Do not smoke or be exposed to cigarette smoke, do not consume alcoholic beverages, and do not use drugs without a doctor's prescription
- Receive the vaccine before pregnancy as directed by the doctor, to prevent infection
- Avoid exposure to radiation and toxic substances, such as arsenic, lead, and formaldehyde
- Undergoing treatment for medical conditions, especially health problems that are at risk of causing miscarriage
Also, talk to your doctor about using a progesterone, such as allylestrenol , early in your pregnancy if you have a history of recurrent miscarriages.