Miscarriage: causes, symptoms, what to do?
"Miscarriage: causes, symptoms, what to do?"
One in ten women has had a miscarriage. Early, late, recurrent miscarriage... How do they manifest themselves and how do you recover psychologically? All the answers to your questions with Dr. Thierry Harvey, gynecologist-obstetrician in Paris.
Early miscarriage: what is it?
[Updated January 26, 2022]. A miscarriage is a pregnancy that ends spontaneously. We distinguish on the one hand those of the first trimester of pregnancy, called early (before 3 months), and on the other hand the miscarriages of the second trimester (before 5 months). Miscarriages affect about 20% of pregnancies. "It is therefore an extraordinarily frequent event. It most often takes place between the 8th and 9th week of amenorrhea. It is often detected during the first ultrasound of pregnancy, without there being any symptoms", explains Dr. Thierry Harvey, gynecologist-obstetrician and head of the maternity department at the Hôpital des Diaconesses, in Paris.
Are miscarriages frequent?
First trimester miscarriages are common, especially during the first pregnancy, but not serious for the woman. "Without denying miscarriage, there's no need to do tons of tests after just one miscarriage," says Dr. Harvey. Second trimester miscarriages are more rare, but can occur after a first ultrasound at 2.5 months. "In this case, examinations can take place to look for a cause, but after a single miscarriage it is not systematic, adds the gynecologist. It all also depends on the woman, her personality, her age, etc."
Repeated miscarriages: when to worry?
There is no need to worry at the first miscarriage, nor to consult specialists immediately. The figures show it: it is a common phenomenon which concerns 15% to 20% of first-time pregnancies. Nearly 200,000 women a year in France therefore have a spontaneous miscarriage. On the other hand, when miscarriages are repeated, the gynecologist may decide to find out if there are specific causes. "When a woman is in her third miscarriage, we generally carry out, in addition to the search for the diseases listed above (thrombophilia, immunology...) a karyotype (the map of the chromosomes) of the two members of the couple to see if there is no genetic problem, explains Dr. Thierry Harvey. But very often, at the end of these examinations, nothing is found. There is no effective treatment against miscarriages ."
Late miscarriages
"When the miscarriage occurs during the second trimester, after a normal first trimester ultrasound, there, we will do a battery of exams to better understand: it's that "A major event has happened. We are talking about a late miscarriage after 3 months of pregnancy. We must find out what it is due to: an abnormal fetus? A problem with the cervix? In addition, we must know that a bacterial infection (vaginosis) can be the cause of a miscarriage: it is a frequent and curable cause." Sometimes it is a problem with the cervix, it is called open cervix. A cerclage can be proposed to the woman. "Studies show that cerclage is only really effective in those who have had 2 miscarriages... In addition, cerclage increases the risk of infection. You should also know that with cerclage, we have no not a normal activity. Women are recommended to rest and it is difficult to make them sit still, at rest, without doing anything..." says Dr Harvey.
What are the symptoms of a miscarriage?
Bleeding in early pregnancy is common, whether the pregnancy is going well or not. Similarly, some women will experience pelvic pain, while others will not. In any case, there are no symptoms specific to miscarriage. In all cases, it is the ultrasound that confirms the termination of the pregnancy. For a very recent pregnancy, the gynecologist may however decide to wait an additional week to redo an ultrasound, the cardiac activity not being visible at the very beginning of pregnancy.
Miscarriages: what are the causes?
The most frequent cause of miscarriage is a chromosomal anomaly: it is not the parents who transmitted this anomaly, it was produced by itself during fertilization. The egg thus formed is not viable and the pregnancy ends on its own. Various factors can lead to miscarriage. The placenta may have an anomaly of insertion into the uterus. The uterus may present with a malformation or a gap in the cervix. Polycystic ovary syndrome (10% of women, leading cause of infertility in France), but also luteal insufficiency (another common cause of infertility) can also be involved, more rarely. In addition, the woman may have a disease favoring miscarriages. Autoimmune diseases for example, but also diabetes, thyroid disease, poorly controlled can be a cause. Likewise, an untreated coagulation defect (thrombophilia) or a bacterial cervico-vaginal infection (vaginosis, sexually transmitted infection).
The age of women is not the only cause of more miscarriages explains Dr. Harvey: "There are more miscarriages, because there are more chromosomal abnormalities with age." There are also exogenous factors, not everything depends on the woman: her environment, her diet can also be the cause of miscarriages. Overconsumption of daily coffee, more than 5 glasses of alcohol per week, smoking but also drug use. Finally, infections such as toxoplasmosis or listeriosis can cause miscarriage.
Miscarriage: transport and sport out of the question
Dr Thierry Harvey returns to a belief: "We must stop saying that sport increases the risk of miscarriage: it's not true Similarly, the car, the plane, the subway, the motorcycle, the train, the vibrations on the pavement absolutely do not lead to miscarriages.Anyway, a long car ride with a pregnant woman does not is not possible: she has to stop every two hours to pee!" On the other hand, "in the event of bleeding at the start of pregnancy or of membrane detachment (and not of the placenta), you must be careful and rest to allow the coagulation of the hematoma", he warns.
What to do after a miscarriage?
How does it happen? Once the pregnancy is terminated, the body will evacuate on its own what is called the embryo sac. "In 60% of cases, the miscarriage and the evacuation of the embryo sac take place without any intervention, explains Dr. Thierry Harvey. Sometimes even before the ultrasound, without the woman having had any predictive sign. Because the embryo sac is not evacuated immediately after the termination of the pregnancy, it sometimes takes several weeks. But anyway, there is no urgency or risk of infection in waiting for this natural expulsion, contrary to certain received ideas. . It could take a month to come, without any danger."
No risk of infection or bleeding. For the remaining 40%, the miscarriage is not evacuated naturally. A drug treatment exists, it is misoprostol. This drug causes uterine contractions and the opening of the cervix which allow the expulsion of the embryo sac. Dr. Thierry Harvey explains: “Hospitalization is not essential because, contrary to certain myths, there is no risk that the woman will bleed to death by expelling the embryo sac. The risk of bleeding is rare. Women often do not want to stay in the hospital during these times, preferring a place they know. In addition, we can very well intervene surgically in an emergency if necessary, when the expulsion is not complete. If drug treatment is not enough, surgery with aspiration is performed, but since it can lead to certain complications, it is not offered as first-line treatment. Sometimes the patient will ask for surgery for personal reasons that must be understood and taken into account.
What psychological follow-up after a miscarriage?
The question of psychological follow-up after the miscarriage is to be discussed: "It's to be seen according to the women. What does the post-miscarriage constitute that a period of reconstruction is coming for the woman. She must grieve. Some women feel the need to see a shrink, others to talk about it with the caregivers around them (doctors, nurses, etc.) “, says Dr. Harvey. Following a miscarriage, the woman may develop psychogenic amenorrhea (a psychological blockage of menstruation). Seeing your gynecologist again about a month later makes it possible in particular to ensure that the return of the diaper has indeed taken place and that the woman does not have this blockage. If this is the case and the woman feels the need for it, a psychological follow-up can be envisaged. However, "the psychological care of the woman who has just had a miscarriage is not to be considered from the outset, she must be given time to find herself. If she does not succeed, we can offer her a consultation," says Dr. Thierry Harvey. There are associations that help women after their miscarriage. Do not hesitate to ask for contacts from the gynecologist or the maternity ward.
To play down without trivializing
The place of loved ones and in particular of the companion with the woman who has just had a miscarriage is not always easy to find. To help her, we must above all show compassion and empathy. "It is important to play down the drama (miscarriages affect 15% of pregnancies), but above all not to trivialize. Avoid the phrases "it's not serious" or "it's nothing, it's forgotten, it will be better next time...", insists Dr. Thierry Harvey. Each woman will apprehend the miscarriage in her own way. For some, the loss of this embryo will be experienced as a failure, a real mourning that casts doubt on their ability to be a mother. , for others they will feel victims of an injustice or it will be a question of a less painful disappointment. Finally, the last step is to fix a new appointment with the gynecologist. "It is important to review the woman about a month after the miscarriage, when the periods reappear. On the one hand, to take stock cold with her and seek, on the other hand, if it is possible, a cause for this event (is there overweight? Untreated thyroid problems?) ."
Can we reduce the risk of miscarriage?
There is no medical treatment with proven efficacy to reduce the risk of spontaneous miscarriage. A study compared the effect of aspirin, which has often been said to be effective, with a placebo. Result: no decrease or increase in the number of miscarriages. On the other hand, there is a link with age which increases the risk of chromosomal abnormalities and therefore promotes the risk of miscarriage. Dr. Thierry Harvey explains: "To reduce the risk of miscarriage, women need to know that the best time to have a child is between 25 and 35 years old, and that after 40 it's more difficult. It's physiological. , their body functions optimally between the ages of 25 and 35, so the risk of miscarriage is lower." In addition, "there is no treatment to avoid miscarriages. Nevertheless, certain preventive actions can reduce them: women who wish to have a child must neither smoke nor drink, not be overweight, avoid bisphenol A , aspartame, etc.", adds the obstetrician-gynecologist. In addition to age and lifestyle, which are important factors, the management of bacterial infections can also help: "Screening is important. By treating vaginosis, for example, we can prevent it from developing. 'later induce a miscarriage,' says Dr Harvey. In other words, pregnancy is not a disease, but there are the usual precautions: you must not smoke, not drink alcohol, do not take drugs, have a balanced and reasoned diet (no question of eating unpasteurized raw milk cheese, for example), treat infections and be reasonable in general.
Miscarriage: should we wait before having another child?
"You must not believe the neighbor or the concierge who says to wait 3 or even sometimes 6 months before to fall pregnant again. The most important thing is that the woman wants to have a child again", insists Dr. Thierry Harvey. The latest studies on the subject indicate that after a miscarriage, the chances of becoming pregnant again are as good as when there was no spontaneous termination of pregnancy. No risk, therefore, for subsequent fertility. Dr Harvey adds: "There is no time limit to try another pregnancy after a miscarriage. Of course the woman has to mourn this pregnancy, but every woman will react differently and there is no need to give a date. from which a pregnancy can be started." The important thing is that she feels able to get pregnant again. And if so, there's no reason to wait. “She is the one who knows when she is ready”, specifies the gynecologist.
Don't rush. On the other hand, do not rush a woman who has just had a miscarriage by encouraging her to try again at all costs and as soon as possible. She must first mourn this pregnancy before she can start another one. Relatives must therefore accompany her in her mourning and support her.
Miscarriage: causes, symptoms, what to do?Early miscarriageFrequencyRepetitionLateSymptomsCausesTransport and sportWhat to do after a miscarriage?Psychological follow-upReduce the risksWait before having another...
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