You are in your fifth month of pregnancy. Four and a half is already behind you, and you are now entering the third week of the fifth month - the nineteenth. How is your baby doing?

Fetus

At the 19th week of pregnancy, the fetus makes a big leap in its development. Now his brain is actively growing and developing, millions of neurons are taking their places, establishing connections with each other. Now the child’s “actions” will be more meaningful, so to speak. That is, coordination of movements will occur; they are no longer as chaotic as before.

Other children’s organs are not slowing down in their development either. The lungs, bronchioles and bronchi form the respiratory system, which will be improved until the birth itself. At week 19, the bronchial tree begins to take shape.

The baby's sebaceous glands are actively working: they produce a white-gray substance that covers the baby's body, accumulating in the skin folds. This original lubricant will remain until birth: it will protect the fetus from the effects of amniotic fluid and pathogenic microorganisms, since it has bactericidal properties.

The baby’s skin also continues to be covered with lanugo fuzz. These hairs are visible even on the baby’s face, which sometimes persists right up to the birth itself. Don't worry, they will disappear later, so the baby won't be furry all the time.

At the 19th week of pregnancy, the baby already confidently raises his head and can turn it around. The neck is already strong enough and rotates 180 degrees. The size of the baby continues to increase: it already weighs on average 250 g, the coccygeal-parietal size is more than 15 cm.

Uterus

The uterus does not lag behind the fetus and continues to grow. At week 19 she weighs 320 g and continues to increase in size and rise higher. You can feel the uterus 1.3 cm below the navel.

The growth of the uterus leads not only to an increase in the tummy, but also to the appearance of various pains. However, these sensations are not dangerous.

Pain at 19 weeks of pregnancy

We are talking about abdominal pain associated with tension in the muscles that hold the uterus. These muscles constantly become thicker and stronger, but with sudden movements a woman can feel their tension. In addition, by the end of the 19th week and beyond, you will begin to feel the pressure of the uterus on the navel - from the inside. This is a very unpleasant and even irritating sensation, but when the uterus overcomes this part of the path, it will disappear, be patient.

The growing weight and size of the uterus puts pressure on the pelvic area and lower back, where pain can also occur. In addition, the bones begin to diverge very slowly, expanding the birth canal through which the baby will move. These processes are also associated with pain in the bones (in particular in the hips).

Pain in the legs and back is the result of standing on your feet for a long time or sitting in an uncomfortable position. If you have a sedentary job, then try to walk at least 1-2 times per hour. Also, do not sit on chairs or couches without a back, do not cross your legs, and do not wear high heels.

Stomach

Abdominal pain may indicate the possibility of miscarriage. If they are pronounced, have a cramping nature, if the lower abdomen really hurts and is very tight, and also if these pains are accompanied by bloody discharge, then you need to tell the doctor about it.

The belly should have grown noticeably by now. Most likely, you can no longer sleep on your stomach, and you don’t need to: in this position, the uterus is compressed, and this is undesirable and unpleasant. It is also not recommended to sleep on your back so that the weight of the uterus does not compress the vena cava, blocking the access of blood and oxygen to the fetus.

Sensations (movements) at 19 weeks of pregnancy

The female body begins to gradually prepare for the upcoming birth and breastfeeding. Colostrum may sometimes be released from the mammary glands. There is no need to do anything special, just wipe the nipples with a clean, soft cloth.

At the 19th week of pregnancy, the level of hemoglobin in the blood may decrease due to an increase in its volume. In this regard, the woman feels weakness, fatigue, and dizziness. Meanwhile, the pulse may quicken, and breathing difficulties may appear: deep inhalations and exhalations are sometimes difficult. At such moments, try to breathe shallowly, like a dog.

In the second trimester, sweating increases and urination becomes more frequent - all these are physiological processes that do not require treatment. But the appearance of stretch marks, although quite natural, is very undesirable. Be sure to prevent stretch marks.

Listen to your tummy. If by week 19 you have not yet felt fetal movements, then perhaps you will feel the first movements now. If you have already gotten to know your baby better, then still expect new shocks. Over time they will become more frequent and active.

Discharge

This period is also characterized by an increase in vaginal discharge. They become liquid and abundant, but do not change their color or smell. Any other discharge is considered pathological and requires contacting a gynecologist. These include yellow, green, gray, red, brown, curdled, heterogeneous, foaming, strong-smelling discharge. They are a sign of infectious diseases that require special treatment. During pregnancy, thrush most often becomes inflamed, which must be treated before childbirth.

Sex

The second trimester is time for yourself. If you were planning a trip, travel or visits to loved ones, then this is the best time to do them. Only poor health and threats of termination of pregnancy, in which such activity is contraindicated, can interfere. Otherwise, continue to walk and move a lot, attend pregnancy fitness, have sex with your beloved husband. Intimacy will benefit the whole family! You shouldn’t deny yourself this pleasure, especially now, during one of the calmest weeks of your entire pregnancy.

Frozen pregnancy

And, nevertheless, listen to your body all the time. Do not ignore the slightest ailments, suspicious symptoms and changes. Unfortunately, it happens that in some women the fetus freezes in utero. Most often this occurs in the first trimester and ends in spontaneous abortion. However, a miscarriage does not always occur, and a woman can walk with a dead fetus for several weeks - this is very dangerous.

A doctor can identify a non-developing pregnancy at the next examination or during an ultrasound scan: the size of the uterus does not correspond to the expected period, the baby’s heartbeat and movements are absent. However, frozen pregnancy at 19 weeks is rare. However, you should not neglect scheduled visits to the doctor.

Tests at 19 weeks of pregnancy

In order to monitor the condition of the fetus and the course of pregnancy, the doctor regularly prescribes a series of tests for his ward and refers her for examinations. At the 19th week of pregnancy, it is worth checking the level of hemoglobin in the blood, blood sugar, and urine for protein.

If the need arises, a woman may also be asked to take a test for hormones, in particular for progesterone, the level of which increases during pregnancy for its preservation and successful development.

If by this time you have not yet undergone second trimester screening (but are planning to do so), then you need to hurry - it is most informative before the 20th week of pregnancy.

The second screening, or triple test, is a biochemical blood test for hCG (human chorionic gonadotropin), AFP (alphafetoprotein) and free (unconjugated) estriol. This test allows you to determine the level of certain markers in the blood of a pregnant woman, and based on these studies, as well as additional data (weight and age of the expectant mother, number of fetuses, etc.), classify her into a group of increased or decreased risk of developing chromosomal abnormalities in the fetus (in particular , Down syndrome, Edwards syndrome and neural tube defect). All indicators can and should be assessed only as a whole! Individually they have no diagnostic value.

Ultrasound

In addition to biochemical blood tests, the second screening also includes an ultrasound, which will necessarily look at the thickness of the fetal collar zone and the nasal bone. The uzist must assess the child’s heartbeat, his motor activity, diagnose the absence of pathologies incompatible with life, examine the uterine myometrium, the size of the uterus and fetus, and the condition of the amniotic fluid. At the request of the parents (and, of course, the child himself), the gender of the baby can be determined. You may be lucky and catch the baby playing: by this time, surprisingly, the fetus has already developed a routine similar to that of a newborn (he sleeps 18 hours a day and is awake the rest of the time).

Nutrition

In order for your baby to develop as best as possible, you must eat properly and nutritiously. The diet should be balanced with a predominance of protein foods. Eat lean boiled beef, nuts, legumes (if there are no problems with gases).

It is better to prepare dishes in ways that exclude frying and the use of large amounts of fat. Also exclude or at least limit spicy, smoked, artificial foods, keep salty, sweet and starchy foods under control.

Be sure to include foods rich in iron and calcium in your diet: dried apricots, figs, persimmons, blueberries, tomato juice, buckwheat and oatmeal, beef and rabbit, tongue, eggs, cheese, green vegetables and fruits, leafy greens.

Eat portions, in small portions, do not starve. However, it is also very important not to overeat: this will prevent the development of many possible problems.

Weight at 19 weeks of pregnancy

It is recommended to weigh yourself at least once a week at approximately the same time, wearing the same clothes (or without them at all), to monitor your weight gain. In the second trimester, the normal weekly gain should be 250-300 g. From the beginning of pregnancy, you should have gained from 3.6 kg to 6.3 kg. However, normally these data may differ on an individual basis. Much depends on the woman’s weight before pregnancy, her age, her health status, the course of pregnancy and other factors. Only the gynecologist leading the pregnancy can correctly assess your gain.

Skorokhod Boris Gennadievich
obstetrician-gynecologist
at the clinic of Professor Gorbakov

You can find the specific cost of abortion, conditions and terms
on the website of Professor Gorbakov’s clinic (Department of Gynecology).

You can also ask a question about the price using the contact form
or contact a gynecologist for consultation at the phone number indicated on the website.

Termination of pregnancy at 19 weeks is a very dangerous manipulation, which is carried out only for a number of compelling reasons. Abortion is definitely indicated if it is determined that the death of the fetus occurred in the womb. The so-called frozen pregnancy is an immediate indication for abortion at 19 weeks, since the tissue decomposition that has begun is very dangerous for the woman.

Late termination of pregnancy is indicated for identified chromosomal mutations and other abnormalities of embryo development. To do this, at a period from 16 to 20 weeks, a second screening is carried out, consisting of an ultrasound and a biochemical blood test. Depending on the results, the doctor may suggest termination of the pathological pregnancy.

An abortion at 19 weeks is carried out if the woman’s health does not allow her to continue bearing the child without risking her life, as well as for some social reasons (death of her husband, rape, etc.).

Surgical abortion at 19 weeks

Termination of pregnancy at 19 weeks is most often performed surgically. The cervix dilates and the doctor scrapes out the contents of the uterus with a curette. The operation takes place under anesthesia, and the woman comes to her senses already in the ward.

A minor caesarean section may be used. The operation is very serious and is only performed if the fetus needs to be removed immediately.

It is extremely rare at this stage to open the membranes, after which a weight is suspended from the fetus. The procedure is considered extremely dangerous and traumatic.

Medical abortion at 19 weeks

It is extremely rare at this stage that artificial birth is used to provoke it using medications. The operation takes place in a hospital setting, as it requires preoperative diagnosis and preparation. First, the woman receives medications that trigger labor, then her amniotic sac is punctured. Natural delivery should occur within 24 hours. If this does not happen, then a minor caesarean section is performed to save the woman’s life.

There is also a “filling method” or saline abortion, when a certain amount of a concentrated solution is injected into the amniotic sac and the fetus dies in the womb. Currently, the method is considered inhumane and is practically not used in practice. In addition, saline abortion causes severe complications in women.

A miscarriage is the loss of an embryo or fetus before the 20th week of pregnancy. The medical term for miscarriage is spontaneous abortion.

Most miscarriages occur during the first trimester, which is the first 12 weeks of pregnancy. Less commonly, miscarriage occurs in the second trimester, during the 13-19th week.

Most people think that miscarriages are very rare, but they are actually extremely common. This is one of the big misconceptions about pregnancy loss. The truth is that 20 to 30% of all pregnancies end in miscarriage. This is approximately 1 in every 5 pregnancies.

The rate of miscarriages may be even higher than reported, as many occur in the early weeks of pregnancy before the woman is even aware.

Because miscarriage has traditionally been a taboo subject, women who have experienced it often don't talk about it, and as a result they can feel guilty, ashamed and lonely as a result. Almost every woman blames herself for the loss of her pregnancy and feels that she did something wrong.

But it's rarely the woman's fault: Most miscarriages - or 60 to 80% of them - are caused by an abnormal number of chromosomes in the embryo.

But 76% of those surveyed thought a stressful event often caused miscarriage, while 64% of men and women thought lifting a heavy object played a role in pregnancy loss. But lifting something heavy, regularly straining, or having an argument at work do not cause miscarriages.

Different types of miscarriage

There are two types of miscarriage. One class is known as sporadic miscarriage.

The vast majority of sporadic miscarriages occur because the embryo receives an abnormal number of chromosomes. This genetic error can occur during fertilization, when the egg and sperm come together and make it difficult for the embryo to grow or survive.

A woman's body functions in a healthy way when it stops pregnancy.

The second class of miscarriages is known as recurrent pregnancy loss. This applies to a woman who has had two or more miscarriages. Recurrent pregnancy loss occurs in 5% of couples trying to conceive.

Women with recurrent miscarriages usually have no problems getting pregnant and often have healthy, normal pregnancies but continue to have miscarriages. To find out the cause of recurrent miscarriages, a woman suffering from this condition should undergo testing and see a specialist who will try to determine the possible cause.

A woman with recurrent pregnancy loss may be evaluated for blood clotting problems, hormonal imbalances, thyroid disorders, autoimmune diseases, and scarring or fibroids in the uterus. The expectant mother and her partner may have blood tests to evaluate chromosome abnormalities. However, this is not unusual because no reason can be found.

Who is at risk of miscarriage?

Maternal age is the biggest risk factor for spontaneous miscarriage.

The older a woman is, the more likely her eggs may contain an abnormal number of chromosomes, making mistakes more likely. The risk of miscarriage increases with maternal age, starting at age 30, and becomes greater after age 35.

Other possible causes of miscarriage include maternal health problems such as

• diabetes, high blood pressure;
• thyroid disease;
• autoimmune disorders (such as lupus);
• abnormalities of the uterus or cervix;
• maternal or fetal infections.

Lifestyle factors, such as a pregnant woman who smokes, drinks alcohol, uses drugs, is obese, or consumes more than 200 milligrams of caffeine (the amount in a 350-ml cup of coffee) the day before pregnancy may also increase the risk of miscarriage.

But it's not just a woman's coffee consumption that may affect her risk of miscarriage. Her male partner's caffeine habits may also play a role. In a 2016 study, among couples in which the man drank two or more coffees daily before conception was associated with a 74 percent risk of miscarriage.

What is stillbirth?

Stillbirth occurs when fetal loss occurs after the 20th week of pregnancy. About half of all stillbirths have no identified cause for pregnancy loss.

Many of the medical and lifestyle reasons listed above as possible causes of miscarriage also apply to stillbirth. Some additional risk factors for stillbirth include problems with the placenta, accidents with the umbilical cords, Rh disease (caused by a blood incompatibility between mother and fetus), and lack of oxygen to the fetus during birth.

Warning signs of miscarriage

The most common symptoms of miscarriage are vaginal bleeding and the passage of blood clots. A woman may also have cramps that are worse than menstrual cramps or mild to severe lower back pain.

A sudden decrease in pregnancy symptoms, such as nausea, may be another possible warning sign of miscarriage.

Although there are clear symptoms that may indicate that a woman is experiencing a miscarriage, some of these same symptoms can also occur during a normal pregnancy.

How are miscarriages treated?

Most couples who have experienced one or two miscarriages and who have no underlying medical problems will usually have a healthy and successful pregnancy.

Pregnancy loss is usually considered one of three ways, and each choice has its own risks and benefits.

1. The first approach is to do nothing and let the woman wait until the pregnancy loss resolves naturally on its own. The advantage of this method is that less medical intervention is required. But one of the disadvantages is that it can take up to two weeks for pregnancy to be lost. In addition, bleeding can be very heavy, and important genetic information from fetal tissue cannot be tested to understand why the miscarriage occurred.
2. The second treatment approach is to use a medication that causes the pregnancy to subside within 6-12 hours. The advantage of this treatment is that the timing of pregnancy loss is known because the cramps can be severe. One disadvantage is that it is difficult to recover embryonic tissue.
3. The third treatment option is a surgical approach known as dilatation and curettage. In this procedure, the doctor will remove remaining fetal tissue from the lining of the woman's uterus, and the tissue can be tested. However, this approach will cause bleeding and carries a small risk of infection or scarring of the uterus.

How long should I wait to get pregnant again?

Medical thinking on this issue has changed over time. It used to be that women were told to wait a year before becoming pregnant again after a miscarriage; then they talked about six months, and now it’s already three months.

Much depends on when the miscarriage occurs during pregnancy. If pregnancy loss occurs in the first weeks of pregnancy, the couple may wait one menstrual cycle. (Most women get their period again 4-6 weeks after a miscarriage.) But if the pregnancy loss occurs after 20 weeks, you must wait at least three months.

After a miscarriage, a woman should ideally wait until her uterus and hormone levels return to normal.

It is important for her human chorionic gonadotropin (hCG) levels to return to zero. This is because if a woman who has had a miscarriage has fluctuating levels of hCG in her blood and is trying to conceive too early, it is difficult to know whether her blood levels of the so-called pregnancy hormone are elevated due to fetal tissue from an old pregnancy or from pregnancy. for a new one.

The bottom line: A woman and her partner should start trying to get pregnant after a miscarriage when they both feel physically and emotionally ready, according to a 2016 study.

These are common early signs of miscarriage, but they don't necessarily mean your pregnancy will end. The only way to definitively tell if a miscarriage is occurring is to have a (pregnancy hormone) test to check your levels, or an ultrasound to listen to the baby's heartbeat.

In the article you can find answers to any questions that arise regarding miscarriage. If you think you have it, you need to seek medical help!

Chance of miscarriage at 8 weeks

A miscarriage is considered to be an interruption of pregnancy before the 24th week, although sometimes it is said to be before the 20th. They occur in approximately 15-20% of diagnosed pregnancies. Although the numbers can be much higher, since in the very early stages women most often do not know either about pregnancy or about the miscarriage that has occurred, taking it simply for heavy menstruation. Especially if you take failed implantation as a miscarriage.

At the 8th week, you can hear the baby's pulse on an ultrasound, and its presence is known to significantly reduce the risk of miscarriage. But this is subject to conditions. According to the UK Miscarriage Association, having a heart rhythm at this stage increases the chances of continuing the pregnancy by almost 98%. A 2008 study suggests a 1.5% risk of spontaneous abortion at 8 weeks of pregnancy among women who had no symptoms.

Although the risk of miscarriage is already quite low, it is still important to do everything possible to ensure a healthy pregnancy. Follow your doctor's recommendations about diet, activity level, and medications.

Symptoms of miscarriage at 8 weeks (early miscarriage)

In fact, some women experience spotting or blood spots quite often during early pregnancy. Statistics show that miscarriages occur in 1 out of 7 cases. Many of them are caused by genetic problems.

• If you are pregnant and have vaginal bleeding, you need to call your doctor immediately.
• If you have very severe cramping and excessive bleeding, you should seek emergency medical attention immediately.
• If there is severe pain and bleeding, you may have a rash, which is very serious.

The loss of pregnancy is a traumatic experience for both partners, but in the future it is possible to carry the child to term.

There are a few common signs to watch for early miscarriage, such as heavy bleeding, clots, and painful cramping. Some women report that all symptoms, such as morning sickness and vomiting, disappear with pregnancy loss. It is possible that the bleeding and cramping may stop while the pregnancy continues - this is known as 'threatened miscarriage'. If this is a true miscarriage, then the symptoms will end with the death of the embryo and the release of the products of conception.

What causes early miscarriage?

Miscarriages, which occur around the 8th week of pregnancy, occur because something is wrong with the development of the embryo. This is usually a genetic or chromosomal defect. When no reason is found for a miscarriage, they usually do not recur.

Embryos require 23 chromosomes from the father and 23 chromosomes from the mother. When these numbers do not match, the embryo cannot develop into a child. If there are serious abnormalities in the chromosome structure, the pregnancy does not continue beyond the embryonic stage and the body terminates it.

What happens after a miscarriage at 8 weeks?

Your doctor will most likely send you home if there is no heavy bleeding. If it gets worse, you need to go to the hospital. As the fetal tissue comes out, the bleeding should decrease and stop in about a week. In total, it can last up to 14 days after the miscarriage. Your doctor may prescribe medication for pain and advise you to use a heating pad or hot water bottle as a compress to relieve cramping. It is better if there is someone next to you so that you can rest peacefully. Some of the treatment options include:

• Monitoring: Your doctor may recommend watching the bleeding and giving it time to stop on its own if you don't have any signs of infection.
• Medications: Your doctor may prescribe medications to help your body get rid of other tissues it doesn't need.
• Surgery: A minor operation known as dilatation and curettage (D&C) may be used to clear any remaining tissue from the uterus, which will help stop bleeding. Doctors may give you medications to help your uterus contract more. In this case, blood can be released for up to three weeks. Most women who undergo this procedure do not require further treatment.

If you have already had 3 recurrent miscarriages, your doctor may refer you for a consultation with a geneticist or for additional testing to find the cause of the repeated occurrences.

Miscarriage at 8 weeks: experiences of other mothers

These are messages from forums from women who experienced miscarriage at around 8 weeks:

"Something's just not right"

“About the 6th week of pregnancy I started spotting. This lasted about 2 weeks. I started to feel like something was wrong and I just knew that my baby's heart had stopped. I started having a very bad headache and cramps. The discharge was brown and then turned bright red and the bleeding began quite heavily. My previous ultrasound showed that the baby had , but when I went to the doctor, no heartbeat was found. This confirmed my feelings that something was wrong. The doctor said that I had lost the child. Since my cervix would not open, he said that a curettage was needed. Just know that you are not alone and I wish you the best of luck in your next attempt to get pregnant.”

“I had no symptoms of miscarriage”

“When I was 11 weeks pregnant, I found out that my baby died at about 8 weeks. I decided to let the miscarriage happen naturally at home, but by 13 weeks it still hadn't happened. I woke up one morning at 13 ½ weeks with severe cramping, bleeding and nausea. The placenta could not completely leave my body, and I had to urgently undergo a curettage to remove unnecessary tissue. Then I recovered and started trying to conceive again.”

How and why does miscarriage happen? Is it possible to avoid termination of pregnancy?

The loss of a child causes deep shock for parents. And rarely the grief is reduced due to the fact that the baby was still tiny and in the womb. Almost always, a woman and a man go through this period very hard, but it is worth continuing to live for the sake of their future children, who will definitely appear.

For many women, the information we have prepared below can cause unpleasant memories and a bitter aftertaste. However, there are others who would be comfortable knowing more about their loss.

What is a miscarriage? How long does it take to occur?

The term is widely used to explain early pregnancy loss, which could be normal or ectopic. It is generally estimated that approximately 20-25% of all pregnancies end in miscarriage, which often occurs so early that the woman is not even aware of the event. In this publication we use this word, although from a medical point of view this event is called spontaneous abortion.

Brief dictionary - what are the types of miscarriages?

In most cases, with timely help from doctors, the child has every chance of survival. A miscarriage is a premature termination of pregnancy that is not caused by outside intervention. If this occurs within 2 months, it is called early, from 12 weeks, respectively, late.

A miscarriage at 5 months is considered to be premature birth. Approximately 20% of all pregnancies end in miscarriage, however, to reassure you, let us clarify that this most often happens when the woman is not yet aware of her pregnancy. If parents are ready and willing to have children, the risk of miscarriage is very low.

Among the possible reasons for sudden
termination of pregnancy should be noted:

• previous induced abortions (especially
  during the first pregnancy);
• short interval between pregnancies (less than two years);
• high degree of physical activity (work of a pregnant woman at work);
• genetic disorders;
• infectious and inflammatory diseases (endometritis,
  pyelonephritis, ureaplasmosis, toxoplasmosis, etc.);
• Rh conflict (incompatibility of blood between mother and fetus);
• hormonal disorders (insufficiency in a woman’s body
  corpus luteum and excess male hormones);
• development of various genital organs
  nature;
• sometimes the reasons for a miscarriage remain unknown.

Symptoms

In the initial stage
spontaneous abortion, aching, sometimes cramping pain is observed below
abdomen or lumbar region. When the placenta separates from the wall of the uterus,
bloody discharge from the genital tract. As the detachment process progresses
bleeding increases. Heavy bleeding may often occur,
leading to severe anemia. Together with the blood, the fetus comes out of the uterus
egg. After this, the uterus begins to contract and the bleeding stops.

If parts of the membranes and placenta remain in the uterus, it does not contract,
and the bleeding continues. Heavy uterine discharge can become dangerous
for life. The cervix remains slightly open, which favors the development of inflammatory
diseases due to the entry of pathogenic microorganisms.

Sometimes the elements of the fertilized egg retained in the uterus are very insignificant,
and the bleeding may stop, but subsequently these elements form
polyps that prevent the healing of the surface of the uterus. They can lead
to prolonged bleeding from the genital tract.

After the 14th week of pregnancy, spontaneous miscarriage usually occurs
by type of birth: due to contraction of the muscles of the uterus, cramping occurs
pain in the lower abdomen, the cervix smooths out and dilates, ruptures
membranes, amniotic fluid is poured out, the fetus is born, and then the afterbirth. Uterine bleeding during these stages of pregnancy
in the absence of complications, as a rule, it is not abundant. And in the uterus just like
and with early miscarriages, parts of the placenta may remain.

Attention: The occurrence of minor pain in the lower abdomen should serve as a
reason to immediately consult a doctor.

Diagnostics

You can determine the threat of miscarriage using a vaginal examination.
smear If the vaginal microflora becomes less so-called scaphoid
cells (modified cells of the intermediate layer of the epithelium - mucous
lining of the uterus) and the number of cells of the superficial layer of the epithelium increases,
there is a risk of spontaneous abortion.

The causes of miscarriage at 20 weeks can be:

Anembryonia - miscarriage, the symptom of which is an unformed fetus when the egg is completely fertilized. It implants itself into the wall of the uterus, sometimes a yolk sac and a gestational sac are formed, but the embryo does not appear there. All this may be accompanied by symptoms characteristic of the normal course of pregnancy.

Chorioadenoma - fertilization occurs with a violation of the genetic fund. Where the embryo should take hold, a piece of tissue appears and begins to grow. When the gynecologist detects such development of the fetus, an abortion is prescribed. Spontaneous abortion often occurs.

First trimester of pregnancy. Miscarriage: symptoms and causes

The threat of unexpected termination of pregnancy may be indicated by nagging pain in the lower back and lower abdomen. The external os of the uterine cervix remains closed.

Sexually transmitted infections, can also cause a threat of miscarriage. Many scientific studies have found that pregnant women suffering from chlamydia, ureaplasmosis, mycoplasmosis, trichomoniasis, herpes, cytomegalovirus infection, Coxsackie virus infection are much more likely to have miscarriage and premature birth than healthy women. In this case, the infections themselves become the direct cause of termination of pregnancy in cases where the pathogen directly infects the fetus and membranes. If the infection occurred before pregnancy and timely preventive measures were taken, a favorable course of pregnancy is quite possible. Sexually transmitted infections can cause abortion in both the first and second half of pregnancy.

Diseases of the genital organs(these include anomalies in the structure of the female genital organs, injuries, as well as diseases such as uterine fibroids, endometriosis) can be a mechanical obstacle to the normal growth and development of the fetus, when the fertilized egg cannot fully implant in the uterus. In addition, these conditions and diseases are accompanied by hormonal imbalances, which lead to the threat of miscarriage.

Isthmic-cervical insufficiency(istmus translated from Latin is “isthmus”; the place where the body of the uterus enters the cervix is ​​cervix) can also cause termination of pregnancy. Isthmic-cervical insufficiency (ICI) develops as a result of injuries to the isthmus and cervix during abortions and traumatic births; The hormonal cause of ICI may be hyperandrogenism. With ICI, the cervix, which is normally tightly closed during pregnancy, opens and does not hold the fertilized egg, which falls down under the influence of gravity. In this case, contractile activity of the uterine muscles may occur (contractions occur) or may be completely absent. Termination of pregnancy, the cause of which is isthmic-cervical insufficiency, most often occurs at a period of 16-18 weeks.

Pathological course of pregnancy may be one of the reasons for its interruption. Most often we are talking about gestosis of pregnancy, in which blood pressure rises, edema appears, and protein appears in the urine. The cause of termination of pregnancy can be placenta previa, when the placenta is attached in the area of ​​the exit from the uterus: the conditions for the blood supply to the fetus in this case are worse than if the placenta is attached in the middle or upper part of the uterus. These conditions lead to premature birth in the second half of pregnancy.

Today, there is a consensus in the global scientific community that habitual miscarriage is considered to be the case when a woman has two miscarriages in a row. If a woman has had one miscarriage and she comes to me and asks what the probability is that it will happen again, it’s the same 15–20%. If this situation occurs two times in a row, then the probability that it will happen again is already about 30–35%, and if three times in a row – almost 40%.

In approximately 2% of married couples, wives suffer from recurrent miscarriage.

If in the case of sporadic miscarriages, the fetus and its disorders are most often “to blame” for them, then with habitual miscarriages, its environment, the woman’s body, is usually “to blame”. As with sporadic miscarriages, genetics may be a factor. But if in sporadic miscarriage genetics are the cause of 70–80% (up to 6 weeks in general 90%) of all interruptions, then in the case of habitual miscarriage genetic disorders are found in only 2–3% of patients. The same is true for infections: with a recurrent miscarriage, the probability that repeated miscarriages occur due to infection is no more than 1%.

Hormonal disorders in a woman’s body, on the contrary, are a more likely cause of habitual rather than accidental miscarriage.

Risk of miscarriage

If during pregnancy a woman feels heaviness in the lower abdomen, pain in this area or cramps, and also if spotting bleeding is observed, this may indicate a threat of miscarriage.
In the case when a woman does not go to the doctor and leaves the situation to chance, spontaneous abortion may occur. Often, if you consult a doctor in a timely manner, a miscarriage can be prevented. But the woman will be under close supervision of the attending physicians until the birth itself. If a threat was observed in the first weeks or months of pregnancy, this may indicate abnormal development of the embryo. Therefore, an ultrasound examination is prescribed, which not only allows one to assess the condition of the fetus, but also detect uterine hypertonicity or problems with the cervix. In addition, a blood test for hormone levels and a special urine test are prescribed.

Often the doctor considers it necessary to check the function of the thyroid gland. For this purpose, a special blood test is also prescribed. It is important to check whether the cause of pregnancy disruption is an infection, such as cytomegalovirus, toxoplasmosis or herpes. In order to get a complete picture of the state of the body, there are two more tests: for antibodies to human chorionic gonadotropin, as well as for lupus anticoagulant.

There is such a term as “unexplained recurrent miscarriage”, as well as “unexplained infertility”. Maybe in five years medicine will find something new in this area, new explanations, but so far this has not happened. This is a psychologically difficult moment for both doctors and patients.

Two worlds, two approaches

If a woman is threatened with miscarriage, the actions of a doctor in Russia and abroad will be fundamentally different, and this is caused not so much by different scientific data as by cultural differences that arose during the isolation of our medical school. Abroad, such women are simply sent home: they are “prescribed” bed rest, a general clinical examination, and sexual rest. Time will tell how this situation will end: either the pregnancy will continue, or a miscarriage will occur if it was of poor quality - and it’s good that it was “rejected” by the body.

In Russia there is a slightly different psychological attitude of the population towards medicine and a slightly different medicine.

8. I have lower back pain. Could this indicate a threat of miscarriage?
Lower back pain can occur when there is a threat of miscarriage. But even under normal conditions, lower back pain is also possible due to the growth of the uterus. For an objective assessment of the condition, you need to contact a gynecologist.

9. What can be done at home if heavy bleeding from the genital tract suddenly appears during pregnancy?
Call an ambulance immediately and place an ice pack on your stomach.

10. How long should you use protection after a miscarriage??
At least 6 months.

Obstetrician-gynecologist, PhD Christina Frambos