First trimester miscarriage
Dr. Sessa from the Women's Unit tells us about the most common causes of miscarriage during the first trimester of pregnancy.
What is considered a miscarriage?
El spontaneous abortion is the involuntary interruption of a pregnancyThis is a very common problem in our setting, with an incidence of up to 20%, although it is likely even higher due to the large number of early miscarriages in women who are unaware of their condition.
Causes of first trimester miscarriage
They have been classically identified two origins, although in most cases we will not get an accurate diagnosis.
Embryonic origin
Most abortions are due to a alteration at the level of the embryo itselfThese alterations may in turn be classified as:
- Morphokinetic alterations: The embryo is unable to complete the steps necessary for pregnancy to progress, halting its development. These alterations depend on other factors such as egg quality, sperm quality, proper embryo interaction with the environment, energy consumption, etc.
- Genetic alterationsThe embryo does not have the correct chromosome set, and in most cases, this leads to pregnancy termination. The rate of genetic alterations, or aneuploidy rate, depends directly on the age of the couple (primarily the woman's). Therefore, the older the couple, the greater the chance of having a genetically abnormal embryo, and therefore, a miscarriage.
- The preexistence of genetic disorders in one of the parents may also cause miscarriages due to genetic disorders, although in this case independently of age.
Maternal origin
In this case, the causes are quantitatively minor, but they will be of enormous importance because, on occasion, they are necessary for treatment. We can divide them into:
- Uterine causes: polyps, fibroids, uterine malformations…
- Immune disorders
- Alterations in the uterine microbiota (imbalance between saprophytic and pathogenic flora)
- Thrombophilias
- Endocrine disorders
- Infectious disorders
- Drugs and toxics
- Environmental changes
Types of miscarriage
biochemical abortion
Pregnancy is confirmed analytically but cannot be seen on ultrasound.
Incomplete abortion
Some of the uterine contents have been expelled, but the uterus is not completely empty.
Complete abortion
The complete expulsion of the abortive remains occurs, leaving the uterus empty.
Anembryonic gestation or blighted egg
An empty gestational sac is seen, without an embryo.
Ectopic or extrauterine pregnancy
The pregnancy occurs outside the uterine cavity, most often inside the fallopian tube. In these cases, early diagnosis is essential to avoid associated morbidity.
Symptoms of miscarriage
Symptoms can vary widely, ranging from completely asymptomatic to severe abdominal pain accompanied by intense vaginal bleeding.
Diagnosis of spontaneous abortion
The diagnosis will be clinical, analytical and/or ultrasound.
At the ultrasound level, the following criteria must be met:
- Absence of a previously visualized intrauterine pregnancy
- Cessation of embryonic heartbeat
- CRL ≥ 7 mm (embryo cranial caudal length) and NO heartbeat
- Gestational sac size ≥ 25 mm and NO embryo
- Absence of a heartbeat ≥ 2 weeks after an ultrasound showing a gestational sac without a yolk sac.
- Absence of heartbeat ≥ 11 days after an ultrasound with gestational sac and yolk sac
Miscarriage Treatment
In those cases where an abortion is confirmed, we must make sure the uterus is empty or has minimal remains that can be expelled on their own. If this is not the case, and depending on each patient's individual circumstances, we may evacuate the uterine contents by:
- Medical treatment with prostaglandins.
- Obstetric evacuatory curettage.
Miscarriage prevention and conclusions
- Abortion is a common condition, and in most cases is an isolated event in a person's reproductive life, which will not lead to future infertility.
- La delay in the age of motherhood will substantially increase the risk of miscarriage.
- If you wish to conceive and have a personal or family history of chromosomal abnormalities, consult a preconception doctor.
- Every woman who has had three or more miscarriages should consult a gynecologist specializing in human reproduction.
- There is no evidence that physical rest can change the course of pregnancy during the first trimester.
- During pregnancy, we should avoid self-medication and the consumption of toxic substances.
- Healthy lifestyle habits, including moderate exercise and a healthy, balanced diet, will be essential for a successful pregnancy.
Related articles
- First trimester ultrasound: pregnancy viability and chromosomal abnormalities
- Perinatal grief: experiencing and dealing with loss
Article written by the Dr. Sebastián Ignacio Sessa Méndez.
If you found this article interesting and would like to be seen by a professional expert in Gynecology and Obstetrics, the Women's Unit at Ruber International Hospital has a specialized unit in this area. You can request more information by calling the following numbers: 91 387 51 72/73/74 or make an appointment for an in-person consultation, always with the best specialists.