Miscarriage and preservation of pregnancy: what is important to know in order to carry a child and not harm yourself

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The topic of pregnancy loss is very difficult and taboo. There are still many myths on both the medical and societal levels that further burden such an experience as natural termination of pregnancy. Many women blame themselves for the loss of a child, because there is an opinion that they “didn’t take care of themselves”, didn’t eat the right way, did sports or “got nervous”. What is important to know about natural abortion and why in most cases we cannot prevent miscarriage? To do this, we talked: With gynecologist Olena Pavlova and gynecologist, geneticist and reproductive specialist Ksenia Khazhilenka. What is a miscarriage, what are its signs and why does it happen? Miscarriage is the termination of pregnancy during the first 22 weeks. The main signs of a miscarriage are vaginal bleeding, pain that resembles cramps in the lower abdomen. However, bleeding does not always mean a miscarriage. Moderate bleeding can be a kind of norm during the first trimester of pregnancy (first 12 weeks) and does not mean at all that there is a risk of fetal loss. As reproductive specialist Ksenia Khazhylenko explains, about 20% of women experience more or less bleeding during pregnancy. Sometimes this can be a bad sign, and sometimes not. “In my practice, there have been many stories when the bleeding during early pregnancy was so profuse that no one hoped for success. Except for the child, as it turned out, because she was then born on time and completely healthy. It also happens. But each such situation is unique, therefore, it is important not to panic, but to consult a doctor, only he can provide clarity,” she says. Obstetrician-gynecologist Olena Pavlova also emphasizes that with any symptoms during pregnancy that bother you, you should only consult a doctor in person. “Why exactly? Because only a doctor will be able to answer these questions for sure. For example, a woman may have slight cervical discharge due to the presence of dysplasia, and this does not indicate a threatened miscarriage. There may be uterine discharge due to a low-lying placenta (we are not talking about complete presentation placenta, especially in the early stages!) – then again, we are talking more about the daily routine and workload than about the need for hospitalization for the entire period of pregnancy. There may be evacuation of the hematoma (removal of hemorrhage), then such secretions will really accompany the woman for a long time, until the hematoma completely disappears, and this is also not necessarily about hospitalization,” the doctor explains. According to statistics, from 10 to 20% of pregnancies end in miscarriage. But these are the data that the medical system was able to record. In reality, the rates may be higher, as miscarriage often occurs before a woman realizes she is pregnant. It is the woman who is accused of not being able to bear the pregnancy. And this is the first and most dangerous myth. In fact, most miscarriages occur because something has gone wrong with the development of the embryo. Approximately 50% of miscarriages occur due to chromosomal abnormalities. For example: anembryonia (an ultrasound phenomenon when the embryo is “missing” in the cavity of the fertile egg). Ksenia Khazhylenko explains that in fact the embryo is always formed, only in cases of anembryonia it stops developing too early, before we can see it”; molar pregnancy. “Molar pregnancy, or cystic drift – an abnormal degeneration of placental tissue with partial or complete displacement of the fetus “, Ksenia Khazhylenko explains. intrauterine death of the fetus. In this case, the embryo is formed, but “freezes” before the signs of miscarriage appear. Photo: iakovenko123/Depositphotos Conditions that can increase the risks of pregnancy loss or provoke it Of course, too categorically say that the state of health of the mother or father has nothing to do with miscarriage. There are conditions that can increase the risks of pregnancy loss or provoke it. For example, diabetes that is not controlled by therapy. But also: infections; hormonal problems; pathologies uterus or cervix; thyroid disease, etc. It is worth talking about infections separately. Certain preventable infections are reported to cause up to 15% of miscarriages in early pregnancy and up to 66% in late pregnancy (between 12 and 23 weeks). Infections that can increase the risk of miscarriage: rubella; gonorrhea; syphilis; cytomegalovirus; bacterial vaginitis; OX; chlamydia; malaria. Sometimes miscarriages also cause severe food poisoning, such as listeriosis, which can be contracted by eating moldy cheese, salmonellosis or toxoplasmosis, which is often found in undercooked meat. That is why during pregnancy it is advised to refrain from thermally unprocessed products. And here Ksenia Khazhilenko emphasizes that it is important to clearly distinguish between “miscarriage” and “miscarriage”, i.e. repeated pregnancy losses: “Any healthy woman can lose a pregnancy due to problems related to the child itself or due to external circumstances. Such (sporadic) losses cause damage to the psychological state, but mostly do not affect subsequent pregnancies. However, repeated losses are often (but also not always!) a certain system, when something is really wrong with the process of fertilization, attachment of the embryo in the uterus or its development. Accordingly, any – any stressful situations, both physical and mental, can cause sudden pregnancy loss. But “chronically” it usually doesn’t work,” emphasizes the doctor. She emphasizes that couples who have had two or more pregnancy losses need a special examination. But “universal” schemes do not work if we do not want to pass 100,500 tests, most of which are unnecessary. “A rational approach involves a very careful conversation with the couple to find out the possible direction of the problem: genetic, uterine, autoimmune, male, etc. Universal is always only a 3D ultrasound of the uterus, it is performed by everyone. Everything else should be according to the indications, then it will be personalized medicine,” explains the reproductive specialist. And he adds that women are very inclined to immediately punish themselves and think that: “I ate the wrong thing, lifted something heavy, went to rest”, etc., and this is definitely not the reason for the loss, because the vast majority of them happen due to the so-called natural selection, when nature stops the development of abnormal the embryo Is it possible to save pregnancy? You may have heard the phrase “bed down,” that is, receiving treatment that can preserve the pregnancy and supposedly “stop” the miscarriage that has begun. However, at present, in Ukraine and many other European countries, pregnancy is not preserved until 12 weeks (if it is not a repeated miscarriage). Ksenia Khazhylenko says that our patients, who can still read “pro-Soviet” resources, do not always like it. But according to her experience, if you take your time and take the time to explain, most Ukrainian women agree to this tactic: “And, you know, how cool it is to see together with the patient that the pregnancy, despite all the difficulties, is developing perfectly on its own! But I emphasize once again – this is not a matter of systematic miscarriages. They practice a different approach there.” Of course, many women will associate intervention according to Soviet protocols as something that saved. But doctor Khazhylenko notes that nature is not subject to anyone and anything, otherwise thanks to such “preservation” the number of children born with genetic problems would be an order of magnitude higher. Elena Pavlova also adds that some Soviet practices can harm and injure a woman. Including psychologically: “The constant forced (and unproven) lying position leads to muscle dystrophy and is a risk of thrombosis. It is also extremely difficult psychologically, especially when there is still a ban on visiting the sanitary room, and the woman is handed a vessel. In the conditions of general rooms for 4-5 people”. If we talk about the risks of medicines, the doctor notes that these are actually the risks that are listed among the side effects: hemolytic anemia, headaches, migraines, depressive disorders, liver dysfunction, dermatitis, etc. If we are talking about a combination of 5 or more drugs and for a long time, then the possible consequences of their interaction in the body are simply impossible to predict. The miscarriage did happen. What’s next? If you have recovered physically, adequately coped with this loss with your partner and want to try to conceive a child again, you can do it at least in the next cycle, after you have made such a decision, says Olena Pavlova. The advice to wait 6-12 months after a loss also has no evidence base. However, the doctor emphasizes: the key is your readiness: “Treating emotional wounds with a quick new pregnancy is not exactly the right tactic. It often causes excessive anxiety, unnecessary stress, overdiagnosis and inappropriate treatment. Therefore, you need to be honest with yourself and honestly answer yourself whether you are ready to a new attempt. Why not – give yourself time. A day, a month, a year – everyone has their period. It is necessary to understand that reproductive violence is not committed against a woman from religious or other points of view, that it is not an attempt to save a marriage or some other substitution concepts and that pregnancy is really her desire.” Of course, if a woman’s physical condition requires further examination, vaccination with live vaccines was missed (because others are allowed during pregnancy) or this is the second pregnancy loss in a row, then time is really needed for diagnostic measures to prevent future troubles. How long exactly it will take – again, it will be individual for everyone. And the main thing to remember is that the loss of pregnancy is not your fault. And no one has the right to impose this guilt on you. Natalya Bushkovska, specially for UP. Life

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