Symptoms and causes of spontaneous miscarriage. Why does spontaneous miscarriage occur in the early stages? What does an early miscarriage look like?

One in five pregnancies ends in miscarriage; More than 80% of miscarriages occur in the first 3 months of pregnancy. However, their actual number may be underestimated, since most occur in the early stages, when pregnancy has not yet been diagnosed. No matter when your miscarriage occurs, you may feel shock, despair and anger. A sharp decrease in estrogen can cause a decline in mood, although most women become depressed without it. Best friends or even family members will sometimes refer to what happened as a “bad period” or “a pregnancy that wasn’t meant to be,” which only adds to your grief. Many women feel guilty, thinking that something wrong was the cause of their miscarriage. What if it's because of the weights you've been lifting at the gym? Because of the computer at work? Or over a glass of wine with lunch? No. Remember that the vast majority of miscarriages are due to chromosomal abnormalities. Only a small proportion of women (4%) with a history of more than one miscarriage suffer from some kind of disease that requires diagnosis and treatment. It is important to find moral support after the incident. Give yourself time to go through all 4 stages of grief—denial, anger, depression, and acceptance—before you try to get pregnant again. Understand that this is an illness and share your pain with someone you trust. Your partner is grieving the loss just as you are, now is the time to support each other. Finally, remember that in most cases, even women who have miscarriages go on to have healthy children in the future.

Classification of miscarriage

Spontaneous miscarriages can be classified according to many criteria.

Of practical interest are classifications based on differences in gestational age, degree of miscarriage development (pathogenetic sign) and clinical course.

Spontaneous - miscarriages are distinguished:

By gestational age: a) early - in the first 12-16 weeks of pregnancy, b) late - in 16-28 weeks of pregnancy.
According to the degree of development: a) threatening, b) beginning, c) in progress, d) incomplete, e) complete, f) failed. If spontaneous miscarriages recur during successive pregnancies, they speak of a habitual miscarriage.
According to the clinical course: a) uninfected (not febrile), b) infected (feverish).

At the core pathogenesis Spontaneous miscarriage may be due to the primary death of the fetal egg due to toxicosis of pregnancy, acute and chronic infections, hydatidiform mole, etc. In such cases, reactive changes usually occur in the pregnant woman’s body, entailing contractions of the uterus with the subsequent expulsion of the dead fertilized egg. In other cases, reflex contractions of the uterus occur primarily and precede the death of the fetal egg (secondary death of the fetal egg), which occurs from a disruption in the connection of the fetal egg with the maternal body due to detachment of the placenta from its bed. Finally, both of these factors, i.e., contractions of the uterus and death of the egg, can be observed simultaneously.

Until 4 weeks of pregnancy, the fertilized egg is still so small that it takes up an insignificant place in the total mass of the falling membrane. Contractions of the uterus can completely or partially remove the falling membrane from its cavity. If the part of the membrane in which the egg is implanted is removed from the uterine cavity, a spontaneous miscarriage occurs, which the pregnant woman either does not notice at all or mistakes for heavy menstrual bleeding. By removing part of the falling membrane that does not contain the fertilized egg, the egg can continue to develop after the contractions have stopped. In such cases, slight bleeding from the pregnant uterus may even be mistaken for menstruation, especially since a small amount of menstruation-like discharge sometimes occurs in the first month of pregnancy. Further observation of the pregnant woman reveals the true picture.

If contractions of the uterus precede the death of the fertilized egg and cause its detachment from the bed in the area of the decidua basalis, where a rich vascular system is developed, short but severe bleeding occurs, quickly bleeding the patient, especially if half or a region is detached.

The closer to the internal os of the uterus the egg is implanted, the more severe the bleeding. This is explained by the lower contractility of the uterine isthmus compared to its body.
Sometimes the fertilized egg of early pregnancy exfoliates entirely and, having overcome the obstacle from the internal uterine os, descends into the cervical canal. If at the same time the external pharynx turns out to be impassable for the egg, it seems to get stuck in the canal of the cervix and stretches its walls, and the cervix takes on a barrel-shaped appearance. This form of miscarriage is called cervical abortion (abortus cervicalis).

A miscarriage in late pregnancy (after 16 weeks) proceeds in the same way as premature birth: first, the uterine os opens with wedging of the amniotic sac, then the amniotic sac opens, the fetus is born, and finally, detachment and the birth of the placenta occur. In multiparous women, the membranes often remain intact, and after the opening of the uterine pharynx, the entire fertilized egg is born entirely at once.

Types of miscarriage

Depending on what was discovered during the examination, your doctor may name the type of miscarriage you experienced:

Risk of miscarriage. If you are bleeding, but the cervix has not begun to dilate, then this is only a threat of miscarriage. After rest, such pregnancies often continue without further problems.
Inevitable miscarriage (abortion in progress). If you are bleeding, your uterus is contracting and your cervix is dilated, a miscarriage is inevitable.
Incomplete miscarriage. If some of the tissue of the fetus or placenta is expelled, but some remains in the uterus, this is an incomplete miscarriage.
Failed miscarriage. The tissues of the placenta and embryo remain in the uterus, but the fetus died or did not form at all.
Complete miscarriage. If all the tissue associated with the pregnancy comes out, it is a complete miscarriage. This is common for miscarriages occurring before 12 weeks.
Septic miscarriage. If you develop a uterine infection, it is a septic miscarriage. Urgent treatment may be required.

Causes of miscarriage

Most miscarriages occur because the fetus does not develop normally. Abnormalities in a child's genes and chromosomes are usually the result of random errors during the division and growth of the embryo - not inherited from the parents.

Some examples of anomalies:

Dead egg (anembryony). This is a fairly common occurrence and is the cause of almost half of miscarriages in the first 12 weeks of pregnancy. Occurs when only the placenta and membranes develop from a fertilized egg, but no embryo.
Intrauterine fetal death (frozen pregnancy). In this situation, the embryo is present, but it dies before any symptoms of miscarriage appear. This also occurs due to genetic abnormalities of the fetus.
Bubble drift. Hydatidiform mole, also called trophoblastic disease of pregnancy, is uncommon. This is an abnormality of the placenta associated with disturbances at the time of fertilization. In this case, the placenta develops into a rapidly growing cystic mass in the uterus, which may or may not contain an embryo. If the embryo does exist, it will not reach maturity.

In some cases, the woman's health status may play a role. Untreated diabetes, thyroid disease, infections, and hormonal imbalances can sometimes lead to miscarriage. Other factors that increase the risk of miscarriage include:

Age. Women over 35 have a higher risk of miscarriage than younger women. At 35 years of age the risk is about 20%. At 40 years old, about 40%. At 45 - about 80%. The age of the father may also play a role.

Here are the possible causes of miscarriages:

Chromosomal abnormalities. During fertilization, the sperm and egg each contribute 23 chromosomes to the future zygote and create a set of 23 carefully selected pairs of chromosomes. This is a complex process, and the slightest disruption can lead to a genetic abnormality, which will stop the growth of the embryo. Research has shown that most miscarriages have a genetic basis. The older the woman, the more likely such anomalies are.

Hormonal imbalance. About 15% of miscarriages are mediated by hormonal imbalances. For example, insufficient progesterone levels can prevent the embryo from implanting into the uterine wall. Your doctor can diagnose the imbalance through an endometrial biopsy, a procedure usually performed at the end of the menstrual cycle to assess ovulation and the development of the lining of the uterus. Treatment uses hormonal drugs that stimulate the development of the embryo.

Uterine diseases. Fibrous tumor of the uterus can cause miscarriage; Such tumors often grow on the outer wall of the uterus and are harmless. If they are located inside the uterus, they can interfere with implantation of the embryo or blood flow to the fetus. Some women are born with a uterine septum, a rare defect that can cause miscarriage. The septum is a tissue wall that divides the uterus in two. Another reason may be scarring on the surface of the uterus, as a result of surgery or abortion. This excess tissue can interfere with embryo implantation and also impede blood flow to the placenta. A doctor can detect these scars using x-rays, and most are treatable.

Chronic diseases. Autoimmune diseases, heart, kidney or liver disease, and diabetes are examples of disorders that lead to approximately 6% of miscarriages. If you have a chronic condition, find an obstetrician/gynecologist who specializes in pregnancies for these women.

Heat. No matter how healthy a woman is normally, if you have a high temperature (above 39°C) in the early stages, this pregnancy may end in miscarriage. Elevated temperature is especially dangerous for an embryo up to 6 weeks.

Miscarriage in the 1st trimester

During this period, miscarriages occur very often, in approximately 15-20% of cases. In most cases, they are caused by a fertilization anomaly, which causes abnormalities in the chromosomes of the fetus, making it non-viable. We are talking about a mechanism of natural selection, which does not imply anomalies on either the mother's or the father's side.

Physical activity has nothing to do with it. Therefore, you don’t have to blame yourself for the fact that you, for example, didn’t get enough rest, nor feel responsible for it. A miscarriage that occurs in the first trimester of pregnancy does not require further special examination, except in cases of two or three consecutive spontaneous abortions.

Miscarriage in the 2nd trimester

From the 13th to the 24th week of amenorrhea, miscarriages occur much less frequently - approximately 0.5%) and, as a rule, are provoked by infection or abnormal opening (gaping) of the cervix. For preventive purposes, you can do a cerclage of the neck, and in case of infection, take antibiotics.

What does not cause miscarriage?

These daily activities do not cause miscarriage:

Physical exercise.
Lifting or physical exertion.
Having sex.
Work that excludes contact with harmful substances. Some studies show that the risk of miscarriage increases if the partner is over 35 years old, and the older the father, the greater.
More than two previous miscarriages. The risk of miscarriage is higher if a woman has already had two or more miscarriages. After one miscarriage, the risk is the same as if you have never had a miscarriage.
Smoking, alcohol, drugs. Women who smoke and drink alcohol during pregnancy have a greater risk of miscarriage than women who do not smoke or drink alcohol. Drugs also increase the risk of miscarriage.
Invasive prenatal examinations. Some prenatal genetic tests, such as human chorionic villus or amniotic fluid testing, may increase the risk of miscarriage.

Symptoms and signs of spontaneous miscarriage

Often the first sign of a miscarriage is metrorrhagia (vaginal bleeding that occurs outside of menstruation) or palpable contractions of the pelvic muscles. However, bleeding is not always a symptom of a miscarriage: we are often talking about a disorder in the 1st trimester (it affects one woman in four); in most cases, pregnancy continues unimpeded.

A threatened miscarriage (abortus imminens) begins either with the destruction of the falling membrane, followed by cramping contractions of the uterus, or with the occurrence of contractions, followed by blood discharge from the uterus - a sign of the beginning detachment of the fertilized egg from its bed. The initial symptom of a threatened miscarriage is, in the first of these options, slight bleeding, in the second, cramping contractions of the uterus. If the process that has begun does not stop, it moves to the next stage - the state of an incipient miscarriage.

Thus, the diagnosis of a threatened miscarriage is made in the presence of a sign in pregnancy on the basis of one of the mentioned symptoms - minor cramping pain in the lower abdomen and sacrum and slight bleeding from the uterus (or both symptoms together), provided that there is no shortening of the cervix uterus and opening of the uterine pharynx. With a two-handed examination performed during contractions, the uterus is compacted, and the compaction remains for some time after the patient has stopped feeling pain from contractions.

Incipient miscarriage (abortus incipiens).. At this stage of miscarriage, cramping pain in the abdomen and sacrum and blood discharge from the uterus are simultaneously observed; both of these symptoms are more pronounced than in the stage of threatened miscarriage. As with a threatened miscarriage, the cervix is preserved, the external os is closed. The compaction of the uterus during contractions is more pronounced than during a threatened miscarriage. If the connection with the uterus is broken only on a small surface of the fertilized egg, for example, less than one third, its development can continue and the pregnancy is sometimes carried to term.

As the process progresses, contractions intensify and become painful, as during childbirth; bleeding also increases. The cervix shortens, the pharynx gradually opens, up to the size necessary for the passage of the fertilized egg. During a vaginal examination, due to the opening of the cervical canal, an examining finger can be inserted into it, which palpates parts of the exfoliated ovum here. This stage of the development of a miscarriage is called abortion in progress (abortus progrediens). In such cases, the fertilized egg is born partially or entirely.

When only parts of the fertilized egg are expelled from the uterine cavity, they speak of an incomplete miscarriage (abortus incom-pletus). In such cases, the main symptoms are: heavy bleeding with large clots, which can lead to acute and severe bleeding of the patient, and painful contractions. A two-manual gynecological examination reveals blood clots, often covering the entire vagina, a shortened and softened cervix, patency of the cervical canal along its entire length for one or two fingers; the presence in the vagina, in the cervical canal and in the lower part of the uterine cavity of parts of the exfoliated fertilized egg, if it was not expelled from the uterus before the examination, an increase in the body of the uterus, some softening (uneven), roundness and pain, short-term contraction of the uterus under the influence of the examination and etc.

A complete miscarriage (abortus completus) is said to occur when the entire fertilized egg is expelled from the uterus. A vaginal examination reveals that the uterus has decreased in volume and is dense, although the cervical canal is open, the bleeding has stopped, only scanty bleeding is observed; After 1-2 days, the cervix is restored and the cervical canal closes. However, although the fertilized egg is expelled from the uterus as if entirely, in the cavity of the latter there are usually still fragments of the falling membrane and villi that have not lost contact with the uterus, etc. When the uterus has expelled the fertilized egg entirely, it can only be decided after clinical observation of the patient and repeated two-manual gynecological examination. In all other cases, it is more correct to clinically consider each miscarriage as incomplete.

A failed miscarriage is recognized after clinical observation on the basis of cessation of growth of the uterus, which had previously increased in accordance with the duration of pregnancy, and then its reduction, the appearance of milk in the mammary glands instead of colostrum, a negative Ashheim-Tsondeka reaction (appears no earlier than 1-2 weeks after death of the fertilized egg), slight bleeding from the uterus, and sometimes even its absence.

One or another stage of development of a miscarriage is established (which is of great practical importance) based on the mentioned signs of each of them.

The following pathological processes can be complications of miscarriage.

Acute anemia, which often requires immediate intervention. If a woman who has a miscarriage is healthy in all other respects, especially if the body’s compensatory ability is full, then with timely and appropriate measures taken to combat acute anemia, death from the latter is very rarely observed.
Infection. During a miscarriage, a number of conditions are created that favor the development of the septic process. These include: an open uterine pharynx, which makes it possible for microorganisms from the cervical canal and vagina to penetrate into the uterine cavity; blood clots and remnants of the fertilized egg located in the uterine cavity, which serve as a good breeding ground for microorganisms; exposed placental area, which is an entrance gate easily permeable to microorganisms; the patient's exsanguinated state, which reduces the body's resistance to infection. In each case, it is necessary to determine whether there is an infected (febrile) or uninfected (non-febrile) miscarriage. An infected miscarriage will be indicated by the presence of at least one of the following signs: high temperature, palpation or percussion pain in the abdomen, pain in the uterus not associated with its contractions, as well as pain in its appendages and fornix, admixture of pus in the blood flowing from the uterus, general intoxication phenomena. body (fast pulse, depressed or excited state of the patient, etc.), if they are not caused by other reasons, etc.
Placental polyp. The formation of such a polyp is usually observed in cases where a small part of the placental tissue is retained in the uterine cavity. Blood oozing from the uterine vessels due to insufficient contraction of the uterus gradually permeates the remaining placental tissue, then layers on it, organizes and takes on the appearance of a polyp. The lower pole of the polyp can reach the internal pharynx, which does not contract completely due to the presence of a placental polyp (like a foreign body) in the uterus. This process is accompanied by slight bleeding from the uterus, which can last up to several weeks or even months, periodically intensifying. The entire uterus contracts poorly. When the polyp reaches a size that causes uterine irritation, contractions begin and bleeding intensifies.
Malignant degeneration of the epithelium of chorionic villi retained in the uterus - chorionepithelioma.

Treatment of spontaneous miscarriage

The main issue that should be resolved at the first examination of a pregnant woman with signs of miscarriage is the possibility of maintaining the pregnancy. With proper care and treatment of a patient with a threatened miscarriage, and somewhat less often with an incipient miscarriage, the pregnancy can be saved; Once a miscarriage has developed, it is impossible to maintain the pregnancy. From this follows the doctor’s tactics when treating a patient with spontaneous miscarriage.

Having established the presence of a threatening and incipient miscarriage, the pregnant woman is immediately placed in a maternity hospital, where a medical and protective regime must be organized. Its necessary elements are bed rest, physical and mental rest, strengthening faith in maintaining pregnancy (psychotherapy, hypnosis), normal or, if necessary, extended sleep, etc.

Drug treatment is carried out taking into account the identified etiological factors that caused the miscarriage. But since this is difficult to establish in most cases, medication measures are aimed at increasing the viability of the fertilized egg and eliminating the increased excitability of the uterus. Sodium bromide is prescribed (1-2% solution orally, 1 tablespoon 3 times a day), glucose (20 ml of a 40% solution intravenously once a day), the patient’s stay in the open air is beneficial (in winter, frequent inhalations of oxygen); for infectious etiologies, injections of penicillin (50,000 units every 3 hours) and other drugs are used; if there are contractions - opium preparations (opium tincture 5-10 drops 2-3 times a day orally or opium extract 0.015 g in suppositories - 2-3 suppositories per day); Progesterone injections are effective (5-10 mg daily for 10 days). After this, take a break and, if necessary, repeat the course after 5-10 days. Continuous injections of large doses of progesterone over a long period of time sometimes have an adverse effect on the course of pregnancy, in particular on the viability of the fetus.

Vitamins A, B2, C, D, E are also useful. They are prescribed in their pure form or products containing these vitamins are recommended: fish oil, brewer’s yeast, etc.

The administration of ergot, ergotine, quinine, pituitrin and other similar hemostatic agents is strictly contraindicated and is a gross medical error, since they increase uterine contractions, and at the same time contribute to further detachment of the ovum.

If these measures do not give the desired effect, bleeding and contractions intensify and the miscarriage moves to the next stage - abortion is in progress, it is not possible to maintain the pregnancy. In such cases, in the first 3 months of pregnancy, if there are no contraindications (infected miscarriage), they resort to instrumental emptying of the uterine cavity - removal of the fertilized egg or its remains from the uterine cavity, followed by curettage.

After 3 months of pregnancy, the patient is prescribed conservative treatment: cold on the lower abdomen, quinine (0.15 g orally every 30-40 minutes, 4-6 times in total) and alternated with injections of pituitrin 0.25 ml every 30-45 minutes, 4-6 times in total. After the birth of the fetus, the placenta, if it is not born on its own, is removed with a finger inserted into the uterine cavity, and its remains are removed using curettes.

In the postoperative period, bed rest, application of cold to the suprapubic area, uterine contractions are prescribed: liquid ergot extract - 25 drops 2 times a day, ergotine 1 ml intramuscularly 2 times a day, etc. With a fever-free course of the postoperative period and good general condition and the patient’s well-being can be discharged 3-5 days after surgery. Before discharge, a thorough general and necessarily special gynecological (two-handed) examination must be performed.

Treatment of patients with an infected, febrile miscarriage is carried out either strictly conservatively (medications), or actively (surgery), or actively expectantly (elimination of infection followed by instrumental removal of the remaining fetal egg). When choosing a method of managing a patient, you should be guided by her general condition and the severity of the infectious process.

In this case, they distinguish:

uncomplicated infected miscarriage, when only the fetal egg or the fetal egg along with the uterus is infected, but the infection has not spread beyond the uterus;
complicated infected miscarriage, when the infection has spread beyond the uterus, but the process has not yet been generalized;
septic miscarriage, when the infection is generalized.

Complicated infected and septic miscarriage is usually observed with criminal intervention for the purpose of expulsion.

When treating patients with an infected uncomplicated miscarriage, some obstetricians prefer immediate instrumental evacuation of the uterine cavity. Another, large part of obstetricians adheres to the active expectant method: for 3-4 days the patient is prescribed bed rest and drugs that tonic the muscles of the uterus (cold on the lower abdomen, orally quinine, pituitrin, ergot preparations, etc.) and aimed at eliminating the infection ( sulfa drugs, antibiotics). After the signs of infection disappear, the uterine cavity is carefully emptied surgically.

Finally, a number of obstetricians prefer strictly conservative management of patients, without any intrauterine intervention. For this purpose, the above remedies are supplemented with injections of the estrogen hormone, pituitrin or thymophysin, the administration of castor oil, etc., in order to stimulate uterine contractions and promote the spontaneous expulsion of the remnants of the fertilized egg from the uterus. Instrumental emptying of the uterus is resorted to only in case of severe bleeding that threatens the patient’s life.

With any of the listed methods of managing patients with an infected uncomplicated miscarriage, measures are taken to increase the patient’s body’s defenses and tone. This is achieved by good care, a rational diet, easily digestible, high in calories, containing a sufficient amount of vitamins, and other measures.

Having tested for many years each of the listed methods of treating patients with uncomplicated infected miscarriage - incomplete and complete, we were convinced of the advantages of the active expectant method. We resort to urgent instrumental evacuation of the uterus only in exceptional cases, when severe bleeding from the uterus threatens the patient’s life and must be stopped immediately.

Treatment of patients with a complicated infected miscarriage, i.e. when the infection has spread beyond the uterus, should only be conservative, since surgical intervention in such cases usually leads to the occurrence of peritonitis or sepsis. Surgical intervention may be necessary only in those exceptional cases when sudden bleeding of the patient and incessant bleeding from the uterus create an immediate threat to the patient’s life.

When treating patients with missed miscarriage, competing methods are expectant-observational and active - one-stage instrumental evacuation of the uterine cavity.

Considering the danger that threatens a pregnant woman when a dead fertilized egg is retained in the uterus, caused by infection, intoxication, malignant degeneration of villi, etc., one should strive to empty the uterine cavity as soon as the diagnosis of the disease is definitely established. In case of a failed miscarriage, treatment begins with the prescription of drugs that stimulate uterine contractions and thereby provoke the onset of a miscarriage: injections of estrogen hormone 10,000 units are made daily for 2-3 days. After this, 60 g of castor oil is given orally, and after half an hour, hydrochloride quinine is given 6 times, 0.2 every 30 minutes; after taking the fourth quinine powder, make 4 injections of pituitrin, 0.25 ml every 15 minutes. Then a hot vaginal douche is prescribed, and the temperature of the liquid should not exceed 38° for the first time; in the future it is gradually increased within the limits of the patient’s endurance. Often, the fetus lingering in the uterus is expelled completely or partially without instrumental intervention, which is subsequently resorted to to remove the remnants of the fetal egg.

Even in cases where this method of treatment does not lead to the goal, i.e., the expulsion of the fertilized egg retained in the uterus, it is useful, as it increases the tone of the uterine muscles. This creates favorable conditions for subsequent surgical removal of the fertilized egg: with a well-contracted uterus, bleeding rarely occurs during and after the operation and there is no perforation of the uterus during the operation.

Treatment for placental polyp consists of instrumental removal (curettage).

Prevention of spontaneous miscarriage

Prevention of spontaneous miscarriage should precede or begin with the appearance of its first symptoms. In the antenatal clinic, at the first visit to a pregnant woman, those women who have a history of spontaneous miscarriages or premature births, especially when there were several of them (“habitual miscarriage”, “habitual premature birth”), and women with various pathological conditions, are taken into special registration. which can cause spontaneous miscarriage. Preventive measures consist of prescribing anti-inflammatory treatment, correcting the abnormal position of the uterus, combating toxicosis of pregnancy, hypovitaminosis, eliminating and preventing mental and physical trauma; in appropriate cases - prohibition of sexual intercourse during pregnancy, transfer to a lighter type of work, etc.

Pregnant women with a “habitual miscarriage,” as well as those with threatened and incipient miscarriage, should be placed in a maternity hospital, in a pregnant ward. Of great importance is strengthening the patient’s faith in the possibility of maintaining pregnancy, as well as carrying out therapeutic measures: maintaining rest, extended sleep, prescribing progesterone, painkillers, drugs that reduce uterine excitability, multivitamins, especially vitamin E, etc.

If deep ruptures of the cervix occur during childbirth, its integrity must be restored immediately after childbirth. If this has not been done, then in order to prevent further spontaneous miscarriage, plastic surgery on the cervix should be performed before the next pregnancy to restore its integrity.

Miscarriage in early pregnancy is a common phenomenon that occurs in women. Many of them don't even know about their situation. Every girl needs to know how spontaneous miscarriage occurs in the early stages in order to know how to act in a dangerous situation and prevent serious consequences.

Causes of miscarriage in early pregnancy

Experts identify the following causes of miscarriage:

Genetic disorder. In the first weeks of pregnancy, it is important that all organs of the fetus are correctly formed, which requires 23 chromosomes from the mother and father. If a mutating element is present in one of them, then it is considered incompetent, as a result of which the pregnancy is terminated. Such an element can arise due to unfavorable ecology, viruses and occupational hazards.
Hormonal imbalances. Hormones are responsible for a woman’s well-being and health. Their imbalance can provoke miscarriage. A deficiency or excess of the male hormone progesterone also causes this phenomenon. It is important to diagnose hormonal disorders before pregnancy in order to undergo hormonal therapy prescribed by your doctor.
Rhesus conflict. To avoid miscarriage, before conceiving a child, a man and a woman must undergo a blood test to determine the group. If a woman is found to have a negative Rh factor, then it is important that the man has the same Rh factor. Otherwise, a Rh conflict may occur, when the fetus inherits the positive indicator of the father, and the mother’s body perceives its tissue as foreign and does not accept it, thereby saving itself. To eliminate this risk, you should take the hormone progesterone, which is responsible for protecting the embryo during pregnancy.
Infectious pathologies. If you have a sexually transmitted infection, it is necessary to cure it before pregnancy, otherwise the fetus will become infected and rejected by the body.
Abortion. If a woman has previously had an abortion, then there is a high probability of spontaneous miscarriage or infertility.
Taking medications. In the first trimester, it is prohibited to use any drugs to prevent defects in fetal development. You should also not take decoctions based on parsley, nettle and tansy.
Frequent stress and emotional overstrain. Severe stress and unstable mental state can lead to sudden termination of pregnancy. A patient with such a threat is prescribed sedatives.
Lifestyle. A woman is strictly prohibited from drinking alcohol and smoking. You should also adjust your diet and make your diet balanced.
Physical impact. Heavy stress in the form of heavy lifting or an unsuccessful fall can lead to miscarriage.
Systemic pathologies of the mother. If a woman has thyroid disease or autoimmune disorders, then her risk of spontaneous abortion increases.

Moderate physical activity, sex before the 13th week, and airplane flights do not provoke a miscarriage.

In the first weeks of pregnancy, special attention is paid to the healthy formation of all organs of the future person, which requires equal 23 chromosomes from mom and dad. And if one of them suddenly contains a mutating element, then it is recognized as incompetent, and a miscarriage occurs

Signs of a miscarriage

Symptoms of early miscarriage are:

pain in the lower abdomen and lower back;
bleeding from the vagina with or without pieces of tissue;
release of amniotic fluid.

With minor discharge there is a chance to continue the pregnancy. If the bleeding was accompanied by parts of the embryo, this indicates a miscarriage that has already occurred.

You can avoid an unpleasant outcome if you consult a doctor in a timely manner. This should be done in the following cases:

spotting at any time;
severe pain in the lower abdomen;
unpleasant sensations in the groin area that were not there before;
release of a large amount of fluid;
weak state of the body;
heat.

To diagnose the symptoms of miscarriage in early pregnancy, the following research methods are used:

PAP test.

With an ultrasound, the doctor can detect the fetus from 3-4 weeks of pregnancy. After a few more weeks, a pronounced heartbeat of the embryo appears. If, with minor bleeding, a specialist detects a fetal heartbeat, then the probability of carrying the pregnancy to term exceeds 95%. If the bleeding is combined with a damaged fetus, the embryo is too small, and there is no heartbeat, then abortion is an inevitable procedure.

Important! Quite often, with bleeding, ultrasound shows a retrochorial hematoma. It is not dangerous if it is not large. In the case of severe detachment and large hematoma, the risk of abortion and heavy bleeding increases significantly.

The study of human chorionic gonadotropin is usually carried out only in the early stages, when ultrasound does not yet show the vital activity of the embryo. If the period is no more than 4 weeks, and the fetus is not found, then there is a need to determine hCG 2 times, with an interval of 2 days. Depending on the results obtained, an ultrasound is prescribed or a termination of pregnancy is confirmed.

In some cases, if there is bleeding, a smear is done for oncocytology. This measure is necessary if an ultrasound revealed a living embryo, a hematoma in the chorion area was not detected, but the bleeding does not stop. A smear helps rule out cervical cancer.

If you still have a miscarriage early on, be sure to consult a doctor to find out if cleaning is necessary. A specialist will examine you and make recommendations

How does early miscarriage occur?

At first, the woman feels weak and dizzy. She is worried about pain in the lower abdomen. Such symptoms should not be ignored. If minor bleeding begins, promptly seeking medical help will help stop it. Typically, a miscarriage occurs at home according to this pattern - a slight delay in menstruation, the test shows 2 lines, then slight bleeding appears.

Important! When a woman realizes that she has lost her baby, she should consult a doctor, since an early miscarriage without cleaning is almost impossible. Remaining tissue will need to be removed from the body. If this procedure is not performed, the remains of the fetus will begin to decompose, which will lead to the spread of harmful microorganisms and the appearance of an inflammatory process.

Cleaning is carried out 2-3 days before the start of menstruation (after a miscarriage this is not always possible). Scraping of fetal remains is carried out on a gynecological chair. First, anesthesia is required, after which the doctor inserts a special dilator into the vagina, which allows you to visually observe the condition of the cervix. Then a probe is inserted into it to examine the cavity using a portable video camera. For scraping, a surgical instrument is used that resembles a spoon in appearance. The specialist carefully removes the surface layer of the uterus, then the resulting material is used for histological examination. The operation lasts on average 30-45 minutes.

Treatment

Treatment for threatened miscarriage depends on the cause that may cause it. It is impossible to influence the course of events before 3 months of pregnancy. Doctors often prescribe Tranexam to patients to stop bleeding. If a woman has had experience with unsuccessful pregnancies, then she is prescribed Utrozhestan.

The following drugs do not have any effect on bleeding:

Baralgin;
Magne B6;
Vitamin E

If the level of male hormones is high, a woman is prescribed medications for hyperandrogenism. You cannot do without certain medications if there is a threat of Rh conflict. If Rh conflict does arise, then therapy includes intrauterine blood transfusion to the fetus through the umbilical cord. After birth, the baby will need treatment for jaundice. To do this, it is placed under special blue lamps. Sometimes such treatment is not necessary.

Most patients with threatened miscarriage in early pregnancy are treated in a hospital setting. In some cases, therapy begins in a hospital, and then the woman may be sent home.

Quite often, the doctor prescribes the drug Duphaston if there is a threat of miscarriage in the early stages. It is a synthetic analogue of progesterone in tablet form. The dose of the drug is prescribed in each case individually, focusing on the condition of the expectant mother and her hormonal disorders. It should be taken at the full course until all symptoms of early miscarriage disappear. When a woman’s health improves and there are no signs of threatening miscarriage, she is prescribed a “maintenance” dosage of the drug. In case of a repeated threat, the course of treatment must be repeated.

Side effects of the drug Duphaston include:

bowel dysfunction;

If pain occurs in the right hypochondrium, as well as with obvious signs of jaundice, you should stop taking Duphaston.

Prevention of miscarriage

Pregnancy planning should be done intelligently. A woman should undergo a medical examination to ensure that she is healthy and ready to bear a child. This significantly reduces possible risks. Expectant parents need to promptly stop drinking alcoholic beverages, smoking cigarettes and uncontrolled use of any medications.

Before conceiving, a woman must treat all existing infectious pathologies. Also, while pregnant, you should avoid company with infected people.

It is important for pregnant women to monitor their diet and not worry about trifles. If for some reason stressful situations cannot be avoided, then you should take sedatives as recommended by your doctor. You should also avoid strenuous physical exertion and blows to the stomach.

If a woman’s first pregnancy occurred at the age of 30-35, then she should especially carefully monitor her health and undergo regular examinations.

What to do after a miscarriage?

In many cases, termination of pregnancy cannot be avoided. This situation becomes a huge tragedy for the woman and her loved ones. The natural reaction then is to conceive a new child as soon as possible. However, doctors strongly recommend planning a pregnancy only 6 months after a miscarriage. It is important to take birth control correctly during this period. According to statistics, a pregnancy that occurs immediately after a miscarriage has a high risk of also ending in termination.

If a woman has a sexually transmitted infection and the bleeding is prolonged, then after a miscarriage it is necessary to take antibacterial drugs. If there is heavy bleeding, you cannot do without taking medications that contain iron for therapy.

If a woman has had more than 3 miscarriages, she must undergo additional procedures and pass all the necessary tests.

A miscarriage is considered to be an interruption of pregnancy before 22 weeks or when the fetal weight is less than 500 g, regardless of the presence or absence of signs of fetal life.

How does a miscarriage occur?

A miscarriage is the premature exit of the fetus from the mother's body. There are two options for this process, which directly depend on the timing of pregnancy.

The first option is a miscarriage by type of rejection. This type of miscarriage is observed in the first trimester of pregnancy as a result of an immune conflict between the mother and fetus. As a result, the functions of the future placenta are disrupted and antibodies are produced to the cells of a “foreign” body. In this case, the chorion is destroyed, and the fertilized egg is expelled from the uterine cavity. The process is accompanied by bleeding of varying degrees - most often it is heavy bleeding.

The second type of miscarriage occurs according to the type of birth, and is observed in the second and third trimester of pregnancy. The main role in this variant is played by a change in the tone of the uterus - a significant increase in the tone of the uterine muscles or insufficiency of the uterine closure apparatus. In this case, contractions, opening of the cervix and the birth of the fetus are observed.

How to understand that a miscarriage has occurred?

During miscarriages in the first trimester, nagging pain occurs in the lower abdomen, spotting red-brown discharge appears, bleeding may appear, and sometimes the urge to urinate and defecate. In this case, the fetus completely or partially leaves the uterine cavity with blood clots.

At later stages, a miscarriage occurs as a premature birth with contractions and cramping pain, the release of amniotic fluid and the fetus with its membranes, in whole or in part.

What to do if there is a miscarriage?

If you notice the appearance of bloody discharge in the early stages of pregnancy, consult your doctor immediately, as there is still a chance of continuing the pregnancy until heavy bleeding occurs. If there is heavy bleeding, hospitalization is necessary, since large blood loss, blood poisoning and death for the woman are possible. It is usually not possible to maintain pregnancy in such cases.

If a late-term miscarriage occurs, a visit to the doctor or hospitalization is also necessary, since fetal membranes may remain in the uterine cavity, the infection of which poses a threat to the life and health of the mother.

What to do if a miscarriage occurs at home?

If you have any miscarriage or suspect one, immediately call a doctor or an ambulance! Try to clearly and clearly tell the dispatcher your address, the symptoms that are bothering you and the timing of your pregnancy.

You should also know what a woman should do before help arrives if a miscarriage occurs:

Lie on the bed and place a folded blanket or pillow under your buttocks to help reduce bleeding.
Cold (an ice pack, if you don’t have one - any frozen food, wrapped in a towel, a heating pad with as cold water as possible) on the lower abdomen.
Remember your blood type and Rh factor (you may need a blood transfusion). It is better to write down this information and put a note next to it.
Do not throw away diapers, towels and blood-soaked materials - the doctor needs them to assess blood loss.
Monitor your general condition - measure your blood pressure and pulse before the doctor arrives.
If possible, prepare a set of instruments for gynecological examination and curettage.

What happens after a miscarriage?

After a spontaneous miscarriage occurs, fetal membranes, blood clots, and remnants of amniotic fluid remain in the birth canal, which become infected and decompose. Complete release of all membranes is extremely rare, which requires diagnostic curettage of the remains from the uterine cavity and suturing of ruptures, if any.

Spontaneous miscarriages are a signal about the need for examination to prevent future miscarriages. It is necessary to find out the cause of the miscarriage and eliminate it. In the early stages of pregnancy, miscarriages rarely threaten a woman’s reproductive health and more often prevent the birth of a child with chromosomal developmental abnormalities, often incompatible with life.

When a woman is pregnant in the early stages, she often does not know about it and only realizes it when her menstruation is delayed. Sometimes menstruation occurs after a pause, but it is larger than in normal life and is marked by increased pain. Spontaneous miscarriage in the very early stages occurs with fairly moderate and localized abdominal pain with severe bleeding. In this case, women often do not come to the doctor. Sometimes the bleeding does not stop for a couple of days. Then you have to make an appointment with a gynecologist. Thus, the woman finds out that she was pregnant, but not successfully.

Sometimes menstruation occurs with constant severe pain from the very beginning. At a certain point, a fairly large blood clot comes out. In appearance it can be compared to a burst bubble. For many, it looks scary.

If a woman notices this phenomenon, it is advisable to consult a doctor, as in some cases special cleaning is necessary.

Miscarriage often occurs with great pain not only for the body, but also for the soul. To prevent a recurrence of this phenomenon, it is necessary to remember that spontaneous miscarriage before three months of pregnancy is a warning for parents. It indicates either the mother’s unwillingness to fully bear the child due to too early an age, or a problem in the health of one of the parents, which is why the fetus is imperfect and is spontaneously rejected by the mother’s body.

What precedes a miscarriage?

To identify in advance the possibility of a miscarriage and prepare for it, you need to check your body for the following pathologies. If they are detected or suspected, you should weigh the risks and think about your readiness for the birth of a child before conceiving a child.

Possible pathologies affecting the formation of spontaneous miscarriage:

Main symptoms of spontaneous miscarriage

The main symptoms of spontaneous miscarriage are pain in the lower abdomen and heavy, sometimes quite prolonged bleeding. Sometimes the painful sensations are interrupted by pauses, often radiate to the back, and have a girdling character, like during contractions, only their intensity is always incomparably less. If strong vaginal discharge appears early in pregnancy, this aspect also indicates the risk of miscarriage. When a woman notices red or brown discharge, she should consult a doctor immediately. Sometimes it is possible to identify and prevent the development of pathology.

If significant bleeding is noticeable, the likelihood of miscarriage increases. When only a small amount of discharge is indicated, this unpleasant fact can be avoided much more often, so treatment makes sense. Increased uterine tone is a symptom of miscarriage, but only if the expectant mother feels discomfort from it. You need to listen to your feelings in time to quickly recognize and moderate this unpleasant symptom. The main method of treating this problem is to reduce or completely eliminate physical activity and get rid of stress.

How to understand that there is a threat of miscarriage?

If the pregnancy was planned in advance, the parents underwent a full course of examinations and, if necessary, completely cured all diseases, then a miscarriage is unlikely.

When conceiving a child, you need to take into account all contraindications and at the slightest manifestation of symptoms of miscarriage, you should consult a doctor to detect violations and prescribe treatment methods.

If pregnancy suddenly occurs without prior examinations and treatment of diseases, it is necessary to undergo an examination by a gynecologist. After determining the approximate duration of pregnancy, the doctor looks at compliance with all standard parameters of the condition of the genital organs.

Aspects that must correspond exactly to the gestational age:

Volume of the uterus.
Absence or presence of tone.
Opening or closing of the cervix.
Abundance, nature and frequency of vaginal discharge.

What standards need to be followed to avoid miscarriage?

You can prevent the appearance of early symptoms of spontaneous miscarriage or its occurrence in the early stages of pregnancy by following these steps:

When the threat of miscarriage in the early stages is very high, the woman remains in the hospital for a long time, perhaps even before giving birth, or visits the hospital regularly, periodically going to the hospital for conservation. Before pregnancy and in the first months of its passage, you need to lead a healthy lifestyle to reduce the likelihood of spontaneous miscarriage. To reproduce healthy offspring, it is necessary not to deviate from the instructions of the attending physician before birth.

Video - behavior when there is a threat of miscarriage

If you observe the basic norms of behavior for pregnant women, follow the doctor’s recommendations, and take the necessary actions to eliminate the risk of miscarriage, there is practically no chance of its occurrence. If the above negative symptoms occur, it is necessary to sharply reduce the load on the body and engage in its restoration, and if a spontaneous miscarriage occurs, it is recommended to consult a doctor.

Early miscarriage is common. According to statistics, every fourth pregnancy ends in spontaneous abortion. What is the cause of this condition and how to prevent the threat of miscarriage? You will find the answer in this article.

Early miscarriage: causes

Early miscarriage in gynecology is a condition in which a woman loses a child up to 12 weeks. Experts note that almost 60% of spontaneous abortions are caused by chromosomal mutations of the fetus. If a certain anomaly appears during the development of the embryo, the woman’s body in most cases gets rid of the non-viable offspring itself.

Genetic defects can be inherited or develop spontaneously. It is impossible to prevent such a miscarriage, but the risk of developing mutations can be eliminated even before conception, protecting the woman from the negative influence of teratogenic factors.

Common causes of abortion:

Hormonal imbalances. Habitual early miscarriages can be provoked by hormonal imbalance, in particular an increased concentration of male sex hormones that interfere with the production of progesterone (the pregnancy hormone). In this case, a properly selected course of hormonal medications will help eliminate the problem.
Influence of the Rh factor. If an embryo receives a positive Rh factor from its father, then the body of a woman with a negative Rh factor perceives it as a foreign object that needs to be gotten rid of. As a result of Rh conflict, spontaneous abortion occurs. A course of immunomodulatory therapy will help correct the situation. Treatment is carried out at the stage of pregnancy planning.
Sexually transmitted infections pose a particular danger to the embryo. Infection of the fetus with pathogens of syphilis, gonorrhea, toxoplasmosis, herpes or chlamydia causes damage to the membranes and provokes miscarriage. Many pathologies can occur secretly, therefore, even at the stage of pregnancy planning, the expectant mother must undergo a medical examination, which allows foci of infection in the body to be promptly eliminated.

Chronic inflammatory diseases of internal organs and general infections accompanied by intoxication of the body are no less dangerous. This list includes rubella, pneumonia, pyelonephritis, and viral hepatitis. Even a common flu or sore throat poses a serious threat to the fetus.
Taking certain medications. Spontaneous abortion in the early stages of pregnancy can be caused by certain drugs - antidepressants, retinoids, NSAIDs or antifungal drugs. When planning conception, this point should definitely be taken into account.
Lifestyle. Improper, unbalanced diet, excessive consumption of caffeine-containing drinks, bad habits (smoking, alcohol) are risk factors that provoke early miscarriage.
The negative impact of regular stress, psycho-emotional stress, and deep personal experiences should also be taken into account. Experts recommend adjusting your lifestyle even before conception and trying to protect the woman as much as possible from the effects of any unfavorable situations and severe nervous shock.

In addition, the cause of miscarriage in the early stages of pregnancy can be chronic diseases of the female genital area, previous abortions, congenital anomalies of the genital organs, obesity, as well as the age factor. It is noted that after 40 years, the risk of miscarriage increases several times.

How does a miscarriage occur?

The process of termination of pregnancy develops gradually, over several hours or even days. If a woman seeks medical help in a timely manner, she can still be helped. How does a miscarriage occur? In its development, spontaneous abortion goes through several stages.

Risk of miscarriage. The woman experiences slight bleeding and complaints of nagging pain in the lower back and suprapubic region. On examination, uterine hypertonicity is revealed. Even a slight discharge of blood is a dangerous sign that requires immediate medical attention. At this stage, it is still possible to stop spontaneous abortion.
The beginning of a miscarriage is manifested by similar symptoms, which gradually increase and become more pronounced. Fragmentary detachment of the fertilized egg begins, and partial opening of the cervical canal occurs. But even at this stage, the woman can still be helped by emergency hospitalization in a hospital.
A miscarriage is in progress - cramping pain occurs in the lower abdomen, the embryo is completely separated from the endometrium, but still remains in the uterine cavity. Heavy bleeding begins, which indicates the final death of the embryo. The external and internal os of the uterus open, and during examination, elements of the fertilized egg are determined in the lumen of the cervix or vagina.
Incomplete abortion. This condition is characterized by painful sensations in the lower abdomen, lower back, and heavy bleeding. Elements of the fertilized egg remain in the uterine cavity. Large blood loss is accompanied by dizziness, weakness, drop in blood pressure, and fainting.
A complete spontaneous abortion is said to occur after all parts of the embryo are completely released. After the uterus is cleansed, it contracts and returns to its previous shape and size. All accompanying symptoms (pain, bleeding) disappear, the woman does not need further therapy, but remains under medical supervision.

But it is not always that fragments of the fertilized egg completely come out of the uterus. In this case, the woman will have to undergo a curettage procedure, otherwise the remains of the embryo will begin to decompose in the uterine cavity and become a source of infection. The spread of pathogenic microorganisms threatens with dangerous complications and severe inflammatory processes. In this case, surgery is necessary, otherwise there is a direct threat to the woman’s health and life.

Consequences of miscarriage

Spontaneous abortion in the early stages can be accompanied by a number of complications.

Injury to the endometrium during uterine curettage can subsequently lead to the development of endometritis.
Significant blood loss during uterine bleeding often becomes the cause of posthemorrhagic anemia, accompanied by constant weakness, pallor, dizziness, and decreased performance.
Hormonal imbalances after a spontaneous abortion can provoke repeated miscarriages, which reduce the chance of carrying a normally developing pregnancy.
Psychological problems. A miscarriage during a long-awaited pregnancy is a strong emotional shock for a woman. Many couples have a hard time dealing with a situation that destroys their hopes for the birth of an heir. At this stage, the woman and her husband need the help of a psychologist in order to come to terms with the loss and continue trying to find a happy, full-fledged family.

If after a miscarriage the temperature rises sharply to high levels, chills, severe weakness, purulent vaginal discharge, pain in the pelvic area appear, you should urgently consult a doctor. Such signs indicate infection of the body and the development of a severe inflammatory process.

A few weeks after a complete abortion, an analysis of HCG levels is necessary. If it does not decrease, there is a risk of developing a dangerous complication - hydatidiform mole. The pathology is characterized by the growth of chorionic villi into blisters filled with fluid. The consequence of this condition may be infertility, intrauterine infections, or the development of malignant choriocarcinoma.

Photo: workingparentshandbook.com

Diagnostic methods

How is threatened early miscarriage diagnosed? If a threat of miscarriage is suspected, the doctor conducts a gynecological examination, takes into account the patient’s complaints and data from laboratory and instrumental research methods.

During the interview, the obstetrician-gynecologist finds out the date of the last menstruation, draws attention to the presence and influence of unfavorable factors - occupational hazards, recent infectious diseases, in the treatment of which certain groups of medications were used, and other nuances. Next, the doctor assesses the woman’s general condition and the nature of the pain syndrome.

During a vaginal examination, the gynecologist finds out whether the uterus is in good shape, whether its size corresponds to the stated period of pregnancy, and also pays attention to the condition of the cervix and the volume of vaginal discharge. In addition to routine blood and urine tests, laboratory tests are performed to determine progesterone levels and detect the hormone human chorionic gonadotropin (hCG), the presence of which may indicate an ectopic pregnancy.

A special role in terms of diagnosis is given to ultrasound examination (transvaginal ultrasound). This method is the “gold standard” for determining the risk of early miscarriage. If it is impossible to carry out this procedure, they resort to a transabdominal scanning procedure. Using this method, it is possible to determine the cessation of cardiac activity of the embryo or the complete absence of the fertilized egg.

Therapy methods

When alarming symptoms appear, it is important not to panic. You need to contact your obstetrician-gynecologist as soon as possible for examination and treatment.

Treatment in a hospital setting

The first recommendations for a woman are to avoid any physical activity and adhere to bed rest. Usually a woman is admitted to a hospital to continue her pregnancy. In especially severe cases, the patient is prohibited from getting out of bed.

In order to maintain pregnancy, doctors prescribe medications to women containing gestagens (female sex hormones) that block uterine contractions. If there is a risk of bleeding, tronexamic acid is used. Antispasmodics - no-spa, drotaverine, rectal suppositories with papaverine - will help relieve pain. Additionally, the doctor may prescribe vitamin injections and magnesium droppers.

If hormonal deficiency is detected, therapy includes drugs with progesterone - utrozhestan or duphaston. If there is a Rh conflict, a woman must take medications to eliminate the threat of rejection of the fertilized egg. After an ultrasound, the doctor may recommend suturing the cervix. This procedure allows you to leave the fertilized egg inside the female womb.

Surgery

Surgical intervention is resorted to at the following stages: spontaneous miscarriage in progress, incomplete abortion or massive bleeding. The purpose of such an intervention is to remove the remains of the embryo and restore full hemostasis. The procedure is performed under anesthesia using a vacuum aspirator or through mechanical curettage (scraping) of the uterine walls.

If a patient is admitted to the hospital with a complete abortion, surgical intervention is not resorted to, limiting itself to monitoring the woman’s condition. Subsequently, in almost 85% of women who have had a spontaneous abortion in the early stages, subsequent pregnancies develop normally.

Treatment at home

If the threat of miscarriage is insignificant, the woman can stay at home provided she carefully follows all medical recommendations. The main ones:

exclusion of physical activity;
correct daily routine;
good nutrition - the basis of the diet is fresh vegetables and fruits, herbs, dairy products, dietary meat;
walks in the fresh air before bedtime;
prohibition on taking hot baths - you should wash in the shower.

On the advice of a doctor, you can take folic acid, vitamin B6 or special vitamin complexes for pregnant women. During the treatment process, it is important to avoid negative thoughts and stressful situations. Relatives and friends at this time should surround the pregnant woman with attention and care.

Prevention of miscarriage

Before planning a pregnancy, every woman is recommended to undergo a full medical examination and consult with a geneticist. It is very important at the stage of preparation for the upcoming conception to exclude the influence of any teratogenic factors. Doctors recommend:

give up bad habits, taking large doses of caffeine;
exclude work in hazardous industries;
maintain physical activity;
Healthy food;
avoid stressful situations;
treat chronic diseases in advance and eliminate foci of infection;

Additionally, you can take special vitamin complexes designed to prepare a woman’s body for conception.