How to deal with a miscarriage

There are two types of miscarriage: natural miscarriage and spontaneous abortion. Generally speaking, natural miscarriage is the most undesirable thing. However, there are many reasons for spontaneous abortion, and many of them are unavoidable. Bleeding and abdominal pain are characteristics of miscarriage. The response measures for different types of miscarriage are different. Once miscarriage occurs, timely response is required. So, what should you do if you have a miscarriage? Let’s take a look below.

1. Threatened abortion : Expectant mothers with threatened abortion should rest in bed, strictly refrain from sexual intercourse, and have adequate nutritional support. Keep your emotions stable. Nervous expectant mothers can be given a small amount of sedatives that are harmless to the fetus. Patients with luteal insufficiency can be given 10-20 mg of progesterone, injected intramuscularly once a day or every other day. Excessive use can lead to missed abortion; or oral dydrogesterone (Duphaston) tablets can be taken. This drug is an oral progestin and is relatively safe. There is currently no evidence that it cannot be used during pregnancy and lactation. The initial dose is 40 mg taken orally once, followed by 10 mg every 8 hours until the symptoms disappear; or hCG 3000U, injected intramuscularly once every other day; vitamin E can also be taken orally to preserve pregnancy. Expectant mothers with hypothyroidism can take small doses of thyroid tablets orally.

2. Inevitable miscarriage: Once inevitable miscarriage is confirmed, the embryo and placental tissue should be expelled as soon as possible. Curettage and curettage are feasible, and the scrapings should be carefully examined and sent for pathological examination. In late-term miscarriage, the uterus is larger and bleeding is more severe. 10-20U of oxytocin can be added to 500ml of 5% glucose solution and intravenously dripped to promote uterine contraction. If necessary, perform curettage to remove intrauterine tissue. After the operation, B-ultrasound examination can be performed to determine whether there are any residual products of pregnancy, and antibiotics can be given to prevent infection.

3. Incomplete abortion: Incomplete abortion can easily cause heavy uterine bleeding because some tissue remains in the uterine cavity or blocks the cervix. Therefore, curettage or forceps scraping should be performed at the same time as infusion and blood transfusion, and antibiotics should be given to prevent infection.

4. Complete abortion: Complete abortion means that all the products of conception have been expelled, vaginal bleeding has decreased and gradually stopped, abdominal pain has disappeared, the cervix has closed during gynecological examination, the uterus has rapidly involuted, and the size of the uterus is close to normal. If there is no infection, no special treatment is required.

5. Missed abortion: If the dead fetus and placental tissue remain in the uterine cavity for too long, it may lead to severe coagulation disorders and the occurrence of DIC. A coagulation function test should be performed first, and a curettage should be performed under the conditions of blood preparation and infusion. If the coagulation mechanism is abnormal, heparin, fibrinogen, fresh blood, platelets, etc. can be used to correct it before curettage.

In case of missed abortion, the placental tissue is often tightly adhered to the uterine wall, making surgery more difficult. If the coagulation function is normal, before curettage, 5 mg of ethinyl estradiol can be taken orally, 3 times a day, for 5 consecutive days, or 5-10 U of estradiol benzoate can be added to 500 ml of 5% glucose solution and intravenously dripped, or 400 μg of misoprostol can be placed in the posterior fornix of the vagina. If the uterus is larger than 12 weeks of gestation, oxytocin should be given intravenously to promote the expulsion of the fetus and placenta. Uterine perforation should be avoided during curettage. After surgery, B-mode ultrasound examination should be performed routinely to confirm whether the residual materials in the uterine cavity are completely discharged and to strengthen anti-infection treatment.

6. Habitual miscarriage: Couples with chromosomal abnormalities should receive genetic counseling before pregnancy to determine whether they can get pregnant. The couple's blood types can also be identified and the husband's semen can be examined to determine whether the woman has reproductive tract malformations, tumors, or uterine adhesions. Patients with cervical relaxation should undergo cervical repair before pregnancy, or cervical cerclage at 12-18 weeks of pregnancy. In addition, after patients with habitual miscarriage are confirmed to be pregnant, routine intramuscular injection of hCG 3000-5000U can be given once every other day until 8 weeks of pregnancy. Or take dydrogesterone orally twice a day, 10 mg each time, until the 20th week of pregnancy.

7. Abortion complicated by infection: The principle of treatment is to quickly control the infection and remove the intrauterine residues as soon as possible. If the infection is mild or the bleeding is heavy, curettage can be performed while effective antibiotics are given intravenously to stop the bleeding. If the infection is severe but the bleeding is not heavy, high-efficiency broad-spectrum antibiotics can be used to control the infection before curettage. When curettage, you can use oval forceps to remove residual tissue. Avoid using a curette to scrape all over the body to prevent the spread of infection. Severe infected abortion may be complicated by pelvic abscess, thrombophlebitis, infected shock, acute renal failure and DIC, etc., and should be taken seriously and actively prevented. If necessary, the uterus should be removed to remove the source of infection.