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Wednesday, November 22, 2023

I had a miscarriage, what should I do?

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A miscarriage is defined as the loss of pregnancy before week 22 of gestation (some authors refer to 20 weeks), with a baby weighing less than 500 grams. It is called abortion precisely because at those months of pregnancy the baby would not be able to survive once the cord is cut.

The causes of abortions are very varied. In abortions before 8 weeks, the most frequent causes found are chromosomal and genetic alterations of the embryo (at the time of union of the ovum with the sperm), the losses that occur around week 12 the most frequent causes are coagulopathies (thrombophilias), endocrine diseases (such as diabetes and hypothyroidism), uterine malformations, vaginal infections, and urinary tract infections. And losses that occur after week 18 generally occur from rheumatic diseases (lupus, antiphospholipid syndrome) and cervical incompetence. It is also important to recognize the importance of the psychological aspect in pregnancy losses, such as stress, strenuous work hours and standing and disruptive family environments.

15% of all pregnancies are lost spontaneously, after tests and examinations, the doctor will inform you if you require a curettage or medical management.

15% OF ALL GESTATIONS ARE SPONTANEOUSLY LOST.

It is important to mention that on some occasions genetic studies can be performed on the ovular remains, the curettage sample is taken to the specialized Genetics laboratory and chromosomal alterations of the sample are detected (13, 18, 21, X, Y), however, in our opinion – and it is an observation that some people will differ – conducting this study is somewhat irrelevant since it only explains this pregnancy, but does not predict the probability of success or failure in a new pregnancy, nor the probability of recurrence (occurring in the next pregnancy), which is why it’s a test that’s not widely used.

It is important that you carry out adequate counseling for an upcoming pregnancy, assess the risk of recurrence. It is recommended to avoid becoming pregnant again within 6 months of a miscarriage, with some gynecologists recommending avoiding pregnancy for up to 2 years. However, each case must be individualized, since it is not the same to recommend waiting 24 months to a 26-year-old patient, than to a 34-year-old.  This is mainly because we know that the quantity and quality of the eggs decrease after the age of 35.

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