The Risk of Miscarriage in Pregnancy and Things to Know
It is estimated that 50-70% of spontaneous pregnancies are lost before completing the first month of pregnancy, especially within the first month of the last menstrual period. These miscarriages are often not noticed if they occur during expected menstrual periods. 10-15% of clinically determined pregnancies are lost. Some women, on the other hand, are considered to have had recurrent miscarriages, contrary to the chain of events that occurred by accident.
The Risk of Miscarriage in Pregnancy and Things to Know First, maternal age significantly increases the risk of miscarriage. A 40-year-old woman has twice the risk of a 20-year-old woman. Second, the previous pregnancy history is also determinant. The rate of loss is the lowest in nulliparous women who have never had a miscarriage (6%), and this rate increases to 25-30% in those who have three or more miscarriages. 9-12. Fetuses that ended with a clinical miscarriage during the weeks of gestation were lost weeks ago. This means that almost all miscarriages are “missed abortion”. In other words, the embryo remains in the uterus for a certain period of time before the miscarriage is diagnosed. Fetus 8-9. If it is detected alive during the gestational weeks, 2-3% of it is lost after that. In the 16th week, only 1% can be lost.
Chromosomal anomalies are the most common cause of clinically diagnosed pregnancy losses. At least 50% of it consists of chromosomal anomalies.
Luteal Phase Defects (LPD): Insufficient progesterone effect.
Thyroid Disorders: Associated with overt hypothyroidism or hyperthyroidism.
Diabetes Mellitus: Women with poorly controlled diabetes mellitus have an increased risk of fetal loss. However, well-controlled or subclinical diabetes is not the cause of early miscarriage.
Intrauterine Adhesions (Synechiae): May prevent implantation or early embryo development. Adhesions may occur in the postpartum period after excessive uterine curettage, intrauterine surgery (eg myomectomy), or endometritis. They can cause 15-30% of recurrent miscarriages. If synechiae are detected in women with recurrent miscarriages, lysis should be performed under direct hysteroscopic observation. Approximately 50% of patients become pregnant after surgery.
Incomplete Mullerian Fusion: Defects of this condition are considered to be a cause of second-trimester losses and pregnancy complications. Low birth weight, breech presentation, and uterine bleeding are other reasons. If the uterine cavity is seen as split when they present with pregnancy loss in the first 3 months, these losses are related to the uterine septum.
Leiomyomas: Although they are common, a small number of women develop findings that require medical or surgical treatment. Because submucous fibroids can cause miscarriage, their location is probably more important than their size.
Cervical Insufficiency: Functionally intact cervix and lower uterine cavity are prerequisites for a successful pregnancy. Cervical insufficiency, characterized by painless dilation and effacement, usually occurs in the middle second trimester or early third trimester. Surgical techniques are used to correct cervical insufficiency.
Infections: Variola, vaccinia, salmonella trophy, Vibrio fetus, malaria cytomegalovirus, brucella, toxoplasma, mycoplasma hominis, chlamydia trachomatis, and ureaplasma urealyticum are reported microorganisms and conditions associated with spontaneous abortion. Ureaplasma and chlamydia from potential organisms are the cause of recurrent miscarriage.
Antifetal Antibodies: The immune system response may be responsible for fetal losses. The immunological process responsible for the continuation of pregnancy is inherently complex. These antibodies are directed against the fetus due to genetic differences. Fetal loss has been well proven in Rh-negative (D-negative) women with anti-D antibodies.
Acquired Thrombophilia: Antibodies found in women with pregnancy loss are antinuclear antibodies. Acquired aPL antibodies show a broad spectrum including lupus anticoagulant (LAC) antibodies and anticardiolipin (ACL) antibodies, respectively. Aspirin and heparin may be recommended for aPL and ACL antibodies (+) treatments with losses in the first 3 months.
Hereditary Thrombophils: Conditions associated with hereditary hypercoagulability include factor V Leiden, homozygosity for its polymorphism in the prothrombin gene.
Medicines, Chemicals, and Harmful Agents
X-Ray: High doses of radiation and antineoplastic agents are known to cause miscarriage. On the other hand. There is little or no increase in risk from women who are exposed to pelvic radiation up to 10 rad.
Smoking: Smoking during pregnancy is considered to be associated with spontaneous abortion.
Caffeine: Caffeine consumption of more than 300 mg per day (1.9 times increase) shows the relationship between pregnancy loss. There can be confidence, however, that generally, moderate caffeine intake will not cause pregnancy loss.
Alcohol: Regardless of pregnancy loss, alcohol use should be avoided during pregnancy.