This is a frightening combination of words, because it refers to a spontaneous process when a pregnant woman can lose a child who has not yet appeared, but is already beloved. To prevent it, it is worth knowing this problem “in person” in order to recognize the signs in time and seek the help of doctors. After all, this is not a death sentence and usually, with good treatment, a woman is able to bear and give birth to a completely healthy baby.

We immediately need to differentiate the concepts. Threats of miscarriage may occur throughout pregnancy. Before the 28th week, in medical circles it is customary to talk about the threat of miscarriage, and after this period - about early birth. The doctors’ task also directly depends on the timing of pregnancy - in the first trimester it is worth prolonging the gestation process, and in the third, it is sometimes more advisable to allow the child to be born prematurely, to keep it in an incubator until the child’s body is finally ripe for an autonomous existence.

Determination of threats of miscarriage

Pregnancy is not a disease, but it is one that must be monitored. Therefore, if possible, you should not put off registration so that a specialist can determine whether the process is going normally or not. Some threatening deviations, for example, the tone of some wall of the uterus, are not felt by a woman and can only be detected on an ultrasound, while others are more obvious.

Signs of a threatened miscarriage:

  • nagging obsessive pain in the lower abdomen;
  • lower back pain;
  • blood from the vagina (at the beginning of pregnancy indicates the process of detachment of the fertilized egg);
  • colorless, copious discharge;
  • hypertonicity of the uterus. The abdomen becomes hard and may be accompanied by pain.

Reasons for threatened miscarriage:

    genetic. During the development of an embryo from an egg, unexplained chromosomal abnormalities or abnormalities can sometimes occur. In this case, the fetus is not viable from the very beginning and, in accordance with the rule of natural selection, the pregnancy is terminated. This usually occurs before 8 weeks. It happens that there are anomalies, but they do not fundamentally affect the viability of the child (Down syndrome). Then the pregnancy can be maintained, although the threat periodically arises throughout the entire period of gestation;

  • hormonal. A low level of progesterone (pregnancy hormone) in the blood or, conversely, a high level of male hormones can affect the ability to bear a child;
  • Rhesus conflict;

    • infectious diseases to which pregnant women are especially susceptible due to weakened immunity;

  • stress, shock;
  • pathologies in the structure of the uterine cavity (bicornuate uterus);
  • weakness of the uterine cervix, which cannot support the developing fetus;
  • inflammatory processes that are not treated until the moment of conception.

Actions in case of threat of miscarriage

It’s very banal and simple here - go to an ambulance. The faster doctors intervene, the greater the likelihood of preventing disastrous consequences. The question of how to maintain an interesting position in the event of a threat is decided by doctors, based on the symptoms and timing. Most often, pregnancy is maintained in a hospital, where the expectant mother is isolated from external influences and feels relatively safe.

List of main methods for treating threatened miscarriage:

  • physical and psychological peace;
  • taking sedatives;
  • use of hemostatic agents;
  • the use of medications that relax smooth muscles;
  • treatment, if necessary, of infectious and inflammatory diseases.

Intimate questions

Doctors are unanimous in their opinion that sexual relations during the threat of termination of pregnancy are strictly prohibited. Especially in the first trimester during bleeding and isthmic-cervical insufficiency. At the same time, oral sex or self-satisfaction is also undesirable. All kinds of contractions of the uterus can provoke its hypertonicity. If there was no significant threat, sex can be resumed after some time, but very carefully and only if the doctor has given permission.

The risk of spontaneous termination of pregnancy is minimized, but such a possibility cannot be excluded. What causes miscarriage in the second trimester of pregnancy? If in the first few months of gestation the key factors provoking spontaneous abortion are genetic defects, then in later stages the reasons are completely different.

Reasons for threatened miscarriage in the second trimester

In 60-70% of cases, termination of pregnancy at 13-24 weeks of pregnancy occurs due to anemia in pregnant women. This condition usually involves iron deficiency in a woman's body.

The second reason is placenta previa. The pathology is characterized by a low location of the child's place from the internal uterine os. Also separately distinguished is the rupture of the membranes as a result of constant leakage of amniotic fluid.

And the third reason is isthmic-cervical insufficiency of anatomical and functional etiology. The elasticity of the cervix is ​​impaired, so the fetus is not retained in its cavity.

These are three main reasons, but there are a number of factors that provoke the development of such pathologies:

  • Various genitourinary infections
  • Poor nutrition and inadequate living conditions (cold and damp rooms)
  • Somatic pathologies (diabetes mellitus, problems with the gastrointestinal tract, kidneys)
  • Hereditary factor
  • Multiple pregnancy or too large fetus
  • Gynecological operations, including medical abortions
  • Chronic endometritis
  • Congenital and functional pathologies of the genital organs
  • Rhesus conflict situation during pregnancy

If you do not waste time, but consult a specialist when the primary symptoms of a threatened miscarriage appear, then there is a chance to save the child.

Symptoms of threatened miscarriage in the second trimester

In the second trimester, any adverse changes cannot occur asymptomatically, so a woman just needs to listen to the body’s alarm bells.

Let's look at the general signs of a threatened miscarriage in the second trimester:

  • Discharge from the genital tract that has a brown or reddish tint, the presence of streaks or mucus
  • Uterine bleeding
  • Moderate to severe cramps
  • Aching pain in the lumbar region, lower abdomen

These are the main signs that should be taken seriously. Concentrate on treatment and do not worry unreasonably.

How to avoid the development of a dangerous pathology? Pay attention to the signs that characterize placenta previa, anemia, ICN and other pathologies dangerous for pregnancy:

  • Vomiting or intestinal upset such as diarrhea
  • The uterus is in constant hypertonicity (“stone”)
  • Weakness and fatigue without much physical activity
  • Dizziness
  • Dry hair, painfully pale skin
  • Blue bags under the eyes
  • The appearance of blood from the genital tract
  • Feeling unwell, restless

Such symptoms cannot be ignored, since they characterize serious abnormalities that can lead to complications and provoke a miscarriage.

Treatment methods

Comprehensive treatment of the threat of miscarriage in the second trimester includes not only sleep and taking pills, but also other procedures aimed at restoring immunity, hormonal levels and the mineral and vitamin balance of the female body.

  • A diet that involves fully saturating the body with essential minerals and vitamin organic compounds
  • Taking iron in tablet form or parenterally (Tardiferon, Totema, Ferrum-Lek, Sorbifer and others)
  • Psycho-emotional peace
  • Prescription of tocolytic drugs (“Ginipral”, “Fenoterol”, “Indocid” and other beta-adenomymetics)
  • Therapy of uteroplacental blood flow (“Curantil”, “Magne-B6”, “Trental”)
  • Applying a suture to the cervix or installing a Meyer ring when identifying isthmic-cervical insufficiency
  • Abstinence from physical activity

If you identify a threat of miscarriage at 13-24 weeks of pregnancy, there is no need to panic. Medical statistics show positive data - in 75-80% of cases, pregnancy can be saved. The main task of a woman is not to self-medicate, consult a specialist and be sure to follow all his instructions. Do not delay the consultation, as just a few hours of delay can decide the fate of your unborn baby.



Many pregnant women are faced with a doctor's diagnosis such as the threat of termination of pregnancy. Quite often this term can be heard in the early stages. Even before conception, during pregnancy planning, a representative of the fair sex must prevent the threat of miscarriage from occurring in the future.

If you had to deal with this diagnosis already during pregnancy, then you should not worry or panic, since this condition can be successfully dealt with.

Threatened miscarriage: what is it?

The possibility of miscarriage is a scary situation that any pregnant woman can face. According to statistics, spontaneous abortion occurs in 10-20% of cases, and more than half of them occur in the early stages (from the moment of conception to 22-23 weeks). Other women face the risk of premature birth between 22-23 and 37 weeks.

Threat of early pregnancy loss is more dangerous, since if a woman does not seek help in a timely manner, the fetus may not be saved. In cases of premature birth, children survive thanks to modern technologies and advances in medicine. That is why doctors, when detecting a threat of miscarriage, strive to prolong the pregnancy (increase the period of intrauterine development of the child).

Reasons for the threat of miscarriage in the early stages

Every woman should know about the factors that can cause a miscarriage. The reasons for the threat of miscarriage may be different. Some of them are genetic. Violations of the chromosomal and gene structure of the fetus are accompanied by malformations of its development.

Pregnancy can be terminated from conception to 8 weeks if the violations are incompatible with life. In case of pathologies compatible with life (for example, Patau, Edwards, Down syndromes), a miscarriage may not occur, but the threat of termination of pregnancy will accompany the woman throughout the entire pregnancy.

A representative of the fair sex in this position is subject to various infections. They do not pass without a trace. Even the most seemingly harmless diseases can lead to tragic consequences. Miscarriages are very common due to infections. Only competent and timely treatment of diseases can prevent fetal death.

Pregnancy may be terminated by immunological reasons. For example, some women with a negative Rh factor who are carrying a child with a positive Rh factor may experience Rhesus conflict: The mother’s immune system may react inadequately to the fetus, since it is half a foreign body. However, this only happens to 30% of women. In the remaining 70%, the immune system does not respond to the fact that the fetus has the opposite Rh factor.

Another reason for the threat of miscarriage in the early stages is hormonal imbalance. It is known that pregnancy is supported by certain hormones produced in the female body. Deviations from the norm can negatively affect the condition of the fair sex.

For example, one of the reasons for a miscarriage may be hyperprolactinemia when there is an increased level of prolactin. In the early stages, this hormone inhibits the production of the main hormone that supports pregnancy - progesterone. If its level decreases, a miscarriage may occur.

Another hormonal reason for the threat of interruption of the “interesting situation” is hyperandrogenism, characterized by an increase in the level of production of male sex hormones in a woman’s body.

Irregularities at work thyroid gland- another reason, the consequence of which may be a miscarriage. Thyroid hormones are very important for the normal course of pregnancy. A risk to pregnancy can occur with both hyper- and hypofunction of the thyroid gland.

The threat of miscarriage in the early stages is also pathological cervical condition and the isthmus of the uterus, called isthmic-cervical insufficiency. They are not able to hold an expanding fetus. As a rule, a miscarriage with this condition occurs at 12-18 weeks of pregnancy. With timely diagnosis, disastrous consequences can be avoided, since the pathology can be corrected.

Anomalies in the structure of the genital organs can lead to miscarriage. Disturbances in the anatomical structure of the uterus (bicornuate uterus, the presence of a septum in its cavity) are often combined with a lack of sex hormones. All this is the reason for the inferiority of the muscular layer of the organ in which the fetus should be born.

The development of pregnancy can be affected by various injuries. Concussions are especially dangerous: past injuries that disrupted the brain’s blood circulation can be recalled after conception.

Thanks to timely diagnosis of any abnormalities, the threat of miscarriage can be prevented. At the slightest symptoms of this condition, you must contact a medical facility for help.

Symptoms of threatened miscarriage in the early stages

One of the signs of an impending miscarriage is nagging pain lower abdomen, lower back pain. At the beginning of pregnancy, discomfort in the lateral parts of the abdomen may make itself felt. They are not related to miscarriage, since their occurrence is associated with changes in the ligaments of the uterus.

Blood, secreted from the genitals, may indicate the presence of a threat of termination of pregnancy in the early stages. Unfortunately, some women perceive it as their period. This point of view is absolutely wrong. There cannot be menstruation during pregnancy.

Even a small amount of bloody discharge signals an unfavorable course of pregnancy. In the early stages, the cause of their occurrence lies in the detachment of the fertilized egg.

Hypertonicity of the uterus- another symptom of a threatened abortion in the early stages. Increased tone in the 1st trimester can be observed on the back or front wall of the uterus. The woman does not feel it, but this is determined by ultrasound. This condition may be the result of psychological stress. For such a woman, the doctor prescribes the necessary antispasmodics and recommends repeating an ultrasound scan after 10 days.

In a condition called total hypertonicity, the uterus becomes “stony” and painful sensations occur. For doctors, this is a sign of a threat of miscarriage. The sooner it is diagnosed, the easier it will be to maintain the pregnancy, so it is very important to monitor the condition of your body and, if you suspect it, you should immediately consult a doctor for help.

Possible treatment for threatened miscarriage

If the condition of a pregnant woman does not cause serious concern, then the specialist may prescribe outpatient treatment. The pregnant woman will have to maintain psychological as well as physical rest. Some women are prescribed sedatives if necessary, because they are very anxious and worried that the baby they carry under their hearts is in danger.

If there is a strong threat of miscarriage, the woman is hospitalized in gynecological department. She finds herself isolated from her relatives, friends, and work. For many this is beneficial. This makes it easier to concentrate on your baby and push all problems and worries into the background.

A woman staying in a medical facility feels especially protected, because if necessary, she will quickly receive qualified assistance.

Specific treatment for threatened miscarriage in the early stages depends on the cause of its occurrence. For example, if there is a possibility that a miscarriage may occur due to hormonal imbalance, then certain hormones are prescribed to promote the normal course of pregnancy.

If an ultrasound and examination reveals isthmic-cervical insufficiency, then doctors put sutures on the cervix, thanks to which the fertilized egg will not be “released” from the organ. The operation is performed under general anesthesia using drugs that relax the uterus.

When immunological factors are identified, treatment of threatened miscarriage in the early stages is aimed at suppressing the production of antibodies.

If a woman has uterine tone, then medications are prescribed to relieve spasm of the uterine muscles. Most often, such drugs are administered using a dropper.

In the presence of infectious, chronic, inflammatory diseases, the doctor will prescribe appropriate treatment.

Prevention of threatened miscarriage in the early stages

In any situation and for any illness, it is much easier to take preventative measures than to find yourself in a situation in the future in which medical workers can no longer help.

Any woman needs in advance plan a pregnancy. This preparatory period is of great importance. During planning, various examinations are carried out and tests are taken. Thanks to all this, you can find out if your partners have any problems or diseases that could cause a risk of miscarriage after conception.

Don't forget that planning can take a long time. By starting to prepare for conception early, you can significantly improve your health.

A pregnant woman should regularly visit a doctor who monitors her condition and the development of the fetus. The main goal of pregnancy monitoring is to identify possible risks and pathologies as early as possible. Only timely diagnosis can have an impact on the course of pregnancy, child development and childbirth.

During pregnancy, it is necessary to protect your body from stress, overwork, because all this weakens the immune system. This can lead to the appearance of various diseases, which may result in the threat of miscarriage in the early stages.

Representatives of the fair sex in position, leading healthy lifestyle and those who wish to engage in physical exercise should consult a doctor about this. He will help determine whether a woman has any contraindications for exercise, and will recommend specific exercises that will not harm either the expectant mother or her baby, but will only benefit both.

If there are any infectious, inflammatory diseases There is no need to self-medicate and take medications that the doctor did not prescribe. In general, during pregnancy you should protect yourself from illnesses, since taking medications during this important period for any woman is undesirable. If, nevertheless, it was not possible to avoid infections, then you need to strictly follow the treatment prescribed by the doctor and follow all his recommendations. Only an experienced specialist can prescribe medications that will not harm the fetus.

A pregnant woman with or without a threat to her position shouldn't worry. It is worth reminding yourself as often as possible that at the moment the most amazing and wonderful days are going on in life. You need to enjoy this period. You should pay special attention to your diet, sleep patterns, walks, and work.

A woman must learn to relax, discard bad thoughts, and avoid negativity. This is the only way to achieve the birth of a healthy, nice and strong baby.

Thus, most life situations in which the threat of miscarriage makes itself felt can be safely avoided. It is very important to plan ahead for your pregnancy. Examinations will help identify reasons that may lead to the loss of a child in the future.

The threat of abortion is often referred to simply as a “threat” by both doctors and patients. Will this condition lead to sad events or can they be avoided? Most often, this depends not only on the timeliness and competence of the doctors’ actions, but also on the behavior of the expectant mother herself.

The threat of miscarriage may occur throughout pregnancy; its reasons can be varied. If this condition occurs at a period before, we are talking about the threat of spontaneous abortion (miscarriage), and at a period from - about the threat of premature birth.

Symptoms of threatened miscarriage

Stomach ache. Regardless of the stage of pregnancy, a sign of trouble is a cramping or nagging pain in the lower abdomen in the center. In the first trimester, discomfort often occurs in the sides of the abdomen. They are associated with changes in the ligaments of the uterus and are not related to the threat of miscarriage.

Tension of the uterine muscles, which is often referred to as hypertonicity. Here it is necessary to distinguish between hypertonicity, diagnosed using ultrasound, and hypertonicity, which is felt by the patient herself.

Increased tone, determined by ultrasound, but not felt by the woman, as a rule, affects only a small area of ​​the muscles of the uterus (the anterior or posterior wall). This phenomenon may be the result of a reaction to the ultrasound examination itself (this is especially typical for the first trimester of pregnancy) or the result of psychological stress. With such local tension: the muscles of the uterus, we can talk about increased excitability of the muscles of the uterus, that is, having seen a similar conclusion in the ultrasound examination protocol, the doctor concludes that the woman is at risk for the threat of miscarriage, and prescribes her preventive treatment - taking medications , relieving spasms of smooth muscles, including the smooth muscles of the uterus (no-shpa, papaverine). You may also be scheduled for a follow-up visit to the doctor in 10 days or a repeat ultrasound examination.

Doctors regard a condition in which the uterus “turns to stone” and painful sensations appear (that is, total hypertonicity) as a threat of termination of pregnancy. This may require hospitalization and special treatment. However, it should be noted that after 32 weeks of pregnancy, periodic uterine contractions that are not accompanied by pain are normal. These are the so-called preparatory Bracketton-Hicks contractions. Their appearance is not necessary and is not a sign of pathology.

Discharge from the genital tract. Signs of a threatened miscarriage are bloody discharge from the genital tract that appears at any stage of pregnancy. Any, even the smallest amount of discharge indicates trouble. The cause of bleeding is most often the detachment of the fertilized egg (in the first trimester of pregnancy) or the placenta (in the second and third trimester of pregnancy) from the wall of the uterus. As a result of such changes, the fetus with a small detachment does not receive enough oxygen and nutrients, and with a massive detachment it can die. The threat of miscarriage can be suspected not only in the presence of sanguineous and bloody discharge, but also in case of watery discharge (in this case we may be talking about). This situation is likely in the second or third trimester of pregnancy. When the membranes are broken, a colorless liquid leaks from the uterine cavity, which normally surrounds the fetus. This situation may be accompanied by tension in the muscles of the uterus and requires hospital observation and treatment, as in this case there is a risk of infection of the fetus.

Reasons for threatened miscarriage

Hormonal disorders- these are disturbances in the functioning of the endocrine glands, which produce biologically active substances - hormones. Hormones are designed to regulate the vital processes of the body, including the process of conception, growth and development of the fetus.

One of the most common hormonal disorders is progesterone deficiency. Progesterone is a hormone that is produced by the ovaries in the second phase of the menstrual cycle and maintains pregnancy. Its role is especially great before; after this period, the task of hormonal provision is taken over by the placenta, which is finally formed just in time for this period. Progesterone deficiency, or, as it is also called, corpus luteum deficiency 1, can occur with inflammatory lesions of the female genital organs (salpingoophoritis - inflammation of the ovaries and fallopian tubes, endomyometritis - inflammation of the mucous and muscular lining of the uterus), after abortion, in case of disruption of the functioning of other internal organs secretions (pituitary gland, thyroid gland, etc.). This reason often leads to the threat of termination of pregnancy in the first trimester.

The threat of miscarriage can also be caused by an increase in the level of male sex hormones - androgens. Male sex hormones in the female body are normally produced in the adrenal glands and ovaries. If there are disturbances in the functioning of these organs, the amount of male sex hormones increases. This leads to a decrease in the amount of female sex hormones that ensure the normal development of pregnancy, which can lead to isthmic-cervical insufficiency (which will be discussed below).

Since the work of all endocrine glands is interconnected, a failure in the production of any hormone, including hormones of the thyroid gland, pituitary gland, adrenal glands, etc., can lead to termination of pregnancy.

Immune causes can lead to termination of pregnancy in the first trimester. If normally a half-alien fetus is not rejected by the mother’s body, then if there is a malfunction in the immune system, antibodies may arise that lead to disruption of the formation of the placenta or death of the fetus. The cause of such failures can be determined. Treatment in such cases is aimed at suppressing the production of antibodies.

Genetic disorders can also cause miscarriage. In the presence of chromosomal and genetic mutations, i.e. in the formation of severe pathology of the fetus, a miscarriage, as a rule, occurs in the early stages. Genetic mutations are most often spontaneous, that is, they are random phenomena that do not recur in the future. However, they can occur under the influence of unfavorable environmental factors (ionizing radiation, chemical influences, etc.). Genetic mutations can also be hereditary.

In cases of a breakdown in the chromosome set, pregnancy is most often terminated in the early stages, i.e. in the first trimester, perhaps even after several days or even during the expected menstruation.

Sexually transmitted infections, can also cause a threat of miscarriage. Many scientific studies have found that pregnant women suffering from chlamydia, ureaplasmosis, mycoplasmosis, trichomoniasis, herpes, cytomegalovirus infection, Coxsackie virus infection are much more likely to have miscarriage and premature birth than healthy women. In this case, the infections themselves become the direct cause of abortion in cases where the pathogen directly infects the fetus and membranes. If the infection occurred before pregnancy and timely preventive measures were taken, a favorable course of pregnancy is quite possible. Sexually transmitted infections can cause abortion in both the first and second half of pregnancy.

Diseases of the genital organs(these include anomalies in the structure of the woman’s genital organs, injuries, as well as diseases such as uterine fibroids) can be a mechanical obstacle to the normal growth and development of the fetus, when the fertilized egg cannot fully implant in the uterus. In addition, these conditions and diseases are accompanied by hormonal imbalances, which lead to the threat of miscarriage.

Isthmic-cervical insufficiency(istmus translated from Latin is “isthmus”, the place where the body of the uterus enters the cervix is ​​cervix) can also cause termination of pregnancy. Isthmic-cervical insufficiency (ICI) develops as a result of injuries to the isthmus and cervix during abortions and traumatic births; The hormonal cause of ICI may be hyperandrogenism. With ICI, the cervix, which is normally tightly closed during pregnancy, opens and does not hold the fertilized egg, which falls down under the influence of gravity. In this case, contractile activity of the uterine muscles may occur (contractions occur) or may be completely absent. Termination of pregnancy, the cause of which is isthmic-cervical insufficiency, most often occurs at term.

Pathological course of pregnancy may be one of the reasons for its interruption. Most often we are talking about gestosis of pregnancy, in which blood pressure rises, edema appears, and protein appears in the urine. The cause of termination of pregnancy can be placenta previa, when the placenta is attached in the area of ​​the exit from the uterus: the conditions for the blood supply to the fetus in this case are worse than if the placenta is attached in the middle or upper part of the uterus. These conditions lead to premature birth in the second half of pregnancy.

Acute inflammatory and general infectious diseases, such as tonsillitis, influenza, viral hepatitis, appendicitis, pyelonephritis, causing an increase in temperature, impaired blood circulation between the mother and the fetus under the influence of toxins, can lead to termination of pregnancy at any stage.

Chronic diseases of the expectant mother problems she has even before pregnancy, especially diseases of the cardiovascular system (hypertension, heart defects), diseases of the kidneys and other organs, can cause termination of pregnancy at any stage. In these cases, the likelihood of complications depends on the severity of the chronic disease.

Injuries, such as bruises, fractures, concussions, especially abdominal injuries, can lead to termination of pregnancy. In this regard, head injuries deserve special attention. Even concussions and bruises to the brain that a woman suffered before pregnancy can lead to the threat of miscarriage and premature birth. This is due to the fact that one of the structures of the brain is the main endocrine gland - the pituitary gland, which regulates the functioning of other organs that ensure the normal course of pregnancy. With “fresh” and old injuries to the brain, blood circulation and the pituitary gland area may be disrupted, which will lead to a failure in ensuring pregnancy.

Stress, to which many are inclined to attribute a fatal role during pregnancy, in themselves, as a rule, do not cause the threat of miscarriage: they can only become a predisposing factor in the presence of the above reasons.


Treatment of threatened miscarriage

If there is a threat of miscarriage, a woman is advised to remain in bed, that is, her physical activity is reduced to a minimum. Sometimes a pregnant woman is not allowed to get out of bed at all.

Naturally, the possibility of losing a child causes anxiety and fear in a woman, which does not contribute to maintaining the pregnancy. Therefore, at any stage, if there is a threat of miscarriage, sedatives are prescribed - valerian or motherwort. You can help yourself calm down. To do this, you need to try to relax, no matter what position you are in (lying or sitting), and think about something pleasant, even if it seems that there is nothing good in life at the moment. For example, you can imagine a baby.

If the threat of miscarriage occurs in the first trimester, then, as a rule, hormonal drugs are prescribed that contribute to the normal course of pregnancy. These include drugs that have the effect of progesterone (duphaston, utrozhestan, etc.), as well as drugs used for immune causes of threatened miscarriage (dexamethasone, metipred).

If insufficiency is detected during examination and ultrasound examination, then sutures are placed on the cervix, which “do not release” the fertilized egg. The operation is performed under anesthesia. At the same time, the woman is given drugs that relax the uterus.

In the early stages (2-4 weeks), spontaneous miscarriages in more than 50% of cases are caused by chromosomal abnormalities, therefore it is not recommended to use hormonal and immune methods of therapy when the cause of the miscarriage is not clear and the woman was not examined before pregnancy.

Threat of miscarriage in the first trimester of pregnancy

If there is a threat of miscarriage in the first trimester of pregnancy, it is necessary to urgently perform an ultrasound to determine the viability of the embryo, because Often signs of a threat appear after his death.

Sedative and anti-stress therapy

Having established that there is an embryonic heartbeat, the patient should be prescribed a comprehensive examination, as well as physical and sexual rest, psychotherapy, and sedatives:

Valerian rhizomes with roots, tincture, orally 1.5 ml (30 drops) 3 times a day, duration of therapy is determined individually or

Motherwort herb, tincture, orally 1.5 ml

(30 drops) 3 times a day, duration of therapy is determined individually

Diazepam, 0.5% solution, 2 ml intramuscularly for stressful situations.

Experimental studies have shown that magnesium has an anti-stress effect, and in patients taking it, the intensity of anxiety decreases by 60%, which allows the use of magnesium preparations as basic therapy for all patients, regardless of the pathogenetic mechanisms of recurrent miscarriage. Magnesium when taken orally not only has a sedative effect and normalizes sleep, but also reduces the tone of the uterus and improves bowel function:

Magnesium lactate/pyridoxine 470 mg (contains 48 mg magnesium)/5 mg orally 2 tablets. 2 r/day or 1 table. in the morning, 1 table. during the day and 2 tablets. overnight, long-term or

Orotic acid, magnesium salt 500 mg (contains 32.8 mg magnesium) orally 2 tablets. 2 times a day, long-term.

In the absence of side effects, oral magnesium preparations can be used for a long time, until the threat of miscarriage is eliminated and throughout pregnancy, to replenish magnesium deficiency, which often accompanies pregnancy.

Magnesium preparations should be used with caution in cases of arterial hypotension. A side effect of oral magnesium supplements is bloating. If this complication develops, the dose of the drug should be reduced until intestinal function normalizes.

Antispasmodic therapy

In addition to magnesium preparations, it is recommended to use antispasmodic drugs in the first trimester of pregnancy:

Drotaverine orally 40-80 mg 2-3 times a day, 2-20 days or Papaverine, suppositories, rectally 20 mg 2-3 times a day, 2-20 days. For severe pain, the following is prescribed: I Drotaverine IM 40-80 mg 2-3 times a day, 2-20 days.

The duration of use of antispasmodics is determined by the clinical manifestations of the threat of interruption (pain in the lower abdomen and/or lower back) from 2-3 days to 2-3 weeks. The only contraindication to use is individual intolerance.

Threat of miscarriage in the second and third trimesters of pregnancy

Antispasmodic therapy If there is a threat of miscarriage in the second and third trimesters of pregnancy, the following is prescribed:

Magnesium sulfate, 25% solution, slow IV or IM 5-20 ml 1-2 times a day, 15-20 days. The duration of treatment is determined by the clinical picture of the threat of interruption and the effectiveness of the drug.

Tocolytic therapy

If the threat of miscarriage occurs in the later stages, drugs are used aimed at reducing the contractile activity of the uterus (tocolytics), in particular, β-adrenergic agonists:

Hexoprenaline IV in a slow stream 10 mcg in 10 ml of 0.9% sodium chloride solution, then 0.3 mcg/min, the duration of treatment is determined individually or Salbutamol IV drip 5 mg in 500 ml of 0.9% solution sodium chloride at a rate of 20-40 drops/min, the duration of treatment is determined individually or Fenoterol intravenously 0.5 mg in 200 ml of 0.9% sodium chloride solution at a rate of 15-20 drops/min, the duration of treatment is determined individually. The duration of IV administration of tocolytics is determined by the degree of threat of interruption from 2-4 hours to 24 hours. The rate of drug administration (drip or using an infusion pump) is determined by its tolerability (control of blood pressure and heart rate is necessary) and the level of reduction in uterine contractility. A pregnant woman's pulse should not be more than 120 beats per minute.

If the effect is positive, 20 minutes before the end of the infusion, oral administration of β-adrenergic agonists is started:

Hexoprenaline orally 0.5 mg 8 times a day, then 0.5 mg 4-6 times a day for at least 2 weeks or

Salbutamol orally 4 mg 3-4 times a day,

for at least 2 weeks or Fenoterol 5 mg orally 4-6 times a day for at least 2 weeks.

Hexoprenaline has fewer side effects than fenoterol. Salbutamol has the same effectiveness, but the side effects are less pronounced than when taking hexoprenaline.

Selective beta-agonists reduce the amplitude of contractions and only then the tone of the uterus, therefore they are the drugs of choice in the treatment of the threat of premature birth from 26-27 weeks of pregnancy. In earlier stages of pregnancy, their use is less effective.

Contraindications to the use of β-adrenergic agonists are weakness, tachycardia, tremor, headache, nausea, and decreased blood pressure. These drugs penetrate to the fetus and have the same effect: tachycardia, increased blood glucose levels. With long-term use of β-adrenomimetics in newborns, manifestations similar to diabetic fetopathy are observed.

If there is a threat of miscarriage in the second and third trimesters of pregnancy, NSAIDs are also used. With increased uterine tone, indomethacin is the drug of choice, because, being a prostaglandin inhibitor, it reduces uterine tone:

Indomethacin rectally 50-100 mg 1 time / day, 7-9 days (total dose should not exceed 1000 mg).

Indomethacin penetrates the placenta, inhibits prostaglandin synthesis in the fetus, causes a narrowing of the ductus arteriosus, but in a total dose of up to 1000 mg no side effects on the fetus are observed.

Contraindications to taking indomethacin are peptic ulcers of the stomach and duodenum. When using indomethacin, adverse reactions such as headache, nausea, and weakness may develop, but they are less pronounced than when using beta-adrenergic agonists.

Hemostatic therapy

When an abortion begins, various hemostatic drugs (fibrinolysis inhibitors) can be used to stop bleeding.

Tranexamic acid has antifibrinolytic, anti-inflammatory and antiallergic effects, does not affect hemostasis, it can be used in the first trimester of pregnancy:

Tranexamic acid IV drip 5-10 ml (250-500 mg) in 200 ml 0.9% sodium chloride solution 1-2 times / day or IM 2 ml (100 mg) 2-3 times / day , until bleeding stops, then orally 250-500 mg 3 times a day, 5 days.

Etamsylate is an angioprotector, increases the stability of capillaries, normalizes their permeability, improves microcirculation, and does not have hypercoagulable properties:

Etamsylate IV or IM 250-500 mg 2-3 times a day until bleeding stops, then orally 250 mg 3 times a day for 5 days.

For bleeding caused by activation of fibrinolysis and thrombocytopenia, aminomethylbenzoic acid is prescribed:

Aminomethylbenzoic acid, 1% solution, 5-10 ml intravenously or 10 ml intramuscularly up to 3-4 times a day, until bleeding stops.

The use of this drug is contraindicated in the first trimester of pregnancy and in chronic disseminated intravascular coagulation. Adverse reactions are possible in the form of tachycardia, dizziness, blood pressure fluctuations, and dyspeptic disorders.

Aminocaproic acid is similar in action to aminomethylbenzoic acid, but less effective:

Aminocaproic acid iv drip 4-5 g in 0.9% sodium chloride solution, once (if necessary, re-administer after 4 hours). Side effects of aminocaproic acid: arterial hypotension, dizziness, nausea.

If there is no effect, fresh frozen plasma can be administered.

Termination of pregnancy

If there is leakage of amniotic fluid, it is not advisable to maintain a pregnancy up to 25-26 weeks. Medical and/or instrumental evacuation of the uterus is performed. At later stages, wait-and-see tactics are possible.

V.I. Kulakov, V.N. Serov