Possible types of miscarriage

The article was professionally consulted by Specialist Doctor II Nguyen Thi Phuong Loan - Obstetrician and Gynecologist - Department of Obstetrics and Gynecology - Vinmec Hai Phong International General Hospital.
Miscarriage is a very common phenomenon, accounting for 12% of cases of women knowing they are pregnant. Clinically, miscarriage has many different forms such as threatened miscarriage, incomplete miscarriage, complete miscarriage,... Distinguishing miscarriage forms helps medical staff to have appropriate treatment and intervention. matching card.

1. What is a miscarriage?

According to the World Health Organization (WHO), a miscarriage is a condition in which a fetus is expelled from the uterus before the 22nd week of pregnancy or before the fetal weight is 500g.
Miscarriage can be classified into spontaneous abortion and consecutive miscarriage. In particular, spontaneous abortion is a sudden miscarriage that occurs in a normal pregnant woman. When three or more consecutive spontaneous miscarriages are called consecutive miscarriages. In women with consecutive miscarriages, the chance of having a live birth is only 50%, in addition, the risk of preterm birth in these women is also 20% higher than that of the general population.
It is difficult to determine the actual miscarriage rate, because there are women who miscarry before they know they are pregnant. For women who already know they are pregnant, the miscarriage rate is about 12%, of which more than 80% miscarry in the first trimester.
Clinically, miscarriage has many different forms, each type of miscarriage has its own treatment and intervention measures.

2. Possible types of miscarriage

2.1 Threatened miscarriage
Threat of miscarriage is a condition where the embryo is still alive and has not been shed from the uterine lining.
When threatened with miscarriage, women have symptoms of red or black vaginal bleeding, the blood is often mixed with mucus, the amount is small, the discharge is intermittent, can last for many days. In addition, pregnant women have a feeling of tightness, heaviness in the lower abdomen, back pain.
When the doctor examines the vagina, the cervix will be long and closed, the uterine body is soft, the size corresponds to the gestational age. When the ultrasound shows a partial dissection of the placenta, the amniotic sac border is clear, even, with echoes of the embryo, the fetal heart is present or not.

2.2 Inevitable miscarriage
Mother has bright red vaginal bleeding, heavy bleeding or not much bleeding but bleeding lasts more than 10 days. Pregnant women have pain in the lower abdomen, pain that is intermittent and the pain is increasing. When the doctor examines the vagina, there is a phenomenon that the cervix is ​​clearing, the lower part of the cervix is ​​enlarged and the fetus drops.

2.3 Incomplete miscarriage
A miscarriage but part of the pregnancy is still in the uterus, this remnant is usually the placenta. Vaginal bleeding in pregnant women is still dull and ongoing, and lower abdominal pain is still there, although it is lighter than during a miscarriage.
The doctor examines that the cervix is ​​still open or closed, the body of the uterus is larger than normal, the ultrasound shows the image of the placenta in the uterus, the patient may have an infection.
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2.4 Complete miscarriage
Pregnant woman with heavy bleeding, intermittent pain in the lower abdomen, then ejected from the vagina a sac or embryo-like tissue. After that, the woman's stomach pain was gone, but the slight bleeding persisted for a few days. On examination, the uterus was retracted normally and the cervix was closed or still open. The extruded gestational sac should be examined anatomically for placental abruption.

2.5 Hemorrhagic miscarriage
Pregnant woman has a lot of vaginal bleeding, bright red blood, showing signs of shock due to blood loss. On vaginal examination, there is a lot of fresh blood mixed with clots, the fetus is usually protruding in the cervix or in the vagina.
If the patient is late to the hospital, when the pregnancy has been miscarried, this symptom will no longer be present, but only the symptoms of blood loss and shock will be prominent.

2.6 Infectious miscarriage
Pregnant woman has a miscarriage with symptoms of prolonged vaginal bleeding accompanied by signs of an infection syndrome such as high fever, rapid pulse, increased white blood cells, increased CRP. Uterine infection is the most common, followed by endometrial, peritoneal, sepsis, endocarditis, etc. The cases of miscarriage with infection are often severe, and the mother can die.
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3. Differentiate miscarriages from other diseases

In addition to distinguishing clinical forms of miscarriage, physicians must also distinguish between miscarriage and pseudo-miscarriage of ectopic pregnancy, distinguish it from ectopic pregnancy, appendicitis,... to avoid confusion.
An ectopic pregnancy that has not yet ruptured also has symptoms of vaginal bleeding, the ectopic endometrial detachment is monolithic, so it is easy to mistake it for a miscarriage. However, when the ultrasound does not show the gestational sac in the uterus, there is no image of the placental tissue plaques, the uterine lining is thick, it is necessary for the patient to test beta hCG to confirm the diagnosis. Pregnant with symptoms of prolonged bleeding, vomiting a lot. On examination, the uterus is larger than the gestational age, the fetal parts cannot be palpated, and the fetal heartbeat cannot be heard. Ultrasound shows snowfall. Measure beta hCG in blood above 100,000 mUI/ml. Appendicitis: The patient has an infection syndrome and gastrointestinal disorders, localized pain in the pelvic cavity. Thus, the phenomenon of clinical miscarriage is very diverse and complicated, and at the same time, it is easy to be confused with other medical conditions. Miscarriage is very common and can cause shock, infection, etc., which greatly affects health. Therefore, pregnant women who have abnormal symptoms such as vaginal bleeding, lower abdominal pain should immediately go to medical facilities for examination and differential diagnosis of their current health status. timely intervention.
If you have unusual symptoms, you should be examined and consulted with a specialist.

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