Treatments for the threat of early spontaneous abortion

Bed rest in first intention

The first therapeutic measures for a pregnancy which presents a threat of miscarriage but which continues to evolve remains:

• Long rest ( bedridden pregnancy )
• supplemented by the usual adjuvant therapies (antispasmodics, muscle relaxants, analgesics …)

And the administration of hormones?

The only therapy that remains under discussion is the administration of hormones . Hormone therapy is generally offered based on the observation of lowered dosages . However, the effect should not be taken for the cause, lowered dosages are generally the consequence of trophoblastic suffering , and not vice versa. It should also be remembered that, physiologically, the level of HCG drops between the 8th and 9th week of pregnancy .

On the other hand, the levels of plasma steroids (estradiol and progesterone) are initially only a reflection of the activity of the pregnancy corpus luteum ( gestational body), and their dosage becomes an indication of embryonic vitality only from about the 8th week of pregnancy . It is probably at the time when the steroid secretions of placental origin replace in the maintenance of the gestation, the steroids of the involut corpus luteum, between the 8th and the 12th week of pregnancy, that the hormonal therapy can take a crucial contribution when this luteoplacental relay is defective .

Progesterone is the pregnancy hormone by definition and par excellence, and it is the only one that also has a sedative effect on the myometrium. Given the known or possible teratogenic potential of some of them, the administration of synthetic progestins should be avoided during pregnancy . Our preference goes to natural progesterone injectable delay (250 to 500 mg per week) alone, if its real effectiveness remains more often than not difficult to prove in each specific case, its absolute safety, for both mother and child, n ‘ has never been questioned.

Threat of early spontaneous abortion: monitoring the evolution of pregnancy

Hormone therapy loses interest after the 14th week of pregnancy , except in cases where the muscle relaxant effect of progesterone remains useful. Finally, the fear that hormone therapy could maintain an egg that later gives birth to a malformed child , who would have been eliminated without this therapy, is not well-founded .

What treatment for early spontaneous abortion?

When, despite everything, the development of the pregnancy stops , the expulsion of embryo-decidual debris occurs spontaneously and simply in almost all cases.

However, it happens that a spontaneous miscarriage is slow to end naturally . In this case, your gynecologist can suggest two treatments depending on your case :

• Medical treatment (misoprostol) : this drug aims to cause uterine contractions and an opening of the cervix, and causes the expulsion of intrauterine tissue.
• Surgical treatment (aspiration or curettage) : this treatment consists in introducing a small tube into the cavity of the uterus, via the vagina and the cervix to aspirate the embryonic tissues. Note: curettage is indicated in the rare cases of hemorrhage, coagulation disorders, refusal of medical treatment or in case of failure of medical treatment.

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