Abortion (from Latin aboriri, disappear, unborn) is the loss of pregnancy before week 20 of gestation. This arbitrary limit is based on the fact that a baby with less than 20 weeks of gestation is not able to survive outside the womb even in the presence of advanced life support measures. This is why after week 20 (and before 37) we talk about premature birth or death from prematurity but never mention the word abortion in this context, premature babies could have a chance of survival, unlike the product of an abortion.

The cardinal sign of abortion is genital bleeding (with or without belly pain) in a pregnant woman before the 20th week of her pregnancy. There are several categories of abortion that you can read in the right column of this article

Spontaneous Abortion is one that occurs “naturally” and without the intervention of obvious adverse factors, this will be our topic to be developed and does not include intentional abortion, whatever the reason. Whenever the word abortion is mentioned it must be clear that it is Spontaneous Abortion.

A particular condition of abortion occurs in the so-called Anembryonic Pregnancies

NOTE: In Rh (-) patients with an Rh (+) partner, the Rhogam “vaccine, anti-Rh antiglobulin can be indicated to prevent Rh isoimmunization, however many authors indicate that it is not necessary if the loss occurs before 12 weeks.

I know many women who have had an abortion, is the problem so frequent?

Abortion is more frequent than is believed, which is why it should not be given much importance if it were to occur in isolation.

The human being is reproductively difficult, not only is it difficult to achieve a pregnancy (the possibility of becoming pregnant in each menstrual cycle is only 20-25% in the best of cases) but the rate of loss of all pregnancies can reach up to 31% according to what some authors have estimated. Clinically diagnosed pregnancies (positive pregnancy test and/or sonography that indicates intrauterine pregnancy) are lost in 8-20% of cases . 80% of abortions occur before week 12.

Age relationship: the frequency of clinically recognized early pregnancy loss for women aged 20–30 years is 9–17%, and this rate increases sharply from 20% at age 35 years to 40% at age 40 years and 80% at age 45 years (ACOG, Practice Bulletin 150, 2017).

Yes, abortion is so frequent that only 70-80 babies are born for every 100 pregnancies diagnosed and undiagnosed. We only knew this recently thanks to the super sensitive pregnancy tests

Why does an abortion occur?

The final purpose of abortion is the arrest of a severely affected pregnancy that would not lead to the birth of a healthy baby. In short, we could suggest, following the evolutionary postulates of Darwin, that abortion is the mechanism of Natural Selection of human reproduction. Of course, there are conditions that increase the risk of abortion in normal pregnancies such as the use of recreational drugs, smoking, ionizing radiation, extreme sports, severe stress, etc.

So, should miscarriage be seen as a necessary evil?

Definitely. Abortion is a means of natural selection that limits the birth of severely malformed and sick babies who would otherwise die in later stages of pregnancy or immediately at birth.

What are the known causes of spontaneous abortion?

The causes are many and varied and probably in our daily practice, we will never know them and we will not even bother looking for them, this is because many researchers have given us long lists of causes associated with abortions so that we can report theoretical way to our patients. Given that the diagnosis of a cause is difficult (and expensive and not guaranteed), we have reached the consensus of seeking it after the third successive abortion, when the patient is called the habitual abortionist. This has a cost-benefit ratio and limits Maternal-Paternal Anxiety; In addition, as most abortions occur due to causes that appear or disappear at random, most of the time, either we fail to reach a diagnosis or we have a condition that does not have to be repeated in a future pregnancy.

Maternal smoking, active or passive (father smoker), discreetly increases the risk of abortion, so it is recommended to suspend the habit before pregnancy or failing, immediately suspecting or knowing their presence.

Is it true that medications cause abortions?

Modern medicine has advanced a lot and it has been possible to catalog most of the medicines within several ranges of safety, with rare exceptions some of them could cause an abortion on its own. There is a small handful of medications that could definitely generate an abortion either directly or through the generation of severe fetal malformations; for ethical reasons I reserve such information, the recommendation is that you always consult your obstetrician before taking any medication or naturopathic preparation (remember, the fact that it is “natural” does not mean it is safe, I could give you some bad examples)

Do falls cause abortions?

If you fall from an eighth floor I do not doubt it, of course maybe you won’t survive and possibly not even abort as a result of the immediate trauma. With this I want to tell you that the embryo or fetus is so well protected by the bones of the pelvic girdle that for a trauma to affect the baby practically the force must be such that it severely injures the mother. Most of the abortion cases that I have handled in relation to alleged falls (typically on the stairs) have been related to intentionally induced abortions.

Can stress be a cause?

Intense physical or emotional stress can cause abortions. By this I do not mean a reasonable domestic argument or fight, I am referring to situations of war, disasters, severe illnesses, exhaustion, starvation, depression, intense work stress, etc.

Could fever condition an abortion?

It has been determined that prolonged febrile temperatures (for days), above 39 degrees Celsius, could lead to embryo-fetal malformations and abortions. This applies mainly during the first 8 weeks of pregnancy, fortunately the frequency is not high and if the temperature is controlled the risk is minimal.

What infections condition abortions?

The best studied are viral infections such as Rubella. There are parasitic (Toxoplasmosis) and bacterial (Chlamydia infection), etc. In general, most infections (such as the common cold) do not cause problems.

Should I be studied after a first abortion?

In daily practice we can rarely give a certain explanation about the cause of a particular abortion, in fact, it is not indicated to medically study the product of conception or to the couple during the first episode of abortion, this is because the greater Some of the known causes of abortion are presented randomly and it is expected that in successive pregnancies chance will be in favor of the mother and her baby.

What is habitual abortion?

It is the consecutive loss of 3 or more pregnancies under 20 weeks (affects 1-2% of women). At this point the study of the patient and her partner is indicated (sometimes we only consider 2 losses to start the diagnostic evaluations). The general causes are the same as we saw for a particular episode of abortion and likewise in most cases we can not specify a valid reason that explains the recurrent loss. The concept of habitual abortion disappears at the moment in which the patient has a pregnancy that reaches a happy term. Most of the habitual abortionists will have a successful pregnancy (60-90%).

Corollary

I hope you have noticed that for almost the entire article I have tried to learn to downplay the importance of an abortion in the unfortunate event that something so common occurs to you: do not feel anguished, frustrated and hopeless; Finally, do not give it more importance than chance deserves and keep in mind, always, that nature is wise. You can be sad and go through a process of mourning (in the psychological aspect, as a process to any loss) but keep it brief and then move on with the certainty that in a short time you will be pregnant again.