-Early miscarriage (FCP): It's a spontaneous cessation of pregnancy in the first trimester before the term of 12 to 14 weeks of amenorrhea (SA). This also includes stopping the development of a clear egg, which is a gestational sac without a visible embryo We also consider a FCP when there is a menstrual delay of a few days with a dose of positive ?HCG which decrease rapidly, which may occur during the MAP((Medically Assisted Procreation). The frequency of FCP is 20% of pregnancies. However, this frequency is largely underestimated because of non-implanted miscarriages which go clinically unnoticed. It is estimated that up to 60% of the products of conception do not exceed the first trimester -Late miscarriage (CTF): This is the spontaneous expulsion of a fetus between 12 (or 14) and 22 SA (before the term viability). This is often accompanied by the premature rupture of membranes within hours or days earlier. -Intrauterine fetal death (IUFD): The cessation of fetal cardiac activity beyond 12 (or 14) SA. The obstetric ultrasound at this stage is to confirm that the fetal measurements correspond to the term, to distinguish this incident of a non expelled stopped miscarriage discovered late.. This distinction is inportant because the causes are different and change the subsequent treatment of the patient. The frequency of CTF and IUFD is difficult to evaluate because they are sometimes mistakenly regarded as FCP , especially during the time limit of 12-14 SA. However, we can estimate that the CTF and IUFD make up to 2% of pregnancies.
Reviews by type of fetal loss:
-In cases of recurrent early miscarriage: We consider that a review is necessary after 3 FCP.s In women over 35 or with difficulty conceiving, the review is necessary after 2 FCPs. The objective is to identify the cause of these miscarriages to treat the patient or to facilitate their access to MAPs if they so desire. During a consultation the history and clinical signs of sterility, diabetes, thyroid disease, and what are called systemic diseases such as lupus will be looked at.
Additional examinations will be:
-laboratory tests of blood taken by searching: -thrombophilia (increased risk to thrombosis) -autoantibodies (lupus and antiphospholipid) -hyperglycemia -hormonal abnormalities (TSH, FSH, LH) -an examination of the uterus by hysteroscopy, with an additional hysterosalpingography. We will -also propose to you and your partner to carry out karyotypes looking for chromosomal abnormalities. -In cases of late miscarriage: A consultation following the accident will look for risk factors for injury or uterine malformation or the concept of genital infection or listeriosis. We will complete by bacteriological samples (vaginal, cervical, blood cultures and urinalysis). An examination of the placenta and fetal autopsy are helpful to find an infection or a malformation of the fetus. -In cases of fetal death in utero: A consultation following the accident to look for signs of-pre-eclampsia -retro-placental hematoma -infection (genital or listeriosis) -diabetes -a weak immune systemA biological assessment by blood tests look for: -disorders of hemostasis -HELLP syndrome (a complication of pre-eclampsia) -fetomaternal hemorrhage -hyperglycemia -Parvovirus B19 serology and CMV, if necessary An examination of the placenta and fetal autopsy are helpful to find an infection, malformation or chromosomal anomaly of the fetus. We will also propose to you and your partner to carry out karyotypes looking for chromosomal abnormalities.
The psychological care:
The loss of a fetus, often experienced with as much difficulty as losing a child, causes strong emotions in parents and even among members of the team of care givers. This loss causes an even stronger shock if the evolution of pregnancy was normal. Psychological support offered to parents is done in several stages. The accompaniment is multidisciplinary, shared between the obstetrician, the foetopathologist, midwife and psychiatrist or psychologist. The sadness is sometimes accompanied by feelings of guilt, as the impression of being a "bad mother". They may have impressions of fatality, particularly in cases of personal or family history of similar fetal loss. The risk is the installation of a prolonged or pathological mourning, in turn leading to psychosomatic or psychiatric disorders. A masked depression may occur, for which focused medical treatment is offered. But the mere fact of talking may be enough to alleviate the discomfort. For many couples it is important to organize a farewell ritual. That's why we give them the opportunity (without imposing) to see the deceased child, give them a name, to declare them to the civil register and make funeral arrangements. A real memory can help the grieving process and reduce the risk of mother-child relationship with pathological subsequent children. It is important to know that parents are free to express their wishes regarding these decisions, which will be respected without being judged, even if they choose to do nothing. Finally, brothers and sisters may also be affected. They will also need to be listened to, including a consultation if necessary, to avert a negative impact later. By helping the couple and their entourage to emerge from this dark,period psychological support is useful for both the present and the future.
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Victor Hugo