Miscarriage - Ryuzan (English spelling)

Japanese: 流産 - りゅうざん（英語表記）Miscarriage
Miscarriage - Ryuzan (English spelling)

What is the disease?

A miscarriage is defined as a birth at a time when the fetus cannot survive outside the womb. In practice, this refers to a birth before 22 weeks of pregnancy, and most spontaneous abortions are early abortions that occur in the first 12 weeks of pregnancy.

In early miscarriage, Embryo ( Taiga ) Because the embryo (a state before it becomes a fetus) is either not recognized or, even if it is recognized, is not viable, there is no way to treat it to turn it into a normal pregnancy and the pregnancy cannot be continued.

Miscarriage is not uncommon, occurring in about 10-20% of people who discover they are pregnant. This means that 80-90% of human pregnancies will develop normally.

The fact that the embryo is not developing can be detected by ultrasound, so it can be diagnosed even if there are no symptoms such as bleeding or pain. Miscarriages that occur after the 12th week of pregnancy are rare and are of a different nature to those described here.

What is the cause?

65-70% of spontaneous abortions are caused by abnormalities in the chromosomes of the fertilized egg. As a result, the embryo does not develop into a normal one and the pregnancy cannot continue. The frequency of chromosomal abnormalities increases with maternal age, so the frequency of miscarriage is said to be 10-20% for healthy women in their 20s, 20-30% for those in their 30s, and over 30% for those in their 40s.

Other causes include poor ovarian hormone secretion before and after pregnancy, Recurrent pregnancy loss ( Fever )・Habitual miscarriage ( Weekend ) However, the causes that many pregnant women worry about, such as "moving too much," "getting cold," "falling," or "hitting their stomach," are not thought to be the most likely causes.

How symptoms manifest

Many people think that bleeding in early pregnancy equals miscarriage, but miscarriage is often diagnosed even when there is no pain or bleeding. On the other hand, even if there is a small amount of bleeding, the pregnancy will continue normally in many cases.

Of course, bleeding is a symptom to watch out for, as miscarriage often involves a small amount of bleeding and the expulsion of the uterine contents is usually accompanied by heavier bleeding and lower abdominal pain.

Testing and diagnosis

Ultrasound is essential for diagnosing early miscarriage. A miscarriage is a state in which the pregnancy has ended, and no viable embryo is found in the uterus.

If you are sure that you are 7 weeks or older, you can definitely check for a heartbeat with an ultrasound, so if you don't detect a heartbeat after 7 weeks, it's a miscarriage. Gestational sac ( Tai ) If this is found, it is certain that the pregnancy is more than four weeks old, and if no heartbeat is observed after three weeks, it has been a miscarriage.

The baby may be observed for 2 to 3 weeks to see if it develops and starts to have a heartbeat. It is natural that no heartbeat can be seen at an earlier stage, but the bag that contains the embryo in the uterus, called the gestational sac, always grows little by little, so if there is no growth, it is a miscarriage.

Among the cases where miscarriage can be diagnosed, those without symptoms are Missed abortion ( Circulation ) Even without an ultrasound examination, if the gestational sac is expelled from the uterus along with heavy bleeding, it is easy to diagnose a miscarriage (progressing miscarriage).

Treatment methods

When a missed or ongoing miscarriage is diagnosed, it is normal to undergo a procedure (anesthesia and surgery) to remove the contents of the uterus. Even if the contents of the uterus are naturally expelled, some may remain (incomplete miscarriage). Usually, you will be hospitalized for one to two days.

However, if the miscarriage is so early that the gestational sac cannot be seen, or if the gestational sac is small, such as 1 to 2 cm, it may be a complete miscarriage and no treatment may be necessary.

What to do if you notice an illness

Leucorrhea ( Taige ) If you experience bleeding that is mixed with vaginal discharge or a small amount of brown discharge, keep an eye on it and tell your doctor at your next visit. If you experience bleeding similar to that of a menstrual period, consult a hospital. Visiting a hospital will not change the outcome of whether the fetus will develop or result in a miscarriage, but it will help you to check the situation.

If you are experiencing bleeding, it is best to avoid strenuous exercise, but rest will not prevent a miscarriage.

After a miscarriage, your period will resume within 1 to 2 months, and you can become pregnant again after about 3 months. Your chances of having another miscarriage remain the same, not higher.

Masato Sakai

Source: Houken “Sixth Edition Family Medicine Encyclopedia” Information about the Sixth Edition Family Medicine Encyclopedia

Japanese:

どんな病気か

　流産とは、胎児が胎外で生存不可能な時期の分娩と定義されています。実際には妊娠22週未満の分娩をいい、このうちほとんどの自然流産は、前半の妊娠12週までに起こる初期流産です。

　初期流産では、胎芽(たいが)（胎児になる前の状態）が認められないか、認められても生存していない状態なので、正常妊娠へと治療する方法はなく、妊娠は継続できません。

　流産はまれなものではなく、妊娠がわかった人の10～20％ほどでみられます。つまり、ヒトの妊娠で正常に育ってくるのは80～90％だということになります。

　胎芽が育っていないことは、超音波検査でわかるため、出血や痛みなどの症状がなくても診断が可能です。妊娠12週を過ぎて起こる流産は少数で、ここで説明するものとは性質が異なります。

原因は何か

　自然流産の原因の65～70％は、受精卵の染色体に異常が起こったためです。そのため正常な胎芽へと発育せず、妊娠が継続できません。染色体異常は母体の年齢が高いほど頻度が増すため、流産の頻度は、健常な女性でも20代で10～20％、30代で20～30％、40代では30％以上といわれています。

　このほかの原因に、妊娠前後の卵巣ホルモン分泌不良や不育症(ふいくしょう)・習慣流産(しゅうかんりゅうざん)がありますが、多くの妊婦さんが心配する「動きすぎ」「冷え」「ころんだ」「おなかをぶつけた」などは、あまり原因とは考えられません。

症状の現れ方

　妊娠初期の出血イコール流産と考える人が多いようですが、痛みや出血がまったくない状態で、流産と診断されることもしばしばあります。反対に少量の出血があっても、その多くは正常に妊娠が継続します。

　もちろん、流産では少量の出血がみられることが多く、子宮内容が排出される時には多めの出血と下腹部痛を伴うので、出血は注目すべき症状です。

検査と診断

　初期流産の診断には、超音波検査が欠かせません。流産は妊娠の継続が絶たれた状態なので、子宮内には生存している胎芽を認めません。

　妊娠7週以降であることが確実なら、必ず超音波検査で心拍が確認できるので、7週以降で心拍を認めなければ流産です。また、胎嚢(たいのう)が認められれば確実に妊娠4週以降ですから、それから3週を過ぎても心拍がみられなければ流産です。

　成長して心拍が現れてくるのかどうか、2～3週間経過を観察することがあります。もっと早い時期では、心拍はみられなくても当然ですが、子宮内の胎芽が入る胎嚢と呼ばれる袋は、必ず少しずつ成長するので、その成長がなければ流産です。

　流産と診断できるもののうち、症状がない状態を稽留流産(けいりゅうりゅうざん)といいます。超音波検査を行わなくても、多めの出血とともに胎嚢が子宮から排出されれば、流産（進行流産）の診断は容易です。

治療の方法

　稽留流産や進行流産と診断された時は、子宮内容を取り除く処置（麻酔・手術）を受けるのが普通です。自然に子宮内容が排出されてしまっても、一部が残ることがある（不全流産）からです。通常は1～2日の入院となります。

　ただし、胎嚢が見えないくらい初期の流産や、胎嚢が1～2㎝など小さい場合は、完全流産となって処置が不要なこともあります。

病気に気づいたらどうする

　帯下(たいげ)（おりもの）に混じる程度の出血、少量の茶色の帯下は経過をみて、次回の受診時に医師に告げましょう。月経くらいの出血がある場合は、病院に相談しましょう。受診しても胎児が発育していくか流産となるかの結果は変わりませんが状況は確認できます。

　出血があれば、激しい運動は避けたほうがよいでしょう。しかし、安静にすれば流産を防げるというわけではありません。

　流産後は1～2カ月で月経が再開し、3カ月ほどたてば再び妊娠してもかまいません。次回も流産する可能性は同率で、高くなることはありません。

坂井　昌人

出典　法研「六訂版 家庭医学大全科」六訂版 家庭医学大全科について　情報

<<:  Zinc sulfate

>>:  Sulfuric acid - Ryusan (English spelling)

Recommend

Mizubee (water bee) - Mizubee (English spelling) Agriotypus gracilis

An insect of the Hymenoptera family, Ichneumonidae...

Qena

It is the capital of the same-named province in Eg...

Cocktail lighting - Kakuteru Shoumei

...Color rendering is the characteristic of a lig...

Asthenosoma

…A general term for three species of the genus As...

Toyama Prefecture

A prefecture in the northern part of the Chubu reg...

Banda Aceh (English spelling)

The capital of the Aceh Special Region, located at...

Kanabuju - Kanabuju

…Indian philosopher. He is believed to have lived...

Jeongok-ri Archaeological Site (English name) Jon'gok-ri

A Paleolithic site in Jeongok-ri, Yeoncheon-gun, G...

Kir (cocktail) - Kir

…Stir gently, then float about 5 spoons of whippe...

John Wesley

The founder of the Methodist Church, one of the m...

Kakizaki Hakyo

Year of death: 22 June 1826 (26 July 1826) Year of...

Young Women's Christian Association

…The official name is the Young Women's Chris...

Morazán, Francisco

Born: October 16, 1799 in Tegucigalpa [Died] Septe...

Medical Law - Ijihosei

… [Historical Background] As the Code of Hammurap...

Tomofusa Sasa - Tomofusa Sasa

Year of death: September 28, 1906 (Meiji 39) Year ...