La fausse couche est l'interruption précoce de la gestation, qu'elle soit spontanée ou provoquée par une cause soit pathologique, soit traumatique. On la distingue de l'accouchement prématuré relativement à l'absence de viabilité du fœtus (morts-nés compris).
Elle se solde par l'expulsion par voie basse de cette progéniture non-viable hors de la matrice utérine.
Les fausses couches spontanées peuvent être primaires (sans enfant vivant déjà né) ou secondaires (avec enfant vivant déjà né). Elles sont précoces si la mort embryonnaire intervient avant la douzième semaine d'aménorrhée (cas de loin le plus fréquent), au-delà on parle de fausses couches spontanées tardives.
Le diagnostic de fausse couche doit porter sur : preuve biologique, échographique ou anatomopathologique.
Environ une grossesse sur quatre se solde par une fausse couche et une femme sur trois environ fera une fausse couche dans sa vie. Le risque augmente avec l'âge et peut atteindre 50 % ; il est également plus élevé quand la grossesse n'est pas connue. La première cause de fausse couche est une anomalie chromosomique.
La fausse couche est accompagnée de saignements qui peuvent être importants, et doit faire l'objet d'un examen médical, afin de vérifier la bonne expulsion du placenta, l'absence d'hémorragie, la nécessité d'un traitement en cas de rhésus négatif. Après une fausse couche, du repos est nécessaire, ainsi qu'une bonne hydratation et un apport suffisant en minéraux (fer notamment) et vitamines. Un accompagnement médical ou psychologique peut être nécessaire.
Une fausse couche aurait tendance à favoriser le bon déroulement de la grossesse suivante, si celle-ci a lieu dans les 6 mois suivants la fausse-couche et en l'absence de risque infectieux, mais à augmenter le risque d'une autre fausse couche, au-delà. Il existe également des cas de fausses couches spontanées à répétition.
On parle de maladie abortive (ou fausses couches spontanées à répétitions) après trois accidents spontanés successifs chez la même femme même en l'absence de changement de procréateur.
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