Why does fetal freezing occur during pregnancy? Fetal freezing: possible causes, symptoms, preventive measures

Freezing early and late pregnancy: causes and prevention

- This is the termination of the development of the fetus and its death for up to 28 weeks. The reasons for this unpleasant and sometimes even dangerous phenomenon can be very different - frozen pregnancy may be the result of genetic disorders in the embryo (or fetus), caused by an exacerbation of infectious diseases or even bad habits. Frozen pregnancy more often diagnosed in the first trimester of pregnancy (up to 13 weeks). The causes of a frozen pregnancy in the early stages are different from the later ones. Let us consider in more detail such a phenomenon as frozen pregnancy causes her and preventive measures.

So, even during the planning period for pregnancy, it is necessary to stop drinking alcoholic beverages (especially in large quantities) and smoking. Alcohol and smoking do not always lead to frozen pregnancy, but the risk of its occurrence in such women increases.

Absolutely exactly during the planning period and the most pregnancy(to avoid miscarriage and frozen) you should not use medications without a doctor's prescription. And before you start taking them, you should carefully read the instructions for the drug, perhaps there is a pregnancy in contraindications. In addition, many drugs have the property of being excreted from the body for a long time. The expectant mother may not know that she has arrived pregnancy and take any medicine and as a result - frozen... The embryo is very susceptible to teratogenic effects. But, meanwhile, will the harm be caused by taking medications at a very early stage - 7-10 days from the date of fertilization of the egg, since during this period there is no close connection between the unborn child and his mother. And after 8-10 weeks, the child is partially protected from teratogenic effects by the placenta and, accordingly, the number frozen pregnancies for long periods of time, it decreases slightly. If you work in hazardous industries, then you also have an increased risk frozen pregnancy.

It can lie in a woman's hormonal imbalance, most often it is a lack of progesterone - the hormone of pregnancy. If you have a history of a frozen pregnancy, miscarriage, often delayed menstruation and male pattern hair growth, then before planning a pregnancy, you need to undergo hormone tests and, if necessary, undergo treatment, thus you will reduce the likelihood frozen pregnancy in future.

The next reason frozen pregnancy not only in the early, but also in the later stages, there are all kinds of infections. Especially dangerous is not the exacerbation of existing infectious diseases, but their infection during pregnancy. Infection with some of them (for example, chickenpox and rubella) can lead not only to frozen pregnancy, but also, what is most terrible, developmental abnormalities in the fetus. And then you will have to decide on the termination of pregnancy ... It is infections that can cause such a condition as late pregnancy.

How to avoid frozen pregnancy due to exacerbation or infection with an infectious disease? Firstly, you should look at your children's medical record or ask your parents (if you don’t remember yourself) about whether you had diseases such as rubella and chickenpox in childhood. If not, and besides, you are at risk (working with children), then in order to avoid infection with them and as a consequence frozen pregnancy or a miscarriage, it is better to vaccinate them 3 months before planning a pregnancy. If you have STIs (sexually transmitted infections), you should first get rid of them and only then plan a pregnancy.

But if pregnancy came unexpectedly, then in order to avoid frozen or a miscarriage, your doctor may prescribe you an antiviral course.

To all women without exception for prevention frozen pregnancy and other troubles, it is necessary to strengthen your immunity during the period of happy waiting for the baby. There are a lot of ways, it is not necessary to drink dietary supplements and vitamins. Correct, nutritious food will be enough. During pregnancy, immunity always decreases, this is due to the production of a special hormone - chorionic gonadotropin, one of the functions of which is to protect the unborn child from the immune system of his mother. Without this, the mother's body perceives the fetus as an "alien" object that needs to be gotten rid of, here's another possible one.

But, nevertheless, most often the reason frozen pregnancy are genetic abnormalities in the fetus. Nature itself does not allow the "sick" embryo to develop and arises frozen pregnancy... As a rule, if this is cause of frozen pregnancy for a woman, then there is a high probability that this will not happen again if the parents themselves are healthy.

Symptoms of a frozen pregnancy and its diagnosis

Unfortunately, missed early pregnancy may not make itself felt in any way. Later, symptoms of a frozen pregnancy a woman may have cramping pains and spotting spotting. This usually occurs when the ovum begins to detach, that is, the beginning of a miscarriage.

To subjective symptoms frozen early pregnancy also can be attributed to the abrupt cessation of toxicosis (if any). Soreness of the mammary glands may also pass and the basal temperature may decrease. Usually these symptoms of a frozen pregnancy women are not left without attention. Freezing late pregnancy characterized by the absence of movement of the child.

There are three ways: to take a blood test for hCG, go for an examination to a gynecologist, or do an ultrasound.

At frozen pregnancy the hCG level is lower than it should be at this stage of pregnancy. An ultrasound scan shows an absence of fetal heartbeat. And on a gynecological examination, the doctor determines the discrepancy between the size of the uterus and the gestational age.

So if you suspect that you have frozen pregnancy, be aware that symptoms are a minor symptom. The main thing is medical evidence, so to speak ... With such a phenomenon as frozen pregnancy symptoms different women may differ or even be absent altogether.

Usually frozen pregnancy ends with the "cleaning" of the uterine cavity in stationary conditions. But in the early stages, it is possible to carry out a vacuum aspiration or cause a miscarriage with the help of certain medications (under the supervision of a doctor). Sometimes when frozen pregnancy in the early stages doctors take a wait-and-see attitude, that is, they wait for a woman to spontaneously miscarry. And if this does not happen within the time specified by the doctor or the remains of the ovum are diagnosed by ultrasound in the uterus, then curettage (scraping) of the uterine cavity is performed.

Pregnancy after a frozen pregnancy

Doctors recommend planning pregnancy after a frozen pregnancy at least six months later. During this time to prevent future cases frozen pregnancy held treatment... Standard for treatment no, it all depends on the reason that caused frozen pregnancy... But absolutely everyone is desirable to pass some tests and undergo examinations.

First of all, it is worth taking a smear for all kinds of sexually transmitted infections by the PCR method, taking a blood test to determine the level of hormones in the blood, and undergoing an ultrasound examination. If necessary, determine the karyotype (your own and your partner), group compatibility and other tests and examinations, as well as undergo treatment recommended by a doctor based on the results of all examinations as a prophylaxis in the future frozen pregnancy.

A woman who has experienced a condition such as missed pregnancy treatment may not be required at all if all test results are normal. As we wrote earlier, frozen pregnancy, most often, it happens due to a genetic error, which is unlikely to ever happen again ... But if frozen pregnancy happened not for the first time, then treatment is most likely needed in any case.

The best prevention is a healthy lifestyle and regular visits to the gynecologist, and then you are unlikely to be threatened frozen pregnancy.

Frozen pregnancy - causes and treatment

Non-developing pregnancy (missed abortion) means the death of an embryo (fetus) without clinical signs of miscarriage. In the structure of reproductive losses, the frequency of this pathology remains stable and amounts to 10-20% of all desired pregnancies.

Frozen pregnancy - causes

The causes of missed pregnancies are numerous and often complex. In everyday practice, it is often difficult to establish a specific factor that led to a given pathology, since this is hampered by tissue maceration after fetal death, which complicates their genetic and morphological studies.

Among the leading etiological factors of non-developing pregnancy, it should be noted, first of all, an infectious one. Persistence in the endometrium of a bacterial-viral infection often contributes to the increase or occurrence of endocrinopathies in the mother, is accompanied by disturbances in the hemostasis system and metabolic changes in the uterine mucosa, which can cause the embryo (fetus) to stop developing.

A feature of the etiological structure of inflammatory diseases is currently various associations of microorganisms, including anaerobic bacteria, facultative streptococci, viruses. This is due to a certain extent to the peculiarities of the immune response of the mother's body, in which complete elimination of the pathogen from the body is impossible.

Not every embryo (fetus) that comes into contact with an infection is necessarily infected; in addition, the degree of damage to it is different. It can be caused by microorganisms that have a certain tropism to some tissues, as well as vascular insufficiency due to inflammation of the vessels of the fetus or placenta.

Frozen pregnancy - infections leading to fetal death

The spectrum of infectious agents that can cause early antenatal infection and subsequent death of the embryo is as follows.

1. Some types of opportunistic flora - streptococci, staphylococci, E. coli, Klebsiella, etc.

2. Rubella viruses, CMV, HSV, adenovirus 7, Coxsackie virus.

3. Mycoplasma, chlamydia, treponema, mycobacterium.

4. Protozoa - Toxoplasma, Plasmodium, fungi of the genus Candida.

In viral and mycoplasma lesions, inflammatory changes in the decidua are combined with acute circulatory disorders in the uteroplacental arteries. In bacterial lesions, inflammatory infiltrates are found more often in the amnion, chorion and intervillous space. In the presence of an infectious pathology in the mother, the death of the embryo (fetus) is caused by massive inflammatory infiltration, as well as micronecrosis at the site of direct contact of the chorion with maternal tissues.

The teratogenic role of infectious diseases in the mother has been proven; she is responsible for 1–2% of all severe congenital anomalies in the fetus that are incompatible with life. Whether the presence of infection is the cause of antenatal death of the embryo (fetus) and spontaneous termination of pregnancy depends on the route of penetration of microorganisms, involvement of the fetus and amniotic membranes in infection, the type and virulence of microbes, the number of pathogens that have entered, the duration of the mother's illness and other factors.

The ascending route of infection of the embryo (fetus), prevailing in the first trimester of pregnancy, is due to opportunistic bacteria, as well as mycoplasmas, chlamydia, fungi of the genus Candida, herpes simplex virus. Predisposing factors for the development of the inflammatory process may be isthmic-cervical insufficiency, partial rupture of the membranes and some invasive manipulations to assess the state of the embryo (fetus): chorionic biopsy, amniocentesis, etc.

Microorganisms penetrate into the uterine cavity from the lower parts of the reproductive system, infecting the amniotic fluid, regardless of whether their integrity is violated or not. The fetus swallows the amniotic fluid or the infection spreads through the amniotic membranes and further to the fetus, causing damage to the lungs, digestive tract and skin, which in turn can cause antenatal death of the fetus. The nature and distribution of inflammatory organ lesions is determined mainly by the intensive exchange of infected amniotic fluid with the respiratory, urinary systems of the fetus, as well as its gastrointestinal tract.

The descending route of infection, as a rule, begins from chronic foci of inflammation in the fallopian tubes and ovaries and is more often due to gonorrheal and chlamydial infections. Inflammatory processes in the uterine appendages contribute to the infection of the marginal sinuses of the placenta with the development of placental chorionamnionitis, which leads to a mixed type of damage to the organs of the fetus and its antenatal death.

Intrauterine death of the fetus can be associated not only with the direct damaging effect of the infectious agent, but also with the inadequate development of immune responses in the tissue of the placenta.

Frozen pregnancy - immunological reasons

It is known that the regulation of the immune response is carried out mainly by T-helpers, or CD4 lymphocytes. There are two substances of these cells - Tx type 1 and Tx type 2. They differ in secreted cytokines. TX1 secrete gamma, IL-2 and beta-TNF, and TX2 - IL-4, -5 and -10. TNF alpha is secreted by both subpopulations of cells, but mainly TX1. Cytokines are mediators in the development of inflammatory and immune reactions in the mother-placenta-fetus system. The cytokines secreted by Th, through a feedback mechanism, regulate the function of these cells. It was found that TX2, which provides mainly humoral immune responses, favors the physiological course of pregnancy. TX1, on the contrary, stimulates the cellular link of immunity and can have an abortive effect.

In the endometrium and decidua, there are a huge number of cells of the immune system, all of which are capable of secreting cytokines. Violation and termination of the development of pregnancy can occur as a result of an impaired immune response to antigens. As a result, the fetal egg becomes the target of the cellular link of immunity. The antigens that activate macrophages and lymphocytes are most likely trophoblast antigens. This is confirmed by the fact that the main cytokines secreted by TX1 suppress the development of the embryo, as well as the proliferation and normal development of the trophoblast. They affect the embryo both directly and indirectly, depending on the intensity of secretion and differentiation of the target tissue.

The immune system can lead to fetal loss through the activation of NK cells and macrophages. NK cells are directly involved in trophoblast lysis. Activation of macrophages enhances the production and secretion of cytokines that act on effector cells, including NK cells. The cytokine cascade can be triggered not only by an infectious agent, but also by endogenous causes (hypoxia, hormones, etc.).

Chromosomal abnormalities in partners are perhaps the only undoubted reason for a missed pregnancy. The death of the embryo can be caused by the pathological development of the zygote, embryo, fetus, or structural abnormalities in the genetic program for the development of the placenta. In the observations of spontaneous miscarriages caused by chromosomal pathology, various disorders of the development of the embryo, up to its complete absence, are very characteristic.

Frozen pregnancy - genetic causes

Chromosomal aberrations play a special role in the etiology of missed pregnancies. The majority of embryos with an aberrant karyotype die in the first weeks of pregnancy. So, in the first 6-7 weeks of pregnancy, 60-75% of abortions have an abnormal karyotype, at 12-47 weeks - 20-25%, 17-28 weeks - only 2-7%. Among the chromosomal aberrations in abortions, 45-55% are autosomal trisomies, 20-30% are monosomy 45X0, 15-20% are triploidy and 5% are tetraploidy.

Autosomal trisomy is responsible for more than half of the pathological karyotypes. In this case, as a rule, the embryo is absent or has multiple developmental defects; the chorionic cavity is empty and small. Most autosomal trisomies are the result of a lack of chromosome separation during the first mitotic division of the oocyte, and the frequency of this phenomenon increases with the age of the mother. It should be noted that the age of the mother is not decisive for other chromosomal abnormalities that cause pregnancy to stop.

In 20-25% of cases with karyotype pathology, monosomy takes place. Monosomy X causes aplasia of the embryo, from which only the remainder of the cord cord is often retained, or the preserved embryo is in a state of pronounced dropsy. With monosomy, 98% of pregnancies end in miscarriage and only 2% in childbirth with Turner syndrome.

Triploidy and tetraploidy occur with moderate frequency, but those cases of triploidy in which there is a dual parent component usually lead to partial bladder drift, which clinically manifests itself later in pregnancy.

An important structural abnormality of chromosomes is translocation (2-10%), which can be transmitted by one of the parents - a balanced carrier. A balanced (compensated) translocation should be suspected in cases where a history of spouses has indications of repeated non-developing pregnancies or spontaneous miscarriages. Other types of karyotype disorders include various forms of mosaicism, double trisomies and other rare pathologies.

Human chromosomal pathology depends not only on the intensity of the mutation process, but also on the efficiency of selection. With age, selection weakens, so developmental anomalies are more common.

Among all non-developing pregnancies, 60% are caused by blastopathies and are mainly associated with chromosomal abnormalities or malformations caused by unfavorable external factors. Blastopathies leading to the death of the embryo in the first weeks of pregnancy are classified as follows.

1. Anomalies in the development of the blastocyst, amniotic cavity and yolk sac.

2. Empty embryonic sac due to aplasia or resorption of the embryoblast (without amnion, amniotic pedicle and yolk sac).

3. Hypoplasia of the amniotic cavity with partial or complete extraamnial embryo in the coelom.

4. Aplasia, hypoplasia or calcification of the yolk sac.

5. Twin defects: thoracopagi, ischiopagi, etc.

6. Unspecified early blastopathies: abnormal blastocyst, complete topographic inversion of the embryoblast.

The most common forms with gross chromosomal abnormalities are empty embryo sacs, which are found in 14.9% of cases. Empty bags are classified as malformations and the following varieties are distinguished.

1.With a sharply hypoplastic amniotic cavity (with or without a yolk sac).

2. With the absence of the embryo, umbilical cord and yolk sac.

3.With the presence of the amniotic membrane, umbilical cord and yolk sac (occurs in 80% of cases).

In 9.3% of observations, there are changes affecting the entire embryo and thereby leading to its death.

Embryopathies are more often manifested by congenital malformations, usually in the form of gross abnormalities in the development of the embryo. However, part of the embryopathy can also cause intrauterine death of the embryo (fetus).

Frozen pregnancy - hormonal causes

Among the reasons for a non-developing pregnancy, endocrine factors should be distinguished - a violation of the formation and hypofunction of the corpus luteum associated with a deficiency of progesterone and a weak decidualization of the endometrial stroma. Incomplete or weak invasion of the cytotrophoblast into the adjacent endometrium contributes to a decrease in the number and volume of gestational changes in the uteroplacental arteries and a decrease in uteroplacental blood circulation. The consequence of this may be the death of the embryo and detachment of the trophoblast.

Insufficiency of the first wave of cytotrophoblast invasion is often combined with chromosomal abnormalities, which is a consequence of a defect in the gene responsible for this process or a violation of the general genetic program for the development of the embryo and placenta.

Not all endocrine diseases cause intrauterine death of the embryo (fetus). Hyperandrogenism (Stein-Leventhal syndrome, adrenogenital syndrome), hypo- and hyperfunction of the thyroid gland contribute to inadequate preparation of the endometrium for pregnancy and defective implantation of the ovum, which requires specific hormonal correction. Often, the death of an embryo (fetus) occurs when the mother has diabetes mellitus, which dictates the need to prepare for a planned pregnancy.

Autoimmune factor. APS is one of the variants of autoimmune disorders.

Antiphospholipid antibodies alter the adhesive characteristics of the preimplantation morula (charge); enhance prothrombotic mechanisms and desynchronize the processes of fibrinolysis and fibrin formation, which leads to implantation defects and a decrease in the depth of decidual trophoblast invasion. Antiphospholipid antibodies directly interact with syncytiotrophoblast and cytotrophoblast and inhibit intercellular fusion of trophoblast cells. In addition, antiphospholipid antibodies suppress hCG production and enhance thrombotic tendencies by providing matrices for coagulation reactions.

In autoimmune diseases, severe rheological disorders are noted, leading to the formation of a retroplacental hematoma and blockade of the uteroplacental and fetoplacental circulation. Due to thromboembolic damage to the trophoblast and placenta due to damage to vascular endothelial cells and platelets, the death of the embryo (fetus) is possible.

According to the literature, without treatment, embryo / fetal death is observed in 90-95% of women with antiphospholipid antibodies.

Frozen pregnancy - causes of fetal death

Other factors leading to intrauterine death of the embryo (fetus). Only 10% of cases of early termination of pregnancy are associated with diseases of the mother, such as acute infection. More often, chronic infectious diseases of the mother do not lead to intrauterine death of the fetus, but cause fetopathies that contribute to intrauterine death under the influence of other factors. Heart defects are a very clear example in this regard.

If we assess the sensitivity of the embryo and fetus to damaging factors, then we can say that the shorter the gestation period, the higher this sensitivity. However, it decreases unevenly during intrauterine development. There are so-called critical periods during pregnancy, when the ovum, embryo, fetus are especially sensitive to adverse factors: the period of implantation (7-12 days), the period of embryogenesis (3-8 weeks), the period of formation of the placenta (up to 12 weeks) , the period of formation of the most important functional systems of the fetus (20-24 weeks).

Frozen pregnancy - consequences

Pathogenesis. The main pathogenetic moment of non-developing pregnancy is the arrest, first of all, of the FPC with the continuing uteroplacental circulation. There are the following pathomorphological processes characteristic of non-developing pregnancy.

1. Reduction and cessation of embryochorionic circulation in combination with involutional changes in the chorionic villi. The borderline state between a disturbed and a non-developing pregnancy is the absence of red blood cells in the lumen of separately preserved vessels. This indicates the undoubted death of the embryo and the complete cessation of metabolic processes necessary for the development of pregnancy.

2. Termination of BMD against the background of involutional changes in decidual tissue.

3. Perifocal leukocyte-fibrinous exudative reaction of the endometrium caused by the presence of dead elements of the ovum in the uterine cavity. Its feature is a pronounced fibrinous component, due to which biological "conservation" of embryotrophoblastic residues occurs.

In non-developing pregnancy, there may be a phenomenon of "reverse development of the endometrium" associated with prolonged persistence of the corpus luteum of the ovary under conditions of gradually fading hormonal activity of the deceased fetus.

The endometrium adjacent to the area of ​​the regressing fetal bladder can maintain a decidual transformation for some time, but for a greater extent it has a non-functioning or hypoplastic appearance. With complete regression of the corpus luteum, maturation of the next follicles in the ovary may begin, and then the endometrium will show signs of an early, middle or late stage of the proliferation phase. Signs of glandular-cystic hyperplasia of the endometrium testify to the prolonged persistence of a non-developing pregnancy.

After the death of the embryo and the arrest of the FPK, the walls of the vessels collapse, erythrocytes are found in the lumen of the capillaries of the villi, hydropic edema (secondary) and fibrosis of the villous stroma are noted. If there are no erythrocytes in the vessels of the villi, then it can be assumed that the embryoplacental circulation stopped before 4-5 weeks of gestation; if nuclear erythrocytes predominate, then the death of the embryo occurred during the yolk circulation (5-9 weeks of pregnancy). The presence of non-nuclear erythrocytes indicates a violation of the development of the embryo already at a later stage of gestation.

Frozen pregnancy - signs

Clinic. A clinical sign of a non-developing pregnancy is an erased picture of subjective manifestations of abnormal pregnancy against the background of stabilization of the size of the uterus and their discrepancy with the period of gravidar amenorrhea. The uterus can be of normal size, it can be reduced, it can even be enlarged if there is a hematoma in the cavity.

Moreover, as a rule, hCG in a woman's blood is at an extremely low level or even completely absent. Subjective signs of pregnancy gradually disappear (although for some time after the death of the embryo or fetus, the patient may feel pregnant), spotting bleeding from the genital tract, abdominal pain of a spastic nature are periodically noted.

Frozen pregnancy - diagnosis

Diagnostics. The diagnosis of non-developing pregnancy is established on the basis of ultrasound scan data in the absence of a fetal heartbeat. With ultrasound, several options for non-developing pregnancy are determined.

The most common is anembryonia, i.e. the absence of an embryo in the cavity of the ovum after 7 weeks of pregnancy. The fetal egg is smaller than it should be for the expected gestational age, the decidua has a discontinuous contour, the embryo is not visualized, or the fetal egg is sized according to the gestational age, the embryo can be visualized, but very small in size and without a heartbeat. Retrochorial hematoma is not uncommon. If the study is carried out before 8 weeks of pregnancy, then it must be repeated after 7 days.

Another echographic picture of a non-developing pregnancy is a "frozen fetus", in which a fetal egg and an embryo of normal shape and size are visualized without signs of fetal activity. As a rule, such signs are characteristic of the recent death of the embryo, which may not yet be accompanied by clinical signs of threatened termination.

With a longer stay of the dead embryo in the uterus, visualization of the embryo is impossible, there are no signs of its vital activity. The size of the uterus lags behind the gestational age, the structure of the ovum is sharply changed - there is deformation, fuzzy contours and shape of the ovum, the presence of multiple constrictions and separate scattered echo structures.

Of particular importance is the establishment of a variant of the echographic picture of a non-developing pregnancy, when a normal fetus may have transient bradycardia or syncopal absence of heartbeat, therefore, observation is necessary for several minutes. Other signs of fetal death are severe lack of water, as well as damage to the bones of the skull with overlapping bone fragments one after another.

Ultrasound can reveal a special form of non-developing pregnancy - multiple pregnancy in the early stages. Often in such women, resorption of one of the embryos is noted with the normal development of the other. More often, the regression of the ovum occurs according to the type of anembryony, less often according to the type of intrauterine death of one of the fetuses (with dichorionic twins).

The differential diagnosis of non-developing pregnancy should be carried out with the onset of spontaneous miscarriage and trophoblastic disease.

Frozen pregnancy - the result

The outcome of an undeveloped pregnancy. The death of the embryo (fetus) is not always accompanied by a rapid spontaneous expulsion from the uterus. The absence of any proliferative and metabolic processes on the part of the cellular tissue elements of the fetal bladder due to their far-reaching degenerative and necrobiotic changes is aggravated by the unresponsiveness of the uterus, which does not reject the dead fetus. Cases are often observed when a dead fertilized egg lingers in the uterus for an indefinitely long time.

To date, the reasons for such a prolonged prolongation of an undeveloped pregnancy and the factors that determine the pathological inertness of the uterus are not clear enough. Apparently, the unresponsiveness of the uterus can be associated with the following factors.

1. Deep invasion of the chorionic villi, providing a tight attachment or true augmentation of the forming placenta due to:

o increased proliferative activity of the invasive chorion in the area of ​​the placental site;

o initial structural and functional inferiority of the endometrium in the implantation zone due to previous curettage of the uterus;

o implantation of the ovum in places of incomplete gravidar transformation of the uterine mucosa.

2. Inadequacy of the reactions of immunocellular rejection of the dead fetal bladder. A cascade of immunocellular reactions is developing, aimed at rejection of the "allogeneic transplant", which has lost all immunoblocking factors due to its death. With a certain genetic identity of the spouses (consanguineous marriage), the biological compatibility of the mother and the fetus can be so close that it determines the state of immunological unresponsiveness of the uterus in relation to the dead embryo.

3. The reactivity of the uterus. The contractile hypofunction of the myometrium may be due to:

o biochemical defects in the enzymatic-protein metabolism system;

o chronic inflammatory processes in the uterus, when receptors for contracting substances are not formed;

o lack of hormonal support from the dead fetus and non-developing placenta.

Most often, a gradual rejection of the dead ovum occurs with the help of a fibrinous-leukocytic exudative reaction in response to necrotic tissue. In the course of this process, along with fibrin and leukocytes, trophoblastic, thromboplastic substances, erythrocytes are released from the endometrial vessels, which leads to constant spotting bloody discharge from the uterus. The body of the uterus becomes soft, the tone of the myometrium disappears, the cervix opens slightly. All signs of pregnancy (cyanosis of the vagina, cervix) disappear.

Frozen pregnancy - the consequences of a dead embryo in the uterus

With a prolonged (2-4 weeks or more) presence of a dead embryo in the uterus, autolysis occurs, the flow of thromboplastic substances into the patient's bloodstream and DIC syndrome develops. All this is the risk of developing severe coagulopathic bleeding when trying to terminate a pregnancy. The most unfavorable conditions of uterine hemostasis occur in patients in whom phase hemocoagulation changes are in a state of hypocoagulation and myometrial hypotension is expressed.

Difficulties arising when removing a dead fetus may be due to the presentation of the chorion, placenta, located in the area of ​​the internal os of the uterus. Before curettage of the uterus, it is necessary to examine the state of the hemostasis system (expanded coagulogram). In case of identified violations (hyperaggregation, hypercoagulation, disseminated intravascular coagulation syndrome), corrective therapy (fresh frozen, and other components) is required. The relief of hemostasiological disorders at the level of the vascular-platelet link is facilitated by the use of dicinone and ATP. In the postoperative period, antiplatelet and anticoagulant therapy is indicated (, courantil,). The energy potential of the uterus is restored by the appointment of glucose, vitamins, calcium chloride in combination with antispasmodic drugs.

Frozen pregnancy - treatment

Treatment. The retention of a dead embryo in the uterine cavity poses a threat not only to health, but also to the life of a woman and therefore requires active tactics. Once a missed pregnancy is diagnosed, long-term conservative management is risky.

After a thorough examination and appropriate training of the woman (carrying out treatment and prevention measures aimed at reducing the risk of developing possible

complications), it is necessary to terminate a non-developing pregnancy. In the first trimester of pregnancy:

1. Dilation of the cervix and vacuum aspiration.

2. Preparation of the cervix with prostaglandins or hydrophilic dilators and vacuum aspiration.

3. The use of antiprogestogens in combination with prostaglandins.

In the second trimester of pregnancy:

1. Expansion of the cervix and evacuation of products of conception with prior preparation of the cervix.

2. Therapeutic abortion using intra- and extra-amniotic administration of prostaglandins or hypertensive agents.

3. The use of an antiprogestagen in combination with a prostaglandin.

4. Isolated use of prostaglandins.

Immediately during the abortion or immediately after its completion, an ultrasound scan is necessary to make sure that parts of the fetus and placenta are completely removed.

After removal of the ovum in non-developing pregnancy, regardless of the chosen method of termination, it is advisable to carry out complex anti-inflammatory treatment, including specific antibacterial, immunocorrective and restorative therapy.

Each case of undeveloped pregnancy requires an in-depth examination in relation to genetic, endocrine, immune and infectious pathology.

Frozen pregnancy - medical measures

The management of patients with a history of non-developing pregnancy is as follows.

1. Identification of pathogenetic factors of death of the embryo (fetus).

2. Elimination or weakening of the identified factors outside and during pregnancy:

o screening examination of patients planning pregnancy, as well as women in early gestation for urogenital infection;

o medical genetic counseling in order to identify high-risk groups for congenital and hereditary pathology;

o differentiated individually selected hormonal therapy for the endocrine genesis of non-developing pregnancy;

o determination of autoimmune disorders (determination of lupus anticoagulant, anti-hCG, anticardiolipin antibodies, etc.) and individual selection of antiplatelet agents and / or anticoagulants and glucocorticoids under the control of hemostasiograms.

3. Normalization of the mental state of a woman (sedatives, promotion of a healthy lifestyle).

Pregnancy after a frozen pregnancy

The tactics of managing patients during subsequent pregnancy are as follows.

1. Screening using non-invasive methods: ultrasound, analysis of marker serum proteins alpha-fetoprotein, chorionic gonadotropin in the blood in the most informative terms.

2. According to indications - invasive prenatal diagnostics for the determination of chromosomal and a number of monogenic diseases of the fetus.

3. Carrying out therapeutic and prophylactic measures aimed at:

o elimination of the infectious process, carrying out specific anti-inflammatory therapy in combination with immunocorrectors;

o suppression of the production of autoantibodies - intravenous drip of gamma-immunoglobulin, 25 ml every other day No. 3;

o elimination of hemostasiological disorders - antiplatelet agents, direct anticoagulants.

SPONTANEOUS ABORTION (Miscarriage)

Spontaneous abortion (miscarriage) - spontaneous abortion before the fetus reaches a viable gestational age.

According to the WHO definition, abortion is spontaneous expulsion or extraction of an embryo or fetus weighing up to 500 g, which corresponds to a gestational age of less than 22 weeks.

ICD-10 code

O03 Spontaneous abortion.
O02.1 Failed miscarriage.
O20.0 Threatened abortion

EPIDEMIOLOGY

Spontaneous abortion is the most common complication of pregnancy. Its frequency ranges from 10 to 20% of all clinically diagnosed pregnancies. About 80% of these losses occur before 12 weeks of gestation. When accounting for pregnancies by determining the level of hCG, the frequency of losses increases to 31%, with 70% of these abortions occurring before the moment when the pregnancy can be clinically recognized. In the structure of sporadic early miscarriages, 1/3 of pregnancies are interrupted before 8 weeks by the type of anembryonia.

CLASSIFICATION

Clinical manifestations are distinguished:

· Threatening abortion;
· Started abortion;
· Abortion in progress (complete and incomplete);
· NB.

The classification of spontaneous abortions, adopted by the WHO, is slightly different from that used in the Russian Federation, combining the miscarriage that has begun and the abortion in progress into one group - an inevitable abortion (i.e., the continuation of pregnancy is impossible).

ETIOLOGY

The leading factor in the etiology of spontaneous abortion is chromosomal pathology, the frequency of which reaches 82-88%.

The most common variants of chromosomal pathology in early spontaneous miscarriages are autosomal trisomies (52%), X monosomy (19%), polyploidy (22%). Other forms are noted in 7% of cases. In 80% of cases, death occurs first, and then the expulsion of the ovum.

The second most important etiological factor is metroendometritis of various etiologies, which causes inflammatory changes in the mucous membrane of the uterus and prevents normal implantation and development of the ovum. Chronic productive endometritis, more often of autoimmune genesis, was observed in 25% of so-called reproductively healthy women who terminated pregnancy by induced abortion, in 63.3% of women with recurrent miscarriage and in 100% of women with NB.

Among other causes of sporadic early miscarriages, anatomical, endocrine, infectious, immunological factors are distinguished, which to a greater extent serve as causes of habitual miscarriages.

RISK FACTORS

Age is one of the main risk factors in healthy women. According to the data obtained in the analysis of the outcomes of 1 million pregnancies, in the age group of women from 20 to 30 years, the risk of spontaneous abortion is 9-17%, at 35 years old - 20%, at 40 years old - 40%, at 45 years old - 80%.

Parity. Women with a history of two or more pregnancies have a higher risk of miscarriage than nulliparous women, and this risk does not depend on age.

History of spontaneous abortion. The risk of miscarriage increases with the number of such. In women with one history of spontaneous miscarriage, the risk is 18-20%, after two miscarriages it reaches 30%, after three miscarriages - 43%. For comparison: the risk of miscarriage in a woman whose previous pregnancy ended successfully is 5%.

Smoking. Consuming more than 10 cigarettes a day increases the risk of spontaneous abortion in the first trimester of pregnancy. These data are most revealing in the analysis of spontaneous abortion in women with a normal chromosome set.

The use of non-steroidal anti-inflammatory drugs in the period preceding conception. Data were obtained indicating the negative effect of inhibition of PG synthesis on the success of implantation. With the use of non-steroidal anti-inflammatory drugs in the period before conception and in the early stages of pregnancy, the frequency of miscarriages was 25% compared with 15% in women who did not receive drugs in this group.

Fever (hyperthermia). An increase in body temperature above 37.7 ° C leads to an increase in the frequency of early spontaneous abortions.

Trauma, including invasive methods of prenatal diagnosis (choriocentesis, amniocentesis, cordocentesis) - the risk is 3-5%.

Drinking caffeine. With a daily intake of more than 100 mg of caffeine (4-5 cups of coffee), the risk of early miscarriages significantly increases, and this trend is valid for a fetus with a normal karyotype.

Exposure to teratogens (infectious agents, toxic substances, drugs with teratogenic effects) is also a risk factor for spontaneous abortion.

Folic acid deficiency. When the concentration of folic acid in the blood serum is less than 2.19 ng / ml (4.9 nmol / l), the risk of spontaneous abortion significantly increases from 6 to 12 weeks of gestation, which is associated with a higher frequency of the formation of an abnormal karyotype of the fetus.

Hormonal disorders, thrombophilic conditions are more the causes of not sporadic, but habitual miscarriages, the main cause of which is the defective luteal phase.

According to numerous publications, from 12 to 25% of pregnancies after IVF end in spontaneous abortion.

CLINICAL PICTURE AND DIAGNOSTICS

Basically, patients complain of bloody discharge from the genital tract, pain in the lower abdomen and lower back with delayed menstruation.

Depending on the clinical symptoms, a threatening spontaneous abortion, started, abortion in progress (incomplete or complete), and NB are distinguished.

Threatened abortion is manifested by pulling pains in the lower abdomen and lower back, there may be scanty bleeding from the genital tract. The tone of the uterus is increased, the cervix is ​​not shortened, the internal pharynx is closed, the body of the uterus corresponds to the gestational age. With ultrasound, the fetal heartbeat is recorded.

With the onset of abortion, pain and bloody discharge from the vagina are more pronounced, the cervical canal is slightly open.

With an abortion in the course, regular cramping contractions of the myometrium are determined. The size of the uterus is less than the expected duration of pregnancy; in the later stages of pregnancy, OM may leak. The internal and external pharynx are open, the elements of the ovum are in the cervical canal or in the vagina. Bloody discharge can be of varying intensity, more often copious.

Incomplete abortion is a condition associated with a delay in the uterine cavity of the elements of the ovum.

The absence of a full contraction of the uterus and the closure of its cavity leads to ongoing bleeding, which in some cases is the cause of large blood loss and hypovolemic shock.

Most often, incomplete abortion is observed after 12 weeks of pregnancy in the case when the miscarriage begins with the outpouring of OS. With a bimanual examination, the uterus is less than the expected gestational age, bloody discharge from the cervical canal is abundant, with the help of ultrasound in the uterine cavity, the remains of the ovum are determined, in the second trimester - the remnants of placental tissue.

A complete abortion is more common in late pregnancy. The fertilized egg comes out completely from the uterine cavity.

The uterus contracts, the bleeding stops. In a bimanual examination, the uterus is well contoured, smaller than the gestational age, the cervical canal can be closed. With a complete miscarriage, a closed uterine cavity is determined using ultrasound. There may be slight spotting.

Infected abortion is a condition accompanied by fever, chills, malaise, pain in the lower abdomen, bloody, sometimes purulent discharge from the genital tract. During physical examination, tachycardia, tachypnea, defiance of the muscles of the anterior abdominal wall are determined, with bimanual examination - a painful, soft consistency of the uterus; the cervical canal is dilated.

With an infected abortion (with mixed bacterial viral infections and autoimmune disorders in women with habitual miscarriage, aggravated by antenatal fetal death by an obstetric history, recurrent course of genital infections), intravenous immunoglobulins (50-100 ml of 10% solution of gamimune 5% octagam) are prescribed and etc.). Extracorporeal therapy (plasmapheresis, cascade plasma filtration) is also carried out, which consists in physicochemical purification of the blood (removal of pathogenic autoantibodies and circulating immune complexes). The use of cascade plasma filtration implies detoxification without removing plasma. In the absence of treatment, generalization of the infection in the form of salpingitis, local or diffuse peritonitis, septicemia is possible.

Non-developing pregnancy (antenatal fetal death) - the death of an embryo or fetus during pregnancy less than 22 weeks in the absence of expulsion of elements of the ovum from the uterine cavity and often without signs of a threat of interruption. An ultrasound scan is performed to make a diagnosis. The tactics of termination of pregnancy are chosen depending on the gestational age. It should be noted that antenatal fetal death is often accompanied by disorders of the hemostasis system and infectious complications (see the chapter "Non-developing pregnancy").

In the diagnosis of bleeding and the development of management tactics in the first trimester of pregnancy, an assessment of the rate and volume of blood loss plays a decisive role.

With ultrasound, unfavorable signs in terms of the development of the ovum during uterine pregnancy are:

· Lack of heartbeat of an embryo with a CTE of more than 5 mm;

· The absence of an embryo with the size of the ovum measured in three orthogonal planes, more than 25 mm in transabdominal scanning and more than 18 mm in transvaginal scanning.

Additional ultrasound signs indicating an unfavorable pregnancy outcome include:

An abnormal yolk sac that does not correspond to the gestational age (more), irregularly shaped, shifted to the periphery or calcified;

· The heart rate of the embryo is less than 100 per minute in the period of 5-7 weeks;

· Large sizes of retrochorial hematoma (more than 25% of the surface of the ovum).

DIFFERENTIAL DIAGNOSTICS

Spontaneous abortion should be differentiated from benign and malignant diseases of the cervix or vagina. During pregnancy, bloody discharge from the ectropion is possible. To exclude diseases of the cervix, a careful examination in the mirrors is performed, if necessary, colposcopy and / or biopsy.

Bloody discharge during miscarriage is differentiated from those during the anovulatory cycle, which are often observed when menstruation is delayed. There are no symptoms of pregnancy, the test for the b-subunit of hCG is negative. On a bimanual examination, the uterus is of normal size, not softened, the cervix is ​​dense, not cyanotic. There may be a history of similar menstrual irregularities.

Differential diagnosis is also carried out with cystic drift and ectopic pregnancy.

With cystic drift, 50% of women may have a characteristic discharge in the form of bubbles; the uterus may be longer than the expected pregnancy. A typical picture with ultrasound.

With an ectopic pregnancy, women may complain of spotting, bilateral or generalized pain; fainting (hypovolemia), a feeling of pressure on the rectum or bladder, b-hCG test is not uncommon. On a bimanual examination, pain is noted when moving behind the cervix. The uterus is smaller than it should be during the expected pregnancy.

You can palpate a thickened fallopian tube, often bulging of the fornices. With an ultrasound in the fallopian tube, it is possible to determine the ovum, if it ruptures, detect an accumulation of blood in the abdominal cavity. To clarify the diagnosis, puncture of the abdominal cavity through the posterior fornix of the vagina or diagnostic laparoscopy is shown.

An example of a diagnosis formulation

Pregnancy 6 weeks. The incipient miscarriage.

OBJECTIVES OF TREATMENT

The goal of treatment for the threat of termination of pregnancy is to relax the uterus, stop bleeding and prolong pregnancy if there is a viable embryo or fetus in the uterus.

In the United States, Western European countries, a threatening miscarriage up to 12 weeks is not treated, considering that 80% of such miscarriages are "natural selection" (genetic defects, chromosomal aberrations).

In the Russian Federation, a different tactics for managing pregnant women with a threat of miscarriage is generally accepted. With this pathology, bed rest is prescribed (physical and sexual rest), a full diet, gestagens, methylxanthines, and as symptomatic treatment - antispasmodic drugs (suppositories with papaverine), herbal sedatives (motherwort decoction, valerian).

NON-MEDICINAL TREATMENT

Oligopeptides, polyunsaturated fatty acids must be included in the diet of a pregnant woman.

MEDICAL TREATMENT

Hormone therapy includes natural micronized at 200,300 mg / day (preferable) or dydrogesterone at 10 mg twice a day, vitamin E at 400 IU / day.

Drotaverin is prescribed for severe painful sensations intramuscularly at 40 mg (2 ml) 2-3 times a day, followed by a switch to oral administration from 3 to 6 tablets per day (40 mg in 1 tablet).

Methylxanthines - (7 mg / kg body weight per day). Suppositories with papaverine, 20-40 mg twice a day, are used rectally.

The approaches to the treatment of the threat of termination of pregnancy are fundamentally different in the Russian Federation and abroad. Most foreign authors insist on the inexpediency of maintaining pregnancy for a period of less than 12 weeks.

It should be noted that the effect of the use of any therapy - medication (antispasmodics, progesterone, magnesium preparations, etc.) and non-drug (protective mode) - has not been proven in randomized multicenter trials.

Prescribing for bloody discharge to pregnant women drugs that affect hemostasis (etamsylate, vikasol, tranexamic acid, aminocaproic acid and other drugs) has no basis and proven clinical effects due to the fact that bleeding during miscarriages is caused by detachment of the chorion (early placenta), rather than coagulation disorders. On the contrary, the doctor's task is to prevent blood loss leading to hemostasis disorders.

Upon admission to the hospital, a blood test should be carried out, the blood group and the belongingness should be determined.

With incomplete abortion, profuse bleeding is often observed, in which emergency assistance is necessary - immediate instrumental removal of the remnants of the ovum and curettage of the walls of the uterine cavity. Emptying the uterus is more gentle (vacuum aspiration is preferable).

Due to the fact that it can have an antidiuretic effect, after emptying the uterus and stopping bleeding, the administration of large doses of oxytocin should be discontinued.

During and after the operation, it is advisable to introduce intravenous isotonic sodium chloride solution with oxytocin (30 U per 1000 ml of solution) at a rate of 200 ml / h (in the early stages of pregnancy, the uterus is less sensitive to oxytocin). They also carry out antibiotic therapy, if necessary, treatment of post-hemorrhagic anemia. Women with Rh-negative blood are injected with anti-rhesus immunoglobulin.

It is advisable to monitor the state of the uterus by ultrasound.

With a complete abortion during pregnancy less than 14-16 weeks, it is advisable to carry out an ultrasound scan and, if necessary, curettage of the walls of the uterus, since there is a high probability of finding parts of the ovum and decidual tissue in the uterine cavity. At a later date, with a well-contracted uterus, curettage is not performed.

It is advisable to prescribe antibiotic therapy, treat anemia according to indications and administer anti-Rhesus immunoglobulin to women with Rh-negative blood.

SURGERY

Surgical treatment of NB is presented in the chapter "Non-developing pregnancy".

Postoperative management

In women with a history of PID (endometritis, salpingitis, oophoritis, tubo-ovarian abscess, pelvioperitonitis), antibiotic therapy should be continued for 5-7 days.

In Rh-negative women (during pregnancy from a re-positive partner), in the first 72 hours after vacuum aspiration or curettage during pregnancy over 7 weeks and in the absence of Rh-AT, Rh immunization is prevented by the administration of anti-Rhesus immunoglobulin at a dose of 300 μg (intramuscularly).

PREVENTION

There are no specific methods for preventing sporadic miscarriage. For the prevention of neural tube defects, which partially lead to early spontaneous abortions, it is recommended to prescribe folic acid 2-3 menstrual cycles before conception and in the first 12 weeks of pregnancy in a daily dose of 0.4 mg. If a woman has a history of fetal neural tube defects during previous pregnancies, the prophylactic dose should be increased to 4 mg / day.

PATIENT INFORMATION

Women should be informed about the need to consult a doctor during pregnancy if pain in the lower abdomen, lower back, or bleeding from the genital tract occurs.

FURTHER INTRODUCTION

After scraping the uterine cavity or vacuum aspiration, it is recommended to exclude the use of tampons and refrain from sexual intercourse for 2 weeks.

As a rule, the prognosis is favorable. After one spontaneous miscarriage, the risk of losing the next pregnancy increases slightly and reaches 18-20% compared to 15% in the absence of a history of miscarriages. In the presence of two consecutive spontaneous abortions of pregnancy, it is recommended to conduct an examination before the desired pregnancy to identify the causes of miscarriage in this married couple.

Sometimes a missed pregnancy is called a non-developing or regressing pregnancy (regression of pregnancy). Most often (in 70–80% of cases), pregnancy fading occurs in the first trimester (up to 12 weeks). Fading is most likely to occur at 7–8 weeks - during the laying of most of the vital organs in the body of the unborn child.

Symptoms of a frozen pregnancy

A frozen pregnancy may not show itself for some time and can only be determined by ultrasound, carried out in a planned manner.

A sign of a frozen pregnancy may be the disappearance of such subjective signs of pregnancy as nausea, drowsiness, etc., if the expectant mother noted them earlier. And for some, they are completely absent. Often the moment of death of the fetus is elusive. Symptoms of threatening miscarriage (bloody discharge, pulling pains in the lower abdomen or in the lumbar region) may be observed, however, the appearance of these symptoms does not always indicate the death of the embryo, therefore, with timely medical attention, it is likely that the pregnancy will be saved.

In the second trimester, a sign of pregnancy fading may be the cessation of fetal movement (during the first pregnancy, fetal movements are felt from 18–20 weeks, with repeated - from 16 weeks).

Frozen Pregnancy: Diagnosis

With a vaginal examination, which is carried out by a gynecologist, there is a discrepancy between the size of the uterus and the gestational age, that is, it is less than it should be at the time at which the examination is carried out. However, in some cases, if the fade occurred a few days ago, the uterus may be of normal size for a given gestational age.

Objective indicators are more valuable for diagnosing a frozen pregnancy:

The content of the hormone hCG in the blood(human chorionic gonadotropin is a pregnancy hormone that is produced by the chorion, the future placenta) - with a frozen pregnancy, its level sharply decreases relative to normal values ​​at a given gestational age. Pregnancy tests after "freezing" may remain positive for several days, and then begin to show a negative result (this is due to a gradual decrease in the level of hCG in the blood and urine).

Ultrasound does not determine the heartbeat and movement of the fetus. The embryo is smaller than it should be. An empty fertilized egg (anembryonia) may be detected. A woman can be referred for an ultrasound scan if a frozen pregnancy is suspected, or it can be detected during a planned ultrasound scan (the first scheduled ultrasound scan is 10-14 weeks).

Frozen Pregnancy: Causes

Genetic pathologies. This is the most common cause of early pregnancy fading. In 70% of cases, when pregnancy freezes, chromosomal abnormalities (changes in the number or structure of chromosomes) are recorded in the fetus. Most of the chromosomal abnormalities in the fetus are incompatible with live birth, as it leads to multiple malformations of various organs and systems of the fetus, therefore, a fetus with an altered set of chromosomes most often dies in utero, that is, pregnancy dies. Thus, one might say, "natural selection" is carried out.

The genetic pathology of the fetus can be "accidental", that is, arising only during this pregnancy due to some harmful effect, without which everything would be normal. Usually, any harmful factor that acts in the early period causes damage to the fetus of the "all or nothing" type, that is, either the factor does not affect the development of the fetus at all, or causes a pathology that is incompatible with life, and the pregnancy fades. Unfortunately, the number of harmful factors that surround us is quite large, and the likelihood of encountering them is quite high. These include environmental factors, radiation, unhealthy diet, bad habits (smoking, drinking alcohol, drugs), contacts with household chemicals, the influence of drugs, a deficiency of essential vitamins and minerals.

In the overwhelming majority of cases, nature protects the unborn baby, but sometimes this protection does not work. Most often, doctors are unable to determine what exactly harmed this pregnancy. But the risk of a recurrence of failure in this case is minimal, since newly arisen genetic breakdowns (not received from the parents) are quite rare, and the likelihood that this "accident" will repeat itself is small. However, sometimes a child can get a genetic "breakdown" from a parent. For example, in one of the parents, a section of one chromosome can "cling" to another, the total amount of genetic material (chromosomes) is not changed and the person is healthy. But only one of these chromosomes can be transferred to the fetus, as a result of which it will either have an excess or lack of genetic material, which can lead to its death.

In addition, a "breakdown" can occur in the "predisposition genes" for miscarriage. This group includes, for example, genes for thrombophilia (increased blood clotting): their carriage can lead to the formation of microthrombi at the site of attachment of the ovum to the uterine wall, malnutrition of the embryo and its death. Also, the risk of miscarriage is increased by mutations in the "environmental genes" (this is a group of genes responsible for the production of enzymes that remove from the body toxic substances that have entered the body from the environment), since the body's resistance to harmful factors decreases. Mutations in these and other "predisposition genes" are not a sentence and are not considered a pathology, but they increase the risk of pregnancy fading. Environmental factors and a woman's lifestyle play a large role in whether a genetic predisposition to miscarriage is realized. For example, the risk that an unfavorable mutation (“breakdown”) in thrombophilia genes is realized is significantly increased by smoking.

Infections. The greatest danger to the fetus is represented by infections, mostly viral, especially if the mother met this disease during pregnancy for the first time. We list the infections that are most dangerous for the fetus and often lead to its death or malformations:

• toxoplasmosis;
• rubella;
• cytomegalovirus;
• herpes.

Some viruses (for example, herpes, cytomegalovirus) remain in the body for life after infection. Chronic infection is much less dangerous for the fetus than primary infection during pregnancy, but its exacerbation while waiting for the baby can in some cases lead to an unfavorable outcome.

Sexually transmitted infections (urealpasma, mycoplasma, chlamydia), other infections that cause inflammation in the genital tract, as well as the presence of foci of chronic infection in the body (chronic diseases of the digestive, respiratory, urinary system, carious teeth, etc.) increase the risk of pregnancy fading. etc.). In some cases, colds and flu in the early stages can also be the cause of pregnancy fading.

The infection leads to fetal death through several mechanisms. First, the microorganism can have a direct effect on the fetus, entering its body through the placenta. Secondly, in the presence of an infection in the body of a pregnant woman, biologically active substances are produced that can have a toxic effect on the fetus or disrupt the blood flow in the area of ​​the ovum and lead to a disruption in the supply of nutrients and oxygen to the fetus. Thirdly, due to a chronic inflammatory process in the uterus, the normal attachment of the ovum and its nutrition may be disrupted.

Hormonal Disorders. Most often, when pregnancy fades, female and male sex hormones, as well as thyroid hormones, play an important role.

The most important thing during pregnancy is a normal level of the hormone progesterone. It is called the "pregnancy hormone" because it is essential for the normal course of pregnancy. Low progesterone levels are one of the common causes of miscarriage.

Thyroid hormones play an important role. The cause of fetal death can be either an excess or a lack of these hormones.

An increase in male sex hormones is also a common cause of pregnancy fading.

Autoimmune disorders. Autoimmune processes are called processes when antibodies are formed by the immune system not to foreign agents (bacteria and viruses), but to the body's own cells. During pregnancy, these antibodies can also infect a fetus that is half the size of the mother's body, which leads to its death.

Quite often, the cause of repeated dying pregnancies is antiphospholipid syndrome(AFS). In this condition, antibodies are formed to their own phospholipids - substances that are involved in the formation of cell walls. Before pregnancy, this syndrome may not manifest itself in any way. APS can be suspected with repeated dying pregnancies. The examination includes both an analysis specifically for markers of APS, and an analysis for blood coagulability (with APS, blood clotting increases, which leads to the formation of microthrombi, including in the vessels of the placenta, which leads to a disruption in the supply of oxygen and nutrients to the fetus, and in the absence of treatment - to his death).

Another fairly common autoimmune disease is autoimmune thyroiditis.

This is a disease in which antibodies are formed against the cells of the thyroid gland, as a result of which its function and the level of hormones that it produces are disrupted. And with a lack of thyroid hormones, fetal death is possible.

Wrong way of life. Bad habits during pregnancy are by no means harmless. Toxic substances in tobacco smoke and alcohol can lead to fetal death.

In some cases, harmful working conditions (for example, radiation, vibration, etc.) can be the cause of pregnancy fading.

What the doctor will do

Upon detection of fetal death, the woman is hospitalized in the department of gynecology of the hospital.

The ovum is removed from the uterine cavity by scraping it or vacuum aspiration (removal of the contents of the uterine cavity using vacuum suction). This procedure is performed under general anesthesia (intravenous anesthesia). Spontaneous miscarriage is not expected, since the toxic decay products of the dead ovum "poison" the mother's body, cause disruption of blood coagulation processes, and can lead to infectious complications (decaying fetal tissue is a good breeding ground for pathogenic microbes).

Fetal tissues obtained by scraping or aspiration are always sent for histological examination (examination of the material under a microscope), and this is not additionally paid by the patient. In some cases, this study helps to identify the cause of the pregnancy fading. For example, a histological examination can reveal changes characteristic of an infectious process in the uterine cavity. The result of histological examination is usually ready in 1–2 weeks.

In some cases, the material is sent for genetic research - the karyotype (the number and structure of chromosomes). In this case, the chromosome set of the fetus is determined.

Submission of material for genetic research is carried out most often in case of repeated cases of pregnancy fading; most often this research is paid. The doctor and the patient discuss the possibility of sending material for genetic testing in advance before the operation. The result of genetic research is ready in 2 weeks on average.

However, a miscarriage can occur on its own, even before it has been established that the pregnancy has stopped. In this case, it is imperative to do an ultrasound scan in order to exclude the delay of parts of the ovum in the uterus, and if they are detected, undergo an operation to scrap the uterine cavity.

When pregnancy fades in the second trimester, an artificial late miscarriage is performed. With the help of medicines, the contractile activity of the uterus is caused and fruiting occurs.

How is this dangerous condition recognized and can it be avoided?

Frozen pregnancy: prevention and prognosis

In 80–90?% Of cases, after one frozen pregnancy, women normally carry a subsequent pregnancy and give birth to a healthy child. However, if there are two freezes in a row, then in the next pregnancy the risk of freezing will be 40%, and if three, then 60%.

It is recommended to plan the next pregnancy no earlier than six months after the dead one. This time is necessary to fully recover the uterine lining (endometrium) and hormones in the body after a failed pregnancy. During this period, it is recommended to take hormonal contraceptives, as they not only have a contraceptive effect, but also help the body recover from hormonal stress, regulate the ovaries and restore the menstrual cycle.

When planning the next pregnancy, it is imperative to contact an obstetrician-gynecologist so that he can schedule an examination to establish the cause of the pregnancy fading and the woman's health status and, if necessary, therapeutic and prophylactic drugs. Before pregnancy, it is imperative to identify and treat infectious diseases. With a chronic infection, it is worth taking care of the state of immunity so that an exacerbation does not occur during pregnancy.

During the planning period for the next pregnancy, it is important to eat right, get the required amount of vitamins (with food or in the form of multivitamin complexes), and lead a healthy lifestyle. This will help the body to protect the baby from negative environmental influences during pregnancy. It is also highly recommended to give up bad habits.

Without a doubt, a frozen pregnancy is a psychological trauma, so if a woman is tormented by obsessive thoughts that she will not be able to have children at all, if she is setting herself up for failure, she should turn to a psychotherapist or perinatal psychologist.

More than 20% of pregnancies end in fetal freezing. To prevent this, you need to know exactly the main factors affecting the arrest of the development of the embryo. Eliminating them increases the chances of carrying and giving birth to a healthy baby.

Not every pregnancy ends with the birth of a child. There are cases in the early stages. Freezing can occur due to a number of factors. Therefore, during the planning period, each future parent must undergo a complete examination to prevent such situations.

Fading pregnancy is possible at any time up to 28 weeks. This most often occurs in the early stages up to 12-13 weeks. It is at this time that the fetus begins to actively develop, and is most susceptible to the influence of external factors.

Why are there chromosomal and genetic abnormalities?

Chromosomal and genetic abnormalities are the main causes of pregnancy fading. A fetus that has received an extra set of chromosomes or a damaged gene is not capable of normal growth and, during development, acquires many defects that are incompatible with life. At this moment, the woman's body independently identifies an unviable fetus and gets rid of it by means of stopping development.

Such anomalies can be obtained from both parents and acquired under the influence of external factors. During pregnancy planning, both parents should lead a healthy lifestyle and take care of their body.

If pregnancy fading occurs repeatedly, then you should consult a doctor, since the reason may lie in the incompatibility of the genetic codes of the parents.

What causes hormonal disorders

Often, a lack of progesterone affects pregnancy termination. This is due to the impossibility of its normal development. The following factors mainly affect the production of progesterone:

• previously transferred abortion;
• various diseases of the reproductive system;
• diseases of the genitourinary system;
• persistent menstrual irregularities;
• a long course of treatment with medications;
• oncological diseases;
• unhealthy and inactive lifestyle;
• constant being in a state of stress.

If the level of male hormones in the blood of the mother exceeds the norm, then this can also provoke freezing of development.

At the planning stage, doctors recommend that a woman undergo a complete examination for hormones, and, if necessary, conduct a course of treatment and restore hormonal levels.

Infections

During the period of bearing a child, every woman should carefully monitor her health. Indeed, it is during this period that the immune system is weakened more than usual. In this regard, both old and new diseases can begin to actively manifest themselves. Particularly dangerous are: rubella, toxoplasmosis, cytomegalovirus and a number of sexually transmitted diseases. Colds are no less dangerous, because under their influence the mother's body is completely depleted and is aimed only at fighting infection, and not at maintaining pregnancy.

Any infection can penetrate directly into the embryo itself and cause malformations or block the access of oxygen and nutrients to it, which leads to inevitable death of the fetus.

This disease causes the occurrence of various pathologies in sperm. Fertilization is often impossible because sperm cells are unable to move quickly due to the abnormal structure of the tail. If it happens, then the egg is fertilized by a sperm with an irregular head structure, which also negatively affects the fetus.

Wrong way of life

The state of the unborn child directly depends on the woman's lifestyle. During pregnancy, the body is significantly weakened. Therefore, every woman needs to reconsider her daily routine, remove harmful foods used in food, give up and spend more time in the fresh air. It is worth remembering that a lack of movement leads to poor child development, but excessive loads can also cause great damage.

Autoimmune pathology

With autoimmune abnormalities, pregnancy fading occurs due to the fact that the antibodies contained in the woman's body begin to attack not foreign, but her own cells, which are also contained in the embryo itself.

Other factors

External factors can also affect a woman's body, including constant stress, poor ecology, and previous abortions. For the normal course of pregnancy, the expectant mother must take care of the state of her body, as well as emotional balance.

Symptoms of a missed pregnancy

Often the fading of pregnancy does not make itself felt for a very long time and this pathology can only be detected after an ultrasound scan. However, after freezing, small changes occur in the body, which are accompanied by the following symptoms:

• abrupt cessation of nausea, vomiting, drowsiness and feelings of fatigue;
• decrease in basal temperature;
• restoration of breast softness;
• slight pains of a pulling character and discharge with blood particles.

Unfortunately, a frozen pregnancy does not have pronounced symptoms, so it is almost impossible to detect it on your own.

Effects

If, during a frozen pregnancy, a spontaneous miscarriage does not occur, then a cleaning is carried out, which is comparable to an abortion in a normal pregnancy. Therefore, the consequences can be the same:

• infection due to the long presence of a dead embryo in the mother's body or during the scraping procedure itself;
• damage to uterine tissue due to mechanical stress;
• infertility. It usually occurs in women with chronic inflammation in the uterus.

If the entire procedure for removing dead tissue was carried out in compliance with all the rules and regulations, the woman underwent a full course of treatment, then the occurrence of negative consequences is almost impossible.

Forecast for the next pregnancy

You can avoid the recurrence of a frozen pregnancy. For this you need:

• eliminate all the causes that initially caused the fetal development to stop;
• constantly visit the gynecologist;
• undergo a full examination;
• to refuse from bad habits;
• taking medications to a minimum.

Compliance with these rules will help to avoid STs in the future. It is best to consult a doctor who will be able to individually select the treatment for and planning a pregnancy.

Pregnancy after a frozen pregnancy

Re-pregnancy is possible only after half a year - a year. During this period, you need to pay special attention to your body, let it fully recover and go through the entire course of treatment.

If the body cannot recover to the end, then the threat of pregnancy fading may arise again.

Prophylaxis

To prevent fetal freezing, certain preventive measures must be followed even before the onset of the pregnancy itself.

It is necessary to avoid getting into the body of various infections. If infection does occur, then the infection must be completely eliminated. You should lead a correct lifestyle, monitor your diet, daily routine, physical activity. It is very important to give up addictions.

For the best result, preventive measures should be followed by two future parents at once. This will increase the chances of pregnancy and the normal course of pregnancy.

If you find a frozen pregnancy, do not despair and get depressed. Almost all women who have lost a child in the early stages during their first pregnancy are capable of having a healthy baby in the future. To do this, you need to pay great attention to your body and focus on the process of its recovery.

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Often in the early stages of pregnancy (up to 28 weeks), the fetus freezes, that is, its further development for some reason stops. According to statistics, this pathology occurs 1 time in 176 cases.

A frozen pregnancy is the death of an embryo, which is surgically removed from the womb as quickly as possible so that the inflammatory process does not start. Most often, with the timely detection of a frozen fetus, the operation takes place without complications. So that carrying a baby does not end in such a deplorable way, you need to know the reasons that can lead to this.

The fetus may stop forming at any stage of pregnancy, but in the first weeks (up to the 28th) this condition is called fading, and after that it is called death. A wide variety of circumstances and factors become the causes of a frozen pregnancy:

• genetic disorders;
• the woman's immune system can mistake the fetus for a hostile body and kill it;
• exacerbation of infections;
• bad habits: alcohol, drugs, smoking;
• taking strong medications (antibiotics or antidepressants);
• external factors: climate change, a sharp drop in temperature, air travel, radioactive radiation, lifting weights, prolonged exposure to the sun, visiting a solarium;
• severe stress.

Often, doctors cannot say for sure what exactly caused the fetal freezing. Whatever provoked a stop in its development, in any case, it is necessary to recognize the pathology as soon as possible so that inflammatory processes do not begin due to the decomposition of the dead embryo in the womb. To prevent this, you need to know how to determine a frozen pregnancy at its different stages.

The symptoms of this pathology differ significantly from each other at different stages of pregnancy.

In the early stages

The first signs of a frozen fetus in the early stages are difficult for a woman to determine on her own, since they are hidden.

• The mammary glands stop swelling, pain in the chest disappears;
• if there was toxicosis, it stops;
• the woman gets tired very quickly, feels bad;
• basal temperature decreases.

An accurate diagnosis can only be made by a doctor after specific examinations. The obligatory analysis for hCG shows that the hCG level either fell or stopped growing, which is one of the indicators of a frozen pregnancy. An ultrasound scan determines that there is no dynamics of fetal development. Sometimes an ultrasound scan reveals that the ovum does not contain an embryo - this condition is called anembryony.

At a later date

If we talk about the signs of fetal fading (death) in late pregnancy, then they are already more obvious, so the child by this time is already moving, and his organs are actively functioning.

• The movements of the fetus in the womb stop, the woman ceases to feel them;
• the mammary glands become soft;
• weakness and malaise at this stage of pregnancy are felt much stronger than in the first trimester;
• the feeling of heaviness in the lower abdomen increases;
• toxicosis disappears;
• appetite increases if it was not there before (and vice versa).

When you go to the doctor, an analysis is performed for hCG and ultrasound, as in the early stages of pregnancy. At whatever stage the fetal freeze occurs, for a woman it becomes a real tragedy, which is why it is so important to be able to prevent such a pathology.

How to prevent fading

To prevent a frozen pregnancy, it is necessary, if possible, to eliminate those factors that can provoke it. You can prevent fetal freezing by taking a number of preventive measures.

1. You need to regularly visit the gynecologist, without missing a single appointment.
2. Both parents need to be screened for genetic abnormalities.
3. A pregnant woman needs to avoid infectious diseases, strengthen the immune system in every possible way, drink vitamin complexes, breathe fresh air, and not come into contact with possible sources of infections.
4. It is strictly forbidden to smoke, drink alcoholic and energy drinks and use drugs.
5. Any medications can only be taken as directed by your doctor. If possible, you should avoid the use of potent antidepressants and.
6. At the time of carrying a child, it is better to refuse long trips and air travel.
7. Eliminate prolonged exposure to the sun. Solarium and saunas are also not the best places for a woman expecting a baby.
8. Staying calm, not getting nervous, relieving yourself of worries - all this will contribute to the normal course of pregnancy and reduce the risk of fetal freezing.

If fetal freezing is still diagnosed, do not despair. Most often this happens due to a genetic error, and the likelihood of its recurrence is negligible. Subject to a healthy lifestyle by both parents, the possibility of pregnancy fading a second time will not threaten you.