Failed miscarriage or frozen pregnancy. Diagnosis of failed miscarriage. Who is in the risk group

What is a failed miscarriageFailed miscarriage- A condition in which a fruit egg at any time of gestation (from 0 to 28 weeks), due to unexplained reasons, ceases further development, but, without rejecting, resorption is subjected to resorption, passing the "blood", "fleshy" and "rocky drift" stage (Latonedion ). Analogue is the failed delivery after 28 weeks of gestation. Aggressive factor - fabric thromboplastin of a fetal egg. It determines the coagulopathy of consumption (DVS syndrome) and blood loss with spontaneous or initiated miscarriage

What provokes a failed miscarriage:

The reasons for the failed miscarriage are diverse.
Most often, according to statistics, the fetal death is guilty of infection (chlamydia, mycoplasma, ureaplasma (although the role of mycoplasm and ureaplasm is doubtful)), bacterial infections (gonorrhea, streptococcus), viral infections.

Next go genetic reasonsthat ensure the inferiority of the product of conception and its spontaneous exile due to non-viability. It may be new-forming mutations when merging the nuclei of sperm and ochocite, and there may be hidden mutations transmitted from the father or mother.

Infliction of the embryo may also be a consequence violations of embryogenesis Due to the impact on the fruit of toxic substances, transferred acute infections and other factors.

An important role is played endocrine reasons. Thus, the lack of progesterone can lead to ischemic phenomena in endometrials and as a result, to its rejection along with a fruit egg.

The immune (rhesus conflict, antibodies against hCG) and autoimnoy (antiphospholipid syndrome, etc.) remain relatively rare.

Miscarriages may also be associated with eastic Cervical Insufficiency (The weak cervix can not keep the fruit in the uterine cavity), Mioma of the uterus (myomatous node deforms a fetal egg, does not allow him to fully fix it), anomalies of the uterus (Curry uterus, saddot uterus, infatiant).

Violations in blood clotting system may affect pregnancy at the stage of formation of the placenta. Too viscous blood quickly thrombles the vessels of the placenta, which is why the blood flow in the system of the mother-placenta-fruit is stopped and the fetus death occurs.

Long stressful impact The mother's body can also cause spontaneous abortion and frozen pregnancy.

Pathogenesis (what happens?) During the failed miscarriage

The pathogenesis of the failed miscarriage is associated with violations of the regulatory functions of the cerebral cortex, a decrease in the body of a pregnant number of estrogenic hormones, a decrease in the excitability of the uterine muscles on the soil of the uterine hypoplasia, the presence of inflammatory processes in it

Symptoms of failed miscarriage

The fetal egg dies in the uterus and continues to remain in it, there are grapple-shaped pain at the bottom of the abdomen, from the genital paths - blood selections. Soon these phenomena are reduced and then completely stopped. There is a cessation of the growth of the uterus, a decrease in its size. Sometimes the dead eagle, long-term in the uterus, is destroyed and at the same time impregnated with blood, the so-called blood skid is formed. After some time, suction of the liquid blood is absorbed, the blood pigment - hemoglobin leaches and discolored, the color of the bunch becomes yellowish-red, reminiscent of meat, is a meaty drift. In rare cases, there is a deposit in the drift of lime salts, and it becomes rocky (lithopedion).

Diagnostics of the failed miscarriage:

The diagnosis is justified by the bleeded bleeding in a woman who knew about pregnancy, with a volume of uterus, not corresponding to the duration of gestational amenorrhea (less expected). The history of pregnant women can be angularity paroxysms shortly before the start of bleeding and episodes of abortion threats that coincide with the date of the fetal death.
The failed miscarriage is an indication for emergency hospitalization in an obstetric and gynecological hospital.

With the help of an ultrasound study, you can define an empty fruit egg (underdeveloped pregnancy). This means that inside the fruit egg is not visible a living embryo (he developed incorrectly or lost viability), and the woman's body did not respond to these changes and did not lead to spontaneous miscarriage

Treatment of failed miscarriage:

Treatment is usually started with intravenous heparin administration at a dose of 20 - 30 units / kg, which is sufficient to interrupt the intravascular blood coagulation for the period of transportation. In addition, 50000 units of contrikala, inhibiting plasmin activity, intravenously injected. It is advisable to use eformzilate (dicinone) - 2-4 ml of 12.5% \u200b\u200bof the solution intravenously or intramuscularly. Then the fetal egg is removed and surgical hemostasis in a specialized hospital with a resuscitation department.

Exile of a frozen embryo- This is only a matter of time, and in such a situation it is better not to wait for the occurrence of bleeding, but to refer to the procedure called the scanning (cleaning) of the uterus. Usually cleaning the uterus, lasting a few minutes, is performed by a physician-gynecologist of the hospital, the patient is under general anesthesia. The procedure is careful, but careful purification of the uterine cavity using special tools. Careful purification of the uterus contributes to its reduction, which prevents bleeding and infection after miscarriage.

Sometimes with a prophylactic goal after the mini-operation, an antibiotic is discharged.

It is also possible to pharmacological purification of the uterine cavity using prostaglandin - a hormonal drug leading to the cuts of the uterus and the neck opening it. However, this agent is not used very often, since it is not always highly efficient.

Prevention of failed miscarriage:

It is necessary to take care of yourself from the very beginning of pregnancy: do not smoke, do not drink alcoholic beverages, eat well and not overwork.
- When bleeding or pain in the bottom of the abdomen immediately consult a doctor.
- If the pain is strong or bleeding abundant, you should not eat or drink, you must contact the nearest hospital.
- If there has been the selection of any tissues from the generic paths, take them with you and transfer the doctor for a mandatory study.

Sometimes a frasonal pregnancy is called undivided, or regressing pregnancy (regress of pregnancy). Most often (in 70-80?% Of cases) Failure to pregnancy occurs in the first trimester (up to 12 weeks). Most likely, the fading may occur at 7-8 weeks - during the laying of most vital organs in the body of the future child.

Symptoms of frozen pregnancy

A frozen pregnancy can no longer manifest itself and determined only by ultrasound, conducted in a planned manner.

A sign of frozen pregnancy can be the disappearance of such subjective signs of pregnancy, as nausea, drowsiness, etc., if the future mother march them. And some they are missing at all. Often the moment of the death of the fetus is no longer. There may be symptoms of threatening miscarriage (bleeding, pulling pain in the lower parts of the abdomen or in the zone area), but the appearance of these symptoms does not always indicate the death of the embryo, so there is a possibility that pregnancy will be able to save.

In the second trimester, a sign of the pregnancy of pregnancy can be the cessation of the movement of the fetus (during the first pregnancy, the movement of the fetus is felt from 18-20 weeks, with a repeated - from 16 weeks).

Measuring Pregnancy: Diagnostics

With a vaginal study, which conducts a gynecologist, there is a non-compliance of the size of the uterus. The term of pregnancy is observed, that is, it is smaller than it should be on the period that is inspected. However, in some cases, if the fading occurred a few days ago, the uterus can be of normal sizes for this period of pregnancy.

More valuable for the diagnosis of frozen pregnancy Objective indicators:

Contents in blood hormone hgch (human chorionic gonadotropin - pregnancy hormone, which is produced by chorion, future placenta) - when measuring pregnancy, its level is dramatically reduced relative to normal values \u200b\u200bat a given period of pregnancy. Pregnancy tests After the "Ferrence" 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).

Ultrasounds are not determined by heartbeat and moving fetus.Embryo size is less than it should be. An empty fetal egg (anembonium) can be revealed. On the ultrasound, a woman can be directed when a frasonal pregnancy can be suspected, or it can be revealed with a scheduled conduct of an ultrasound (the term of the first planned ultrasound - 10-14 weeks).

Measuring Pregnancy: Causes

Genetic pathologies.This is the most common cause of the pregnancy of early last periods. In 70?% Of cases during pregnancy, chromosomal anomalies are recorded in the fetus (change in the amount or structure of chromosomes). Most chromosomal abnormalities in the fetus are incompatible with livingborn, as it leads to multiple defects for the development of various organs and fetal systems, so the fruit with a changed set of chromosomes most often dies intrauterine, that is, a pregnancy is fading. Thus, it can be said, "Natural selection" is carried out.

The genetic pathology of the fetus may be "random", that is, which occurred only in this pregnancy because of some harmful effect, without which everything would be fine. Usually, any harmful factor impassing in an early term causes damage to the fetus by the type "All or nothing", that is, either the factor does not affect the development of the fetus, or causes pathology incompatible with life, and a pregnancy is fading. Unfortunately, the number of harmful factors surrounding us is quite large, and the likelihood of a collision with them is quite large. It can include environmental factors, radiation, improper nutrition, harmful habits (smoking, drinking alcohol, narcotic substances), contacts with household chemicals, the influence of drugs, the deficit of the necessary vitamins and mineral substances.

In the overwhelming majority of cases, nature protects the future baby, but sometimes this protection does not work. Most often doctors fail to determine what specifically hurt this pregnancy. But the risk of repeating failures in this case is minimal, since the newly emerged genetic breakdowns (not received from the parents) are quite rare, and the likelihood that this "chance" will repeat, is small. However, sometimes a child can get a genetic "breakdown" from parents. For example, at one of the parents, a plot of one chromosome can "clutch" to another, the total number of genetic material (chromosomes) is not changed and the person is well. But only one of these chromosomes can be transferred to the fetus, with the result that it will have either an excess, or a lack of genetic material, which can lead to his death.

In addition, the "breakdown" may arise in the "predisposition genes" to unbearab pregnancy. This group includes, for example, thrombophilia genes (increased blood clotting): Their carriage can lead to the formation of microtrombov at the site of attaching the fetal egg to the wall of the uterus, the nutrition of the nutrition and its death. Also increase the risk of non-pregnancy of mutation in the "Environment genes" (this is a group of genes responsible for the production of enzymes, which are removed from the body toxic substances that have fallen into the body from the environment), since the resistance of the body is reduced to the effects of harmful factors. Mutations in these and other "predisposition genes" are not a sentence and are not considered pathology, but increase the risk of pregnancy. A large role is whether the genetic predisposition is being implemented, environmental factors and women's lifestyle play. For example, the risk that adverse mutation ("breakdown") is being implemented in thrombophilia genes, significantly rises during smoking.

Infections. The greatest danger to the fetus are infections, mostly viral, especially if the mother met with this disease during pregnancy for the first time. We list infections, the most dangerous to the fetus and often leading to its death or developmental deposits:

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

Some viruses (for example, herpes, cytomegalovirus) after infection are in the body for life. Chronic infection is significantly less dangerous for the fetus than primary infection during pregnancy, but its exacerbation during the expectation of the baby may in some cases lead to an unfavorable outcome.

Increase the risk of pregnancy for pregnancy infection transmitted by sexual means (urealpasm, mycoplasma, chlamydia), other infections that cause inflammatory processes in the genital paths, as well as the presence of foci of chronic infection in the body (chronic diseases of the digestive, respiratory, urinary system, carious teeth, etc. d.). Frequent diseases and flu in early terms in some cases may also be the cause of pregnancy.

The infection leads to the death of the fetus as a result of several mechanisms. First, the microorganism can have a direct impact on the fruit, penetrating into its body through the placenta. Secondly, in the presence of infection in the body of pregnant women, biologically active substances are produced, which can have a toxic effect on the fruit or disrupt the blood flow in the field of the fruit egg and lead to a violation of nutrients and oxygen to the fetus. Thirdly, due to the chronic inflammatory process in the uterus, the normal attachment of the fetal egg and its nutrition may violate.

Hormonal disorders. Most often, during pregnancy, women's and men's sex hormones play a big role, as well as thyroid hormones.

The most important during pregnancy is the normal level of hormone progesterone. It is called "a hormone of pregnancy", as it is necessary for its normal flow. The low level of progesterone is one of the frequent causes of non-pending pregnancy.

The hormones of the thyroid gland play an important role. The cause of the death of the fetus can be both an excess and disadvantage of these hormones.

The increase in male genital hormones is also the reason for the pregnancy of pregnancy.

Autoimmune violations.The autoimmunes are called processes when antibodies are formed by the immune system not to alien agents (bacteria and viruses), but to their own cells of the body. These antibodies during pregnancy can affect both the fruit, half a similar to the mother's organism, which leads to his death.

Quite often the cause of re-serve pregnancies is antiphospholipid syndrome (AFS). At the same time, the state of the 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. Substitute AFS can be used in re-serve pregnancies. The examination includes both the analysis specifically on APS markers and blood clotting (at APS, blood coagulation increases, which leads to the formation of microtrombov, including in the placenta vessels, which leads to a violation of the oxygen and nutrient proceeds, and In the absence of treatment - to his death).

Another rather common autoimmune disease is autoimmune thyroiditis.

This disease in which antibodies are formed to cells of their own thyroid gland, resulting in its function and the level of hormones that it produces is disturbed. And with a lack of hormones of the thyroid gland, the fetus death is possible.

Wrong lifestyle. Harmful habits during pregnancy are not harmless. Toxic substances contained in tobacco smoke, and alcohol can lead to fetal death.

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

What a doctor will do

If the fetal death is detected, the woman is hospitalized into the hospital gynecology separation.

It is removed from the fetal egg from the uterus by scraping or vacuum aspiration (removing the contents of the uterine cavity using vacuum suction). This procedure is performed under general anesthesia (intravenous anesthesia). The spontaneous miscarriage does not expect, since the toxic foods of the decay of the deceased fruit egg "poison" the maternal organism cause a violation of blood coagulation processes, can lead to infectious complications (destroyable fetal tissue - a good medium for breeding pathogenic microbes).

The fetus fabrics obtained during scanning or aspiration are always sent to histological examination (testing of the material under the microscope), and this is not additionally paid by the patient. In some cases, this study helps to identify the cause of pregnancy. For example, with histological examination, changes that are characteristic of the infectious process in the uterine cavity can be revealed. The result of histological research is usually ready after 1-2 weeks.

In some cases, the material is sent to a genetic study - karyotype (quantity and structure of chromosomes). This determines the chromosomal set of the fetus.

Sending a material on a genetic study is most often done with repeated cases of pregnancy; Most often this study is paid. The possibility of sending material to a genetic study doctor and the patient are discussed in advance before the operation. The result of a genetic study is ready on average after 2 weeks.

However, the miscarriage can occur independently, even before it was found that the pregnancy froze. In this case, it is necessary to do an ultrasound to eliminate the delay in the parts of the fetal egg in the uterus, and when they are detected, it is discovered to pass an operation on the scattering of the uterine cavity.

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

How to recognize this dangerous condition and can it be avoided?

Measuring Pregnancy: Prevention and Forecast

In 80-90?% Of cases after one frozen pregnancy, women normally hatch the subsequent pregnancy and give birth to a healthy child. However, if there were two fools in a row, then the next pregnancy risk of its fading will be 40?%, And if three, then 60?%.

Plan the next pregnancy is recommended no earlier than six months after frozen. This time is necessary that the mucous membrane of the uterus (endometrium) and hormonal background in the body after failed pregnancy are fully recovered. During this period, hormonal contraceptives are recommended, as they not only have a contraceptive effect, but also help the body recover after hormonal stress, regulate the work of the ovaries and restore the menstrual cycle.

When planning the next pregnancy, it is necessary to contact the Akuster-Gynecologist so that he appoints a survey to establish the cause of the pregnancy and the health of the woman and, if necessary, therapeutic and preventive drugs. Before pregnancy, it is necessary to identify and treat infectious diseases. In a chronic infection, it is worth taking care of the state of immunity so that during pregnancy does not exacerbate.

In the period of planning the next pregnancy, it is important to eat properly, to obtain the required amount of vitamins (with food or in the form of multivitamine complexes), lead a healthy lifestyle. This will help the body during pregnancy to protect the baby from negative environmental impacts. It is also strongly recommended to abandon bad habits.

Without a doubt, a frozen pregnancy is psychological trauma, so if a woman is tormented by obsessive thoughts that she will not be able to have children at all, if she sets himself to fail - she should turn to a psychotherapist or a perinatal psychologist.

Unbearable pregnancy - pathology, in which the fruit ceases to develop and die.
Another name of this pathology is measuring pregnancy.
Its variety is an empty fruit egg. In this case, the fertilization of the egg is normally normally, but then the embryo does not develop.

Specialists still cannot call the exact causes of frozen pregnancy; In early dates, as a rule, these are serious genetic disorders in the embryo (in 70% of cases).

At the later deadlines, a frozen pregnancy (the second trimester and later) can be provoked by the infectious diseases of the woman, traumatic influences, etc.

However, there are cases when pregnancy freezes without any visible reasons; A woman may have two frozen pregnancy and 3 frozen pregnancy.

But you should not despair! Just as a spontaneous conception may occur after unsuccessful treatment of infertility, it can also be pregnant after frozen pregnancy.

Causes of frozen pregnancy

In the early periods (and during the period of pregnancy), the reasons for the development of pathology may be the following:

• use of nicotine and alcohol;
• the use of a number of drugs;
• infectious diseases (flu, cytomegalovirus; especially dangerous rubella);
• STD (gonorrhea, syphilis, mycoplasmosis, etc.);
• diabetes;
• violation of hormonal balance (lack of progesterone or estrogen);
• the drill immune response of the mother's body (in this case, the embryo proteins are perceived as alien, and there is an immune attack on them);
• antiphosobolipid syndrome (the formation of blood clots in the placenta vessels, as a result of which the nutrition of the embryo is disturbed, and it dies);
• work in harmful production;
• lifting weights;
• regular stress.

The most susceptible to the risk of pregnancy is the following groups of women:

• aged after 35 years;
• made a lot of abortion;
• women who had previously diagnosed ectopic pregnancy;
• women with uterus development anomalies;

The most dangerous period is the eighth week of pregnancy. At this stage of development, the embryo is particularly susceptible to teratogenic effects, the result of which may be frozen fruit. Pregnancy (no matter, the first or second faithful pregnancy) in this case stops developing.

The first trimester (from 1 to 13 week) is generally more dangerous for the development of the fetus; We must be especially attentive to 3-4 and 8-11 weeks.

However, the risk is also the second trimester of pregnancy (signs of frozen pregnancy will be listed below), especially 16-18 weeks.

How to determine a frozen pregnancy?

The fruit froze, and the pregnancy is further not developing. However, in the early periods (in the first and even in the second trimester of pregnancy), signs of frozen pregnancy can not be recognized. At home, no test will show a frasonal pregnancy.

From different women, symptoms may vary, or a frozen pregnancy does not exhibit oneself at all over several weeks. Therefore, it is not necessary to look for on the Internet about signs of frozen pregnancy; Forum in this case will not be the best adviser.

Symptoms also do not depend on whether the first pregnancy is frozen, or a woman has already 2 frozen pregnancy or 3 frozen pregnancy.

The list below is not an unambiguous measuring pregnancy. However, in case of symptoms that may indicate a frozen pregnancy (in the early periods), the most correct decision will appeal to the gynecologist:

• sudden termination of toxicosis;
• catching pains;
• stitching bleeding;
• stopping the swelling of the mammary glands;
• the basal temperature at measuring pregnancy is reduced;
• the total temperature during frozen pregnancy can be elevated.

Measuring pregnancy in the second trimester and a frozen pregnancy in late terms is determined to terminate the fetal movements.

How to determine the frasonal pregnancy - diagnostics

As mentioned above, if a woman finds signs of frozen pregnancy - the forum on the Internet, the tips of the girlfriends and attempts to independently formulate the diagnosis will not be the best way out of the situation. Even if the basal temperature is lowered (when measuring pregnancy, this is one of the symptoms), if the woman has the first pregnancy - a frozen pregnancy, or not, can only determine the specialist.

What methods is the diagnosis of "frozen pregnancy" (in the second trimester or in early terms and "frozen pregnancy in late terms")?

1.Analyz on hgch.
The level of this hormone when measuring pregnancy is lower than it should be with normal pregnancy at such a period (first or second trimester) - thus show the test of the frasonal pregnancy. However, it is necessary to keep in mind that the high level of hCG can be maintained and within a few weeks after the first or second pregnancy has come. The fruit is measuring - but the hormonal background has not changed.

2. Ultrasound.
If a frozen pregnancy is diagnosed with ultrasound examination, the video "shows" the lack of heartbeat in the fetus.

3. Gynecological examination.
The reduced basal temperature at measuring pregnancy, the correspondence of the size of the uterus. The term of pregnancy is all determines the doctor.

Also, the Gynecologist also appoints the necessary treatment after measuring pregnancy, appoints analyzes after frozen pregnancy, determines the planning of pregnancy after a frozen pregnancy.

If a woman is diagnosed with "frozen pregnancy", the forum on the Internet is unlikely to help in treatment; All appointments should do a doctor.

Treatment after frozen pregnancy.

Unfortunately, when pregnancy freezes, it is not about preserving the fetus, but about the restoration of the health of a woman. The fetus cessation may cause intoxicating the body, so it must be removed from the uterus.

Often in the earliest period of a woman there is a spontaneous abortion; It even happens that the woman does not suspect that she had a frozen pregnancy, monthly arrive with a minor inturn.

If the diagnosis of "frozen pregnancy" is diagnosed, treatment is made by the following methods:

• Medical. Applied for a period of less than 8 weeks. Prescribed drugs causing miscarriage.
• Vacuum Aspiration (mini abortion). The operation is carried out as a rule under anesthesia using vacuum suction cleansing the uterus.

It also happens that doctors occupy an expectant position; If for some reason it happened a frozen pregnancy, the treatment of a woman's body produces independently, by spontaneous abortion.

But in any case, it is necessary to observe the doctor. If the spontaneous miscarriage did not occur, it is necessary to clean (scraping after frozen pregnancy) of the uterine cavity. Also, scraping after frozen pregnancy is necessary, if after one or two weeks the ultrasound shows the presence of residues of the fetal egg in the uterus.

Pregnancy planning after measuring pregnancy

How can you get pregnant after frozen pregnancy? When to pregnant after frozen pregnancy? This issue is solved individually in each specific case - depending on the deadline for the pregnancy, the overall state of the health of women, the results of the surveys, etc.
To the question, when planning a pregnancy after a frozen pregnancy, the forum on the Internet is unlikely to give an unequivocal answer - only the impressions of women who had the chance to transfer one or even two frome pregnancy.

On the recommendation of the doctors, the minimum time is to wait six months. During this time, after the diagnosis of "frozen pregnancy", the consequences of such a pathological state will decrease. All over two frozen pregnancy have a negative impact on the woman's body. It is necessary to hold a number of preventive measures in order to exclude fetal fetus in the future.

What are the tests after measuring pregnancy?

Before pregnant after frozen pregnancy, it is recommended to take the following tests:

• blood test to the level of hormones (progesterone and estrogen);
• vagina smear on STDs;
• Ultrasound pelvis organs;
• study of uterus tissues (histology).

After frozen pregnancy, it may also be necessary to carry out a genetic survey on the compatibility of partners.

Preventing pregnancy prevention

How to get pregnant after frozen pregnancy? Is it possible? Yes, perhaps! - Doctors say.

Why pregnancy freezes, it is still unknown so far. However, not one woman gave birth after frozen pregnancy; To make a healthy child - quite real. Of course, if necessary (based on analyzes), you need to undergo treatment.

Before planning pregnancy, it is recommended to make vaccinations from rubella and chickenpox. This is especially true for women in the risk group - in this case, this is a job in children's institutions, where you can easily become infected with these diseases. It is also necessary to massive diseases transmitted by sexually, to undergo a secretioning course of vitamins, stimulate the immune system. The treatment regimen must be coordinated with the attending physician.

And if all the results of the analyzes are normal, then the treatment may not be required.

The best protection against fetal fetal is a healthy lifestyle when planning pregnancy.

Measuring pregnancy in the early and later dates: 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 the most different - measuring pregnancy It may be due to genetic disorders in the embryo (or fetus), caused by the exacerbation of infectious diseases or even harmful habits. Measuring pregnancy It is more often diagnosed in the first trimester of pregnancy (up to 13 weeks). Measuring pregnancy causes in early time differ from later. Consider more such a phenomenon as measuring pregnancy reasons Its and prevention measures.

So, in the period of pregnancy planning, it is necessary to abandon the use of alcoholic beverages (especially in large quantities) and smoking. Not always alcohol and smoking leads to measuring pregnancyBut the risk of her offensive in such women increases.

Absolutely exactly during the planning period and the most pregnancy (in order to avoid miscarriage and measured) It is not necessary to use drugs without appointing a doctor. And before starting their reception, you should carefully read the instructions for the drug, maybe there is a pregnancy in contraindications. In addition, many drugs have a property for a long time output from the body. Future mom may not be aware of what came pregnancy and take any medicine and as a result - froker. The embryo is very susceptible to teratogenic action. But, meanwhile, harm will cause the reception of drugs in very early time - 7-10 days from the date of fertilization of the egg, since during this period there is no close connection between the future child and his mother. And after 8-10 weeks of the child from teratogenic exposure partially protects the placenta and, accordingly, the number measuring pregnancies In big times, it decreases somewhat. If you work in harmful production, you also have an increased risk measuring pregnancy.

May be held in violations of the hormonal background of a woman, most often, this is a lack of progesterone - pregnancy hormone. If you have a history of a frozen pregnancy, miscarriage, often happen delays in menstruation and is observed for male type, then before planning a pregnancy, you need to pass tests for hormones and if you need to undergo treatment, so you will reduce the likelihood measuring pregnancy in future.

Next reason measuring pregnancy Not only in the early, but in the later dates are all sorts of infections. It is especially dangerous not to exacerbating already available infectious diseases, but infection by them during pregnancy. Infection by some of them (for example, chickenpox and rubella) can lead not only to measuring pregnancy, but also, most terrible, fetal development anomalies. And then will have to decide on the interruption of pregnancy ... it is infections that can cause such a state as measuring pregnancy in late terms.

How to avoid measuring pregnancy Due to exacerbation or infection with infectious disease? First, you should look at your children's medical card or learn from the parents (if you yourself do not remember) whether you were transferred in childhood such diseases like rubella and windmill. If not, and besides enter the risk group (work with children), then in order to avoid infection with them and as a result measuring pregnancy Or miscarriage, better 3 months before pregnancy planning to make vaccinations from them. If you have an STIs (sexually transmitted infections), then it is necessary to get rid of them and then plan a pregnancy.

But if pregnancy emerged unexpectedly, then in order to avoid measured Or miscarriage the doctor can appoint you an antiviral course.

Everyone without exception to women for prevention measuring pregnancy And other troubles are necessary during the period of happy expectation of the baby to strengthen their immunity. There are a lot of ways, it is not necessary to drink dietary supplements and vitamins. It will be enough proper, full nutrition. During pregnancy, immunity is always reduced, this is due to the production of a special hormone - chorionic gonadotropin, one of whose functions is to protect the future child from his mother's immune system. Without this, the mother's body perceives the fruit of the fringe, as the "alien" object, from which you need to get rid of, that's another possible.

But, after all, the most often cause measuring pregnancy are genetic deviations from the fetus. Nature itself does not give to develop a "patient" embryo and arises measuring pregnancy. As a rule, if this is cause of frozen pregnancy In a woman, that is, the high probability that it will no longer happen if parents themselves are healthy.

Symptoms of frozen pregnancy and its diagnosis

Unfortunately, measuring pregnancy early Maybe not to give yourself to know. Later, symptoms of frozen pregnancy A woman can become grapple-shaped pains and cargo bleeding. This usually occurs at the beginning of a detachment of a fetal egg, that is, starting miscarriage.

To subjective symptoms froker pregnancy early You can also attribute a sharp cessation of toxicosis (if it was). Also may pass the painfulness of the mammary glands and decrease the basal temperature. Usually these symptoms of frozen pregnancy There are no fearless women. Measuring pregnancy in late terms It is characterized by the lack of a child's movements.

Can be three ways: to pass the blood test to hCG, go to the explorer to the gynecologist or do ultrasound.

For measuring pregnancy The level of hCG is lower than should be on this period of pregnancy. Uzi shows the lack of fetal heartbeat. And on the gynecological examination, the doctor determines the inconsistency of the sizes of the uterus.

So, if you suspect that you have measuring pregnancy, Know that symptoms are a secondary sign. The main thing is medical evidence if you can put it ... With such a phenomenon as measuring pregnancy symptoms Different women may vary or even absent.

Usually measuring pregnancy Ends in "cleaning" cavity of the uterus in stationary conditions. But in the early terms it is possible to conduct a vacuum aspiration or cause miscarriage with certain medicines (under the supervision of the doctor). Sometimes frosting pregnancy in early time Doctors occupy an expectant position, that is, they expect when a woman will spontaneously have miscarriage. And if this does not occur during a time-defined time or on an ultrasound, the residues of the fetal egg are diagnosed in the ultrasound in the ultrasound, they are conducted by a curethip (scraping) of the uterine cavity.

Pregnancy after frozen pregnancy

Doctors recommend planning pregnancy after frozen pregnancy At least six months. During this time for preventing future cases measuring pregnancy held treatment. Standard for treatment No, it all depends on the cause that caused frasonable pregnancy. But absolutely everyone is desirable to pass some tests and pass surveys.

First of all, it is worthwhile to hand over the smear to all sorts of infections transmitted by sexually by PCR, to hand over blood test to determine the level of hormones in the blood, to undergo an ultrasound examination. If necessary, determine the karyotype (your partner), group compatibility and other analyzes and surveys, as well as pass treatmentrecommended by the doctor based on the results of all surveys as prevention in the future measuring pregnancy.

A woman who survived such a state as family pregnancy treatment It may not be necessary at all if all the results of the analyzes are normal. As we have already written earlier measuring pregnancy, most often, happens due to a genetic error, which is unlikely to once again happen ... But if measuring pregnancy It happened not for the first time, then the treatment is most likely necessary in any case.

Best prevention is a healthy lifestyle and regular visits to the gynecologist, and then you can hardly threaten measuring pregnancy.

Measuring Pregnancy - Causes and Treatment

Untrectable pregnancy (a frozen pregnancy, failed miscarriage, Missed Ableion) means the death of the embryo (fetus) without clinical signs of miscarriage. In the structure of reproductive losses, the frequency of this pathology remains stable and is 10-20% of all desired pregnancies.

Measuring Pregnancy - Causes

The causes of undeveloped pregnancy are numerous and often complex. In everyday practice, it is often difficult to establish a specific factor that led to this pathology, since this prevents the maceration of tissues after the fetus death, which makes their genetic and morphological research.

Among the leading etiological factors of undeveloped pregnancy should first be noted infectious. Persistence in endometrials of a bacterial-viral infection often helps to strengthen or occur endocrinopathies in the mother, accompanied by disorders in the hemostasis system and metabolic changes in the mucous membrane of the uterus, which can cause the development of the embryo development (fetus).

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

Not every embryo (fruit) in contact with the infection is necessarily infected; In addition, the degree of damage is different. It can be caused by microorganisms having a certain tropism to some tissues, as well as vascular failure caused by inflammation of the vessels of the fetus or placenta.

Measuring pregnancy - infections leading to the death of the fetus

The spectrum of causative agents of infections capable of causeing early antenatal infection and the subsequent death of the embryo, the following.

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

2. Rush viruses, CMV, HPV, adenovirus 7, coking virus.

3.Micoplasm, chlamydia, treponam, mycobacteria.

4. Simplest - toxoplasm, plasmodia, mushrooms genus Candida.

With viral and mycoplasma damage, inflammatory changes in the decidual shell are combined with sharp circulatory disorders in the uterine-placental arteries. In case of bacterial damage, inflammatory infiltrates detect more often in amnion, chorion and intervalistic space. In the presence of infectious pathology, the mother's death of the embryo (fetus) is due to massive inflammatory infiltration, as well as micronecrosis in the place of direct contact of the chorion with maternal fabrics.

The teratogenic role of infectious diseases of the mother has been proven, it is responsible for 1- 2% of all severe innate anomalies from the fetus incompatible with life. Whether the presence of an infection causes the antenatal death of the embryo (fetus) and spontaneous interruption of pregnancy depends on the path of penetration of microorganisms, involvement in fetal infection and accumulating shells, type and virulence of microbes, the number of penetrated pathogens, the duration of the mother's disease and other factors.

The ascending path of infection of the embryo (fetus), prevailing in the first trimester of pregnancy, is due to conditionally pathogenic bacteria, as well as by mycoplasmas, chlamydia, mushrooms of the genus Candida, a virus of a simple herpes. The predisposing factors for the development of the inflammatory process may be erecting-cervical insufficiency, partial rupture of the fetal shells and carrying out some invasive manipulations in order to estimate the state of the embryo (fetus): the biopsy of chorion, amniocentesis, etc.

Microorganisms penetrate into the uterine cavity from the following departments of the reproductive system, infecting the oily water, regardless of whether their integrity is impaired or not. The fetus swallows the amniotic fluid or the infection spreads through the aircraft shells and further to the fetus, causing the lesion of the lungs, the digestive tract and the skin, which in turn may be the cause of the antenatal death of the fetus. The nature and distribution of inflammatory lesions of the organs is mainly determined by the intensive exchange of infected acid-free waters with respiratory, urinary fetal systems, as well as its gastrointestinal tract.

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

The intrauterine death of the fetus may be associated not only with the direct damaging effect of the infectious agent, but also inadequate development of immune reactions in the placenta tissue.

Measuring Pregnancy - Immunistical Causes

It is known that regulation of an immune response is carried out mainly by T-helpers, or CD4 lymphocytes. Two substances of these cells type 1 and TX type 2. They differ in secreted cytokines. TX1 secrete gamma, IL-2 and beta-flops, and TX2 - IL-4, -5 and -10. Alpha FNF secrete both subpopulations of cells, but predominantly TX1. Cytokines - Intermediaries in the development of inflammatory and immune reactions in the mother's system - a placenta - fruit. Cytokines secreted by TX, according to the feedback mechanism regulate the function of these cells. It has been established that TX2, providing mainly humoral immunity reactions, favors the physiological flow of pregnancy. TX1, on the contrary, stimulates the cellular immunity and may be an abortive effect.

There is a huge number of cells of the immune system in endometrials and decidual shell, they are all able to secrete cytokines. Violation and termination of the development of pregnancy can occur as a result of a violated immune response to antigens. As a result of this target of the cellular immunity becomes a fruit egg. Antigens activating macrophages and lymphocytes are most likely antigens of trophoblast. 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 as directly and indirectly depending on the intensity of the 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 the lysis of trophoblast. Activation of macrophages contributes to increased production and secretion of cytokines that have an effect on effector cells, including NK cells. The cytokine cascade can be launched not only by the infectious agent, but also endogenous causes (hypoxia, hormones, etc.).

Chromosomal anomalies in partners, perhaps, the only one who does not doubt the cause of underdeveloped pregnancy. The death of the embryo may be due to the pathological development of the zygota, embryo, fetus or structural disorders in the genetic program for the development of the placenta. In the observations of spontaneous miscarriages due to chromosomal pathology, various violations of the embryo development are very characteristic of its complete absence.

Measuring Pregnancy - Genetic Causes

A special role in the etiology of undeveloped pregnancy belongs to chromosomal aberrations. The main number of embryos with the aberrant karyotype dying in the first weeks of pregnancy. Thus, in the first 6-7 weeks of pregnancy, the abnormal karyotypes have 60-75% of the abortures, in 12-47 weeks 20-25%, 17-28 weeks about 2-7%. Among the chromosomal abberats, the abortures 45-55% amounted to autosomal trisomy, 20-30% - monosomy 45x0, 15-20% -tritidide and 5% - tetraploidide.

Autosomal trisomy is responsible for more than half of pathological karyotypes. At the same time, as a rule, the embryo is absent or has multiple defects; The chorionic cavity is empty and small. Most autosomal trisomy are the result of the lack of chromosome discrepancy during the first mitotic division of the ovocyte, and the frequency of this phenomenon increases with the age of the mother. It should be noted that the age of the mother does not have a decisive value for other chromosomal anomalies, which are the cause of stopping the development of pregnancy.

In 20-25% of observations with the pathology of the karyotype, monosomy takes place. Monosomy X causes an aplasia of an embryo, from which only the remainder of the umbilical chopper is often preserved or the preserved embryo is in a state of pronounced water. With monosomy, 98% of pregnancies ends with miscarriage and only 2% of the child's birth with Turner syndrome.

Triploidy and tetraploidy occurred with moderate frequency, but those cases of triploidy, in which a double parent component takes place, usually lead to a partial bubble drift, clinically manifested in a later date of pregnancy.

An important structural pathology of chromosomes is translocation (2-10%), which can be transmitted by one of the parents - a balanced carrier. Balanced (compensated) translocation should be suspected whenever the spouses have an instructions for repeated undeveloped pregnancies or spontaneous miscarriages. Among other types of karyotype disorders are various forms of mosaicism, double trisomy and other rare pathology.

Chromosomal human pathology depends not only on the intensity of the mutational process, but also on the effectiveness of the selection. With age, the selection is weakened, therefore, the developmental abnormalities are more common.

Among all undeveloped pregnancies, 60% are due to blastopaths and are mainly due to chromosomal anomalies or defects caused by unfavorable external factors. Blastopathy, leading to the death of the embryo in the first weeks of pregnancy, is classified as follows.

1. Development anomalies blastocysts, amniotic cavity and yolk bag.

2. Empty germ bag due to aplasia or resorption of the embryoblast (without amnion, amniotic legs and a yellow bag).

3. The hypoplasia of the amniotic cavity with a partial or complete out-of-interest arrangement of the embryo in the whole.

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

5. Double vices: Torakopagi, Ishopagi, etc.

6. Uncomfortable early blastopathops: anomalous blastocyst, complete topographic inversion of the Embubline.

The most frequent forms with coarse chromosomal pathology are empty germinal bags found in 14.9% of observations. Blank bags belong to malformations and allocate the following varieties.

1. With a sharply hypoplasmic amniotic cavity (in the presence of a yellow bag or without it).

2. With the absence of an embryo, umbilical umbilical bags.

3. With the presence of an amniotic shell, umbilical cord and the yolk bag (occurs in 80% of cases).

In 9.3% of observations there are changes that affect the entire embryo and thereby leading to his death.

Embrypathics are more often manifested by congenital vices, usually in the form of gross violations of the embryo development. However, part of embrypathy can also cause the intrauterine death of the embryo (fetus).

Measuring Pregnancy - Hormonal Causes

Among the reasons for undeveloped pregnancy, endocrine factors should be isolated - the violation of the formation and hypofunction of the yellow body associated with the deficiency of progesterone and the weak decidualization of the endometrium stroma. The incomplete or weak invasion of the cytotrofoblast in the adjacent endometrium helps to reduce the number and volume of gestational changes in the uterine-placental arteries and a decrease in the uterine-placental blood circulation. The consequence of this may appear the death of the embryo and the detachment of the trophoblast.

The insufficiency of the first wave of the invasion of the cytotrofoblast is often combined with chromosomal anomalies, which is a consequence of a defect responsible for this process of gene or violation of the general genetic program for the development of the embryo and placenta.

Not at all endocrine diseases, the intrauterine death of the embryo (fetus) is observed. Hyperandrogenation (matte - leventul syndrome, adrenogenital syndrome), hypo-and hyperfunction of the thyroid gland contribute to insufficient preparation of endometrials to pregnancy and defective implantation of the fetal egg, which requires a specific hormonal correction. Often, the death of the embryo (fetus) occurs in the presence of diabetes mellitus, which dictates the need to prepare for the planned pregnancy.

An autoimmune factor. One of the options for autoimmune violations is AFS.

Antiphospholipid antibodies change the adhesive characteristics of the foregoing Morula (charge); Adventure protchotic mechanisms and desynchronize the processes of fibrinolysis and fibrinetsis, which leads to defects of implantation and a decrease in the depth of the dezidal invasion of the trophoblast. Antiphospollipid antibodies directly interact with the syncytotrophoblast and cytotrofublast and inhibit the intercellular fusion of trophoblast cells. In addition, antiphospolipid antibodies suppress the production of XG and enhance thrombotic trends due to the provision of matrices for coagulation reactions.

In autoimmune diseases, severe rheological disorders are noted, leading to the formation of retroplatecentary hematoma and blockade of the uterine-placental and fetoplacementar blood circulation. Due to thromboembolic damage to the trophoblast and placenta due to damage to the cells of the endothelium of vessels and platelets, the death of the embryo (fetus) is possible.

According to literary data, without treatment, the death of embryo / fetus is observed in 90-95% of women with antiphospollipid antibodies.

Measuring 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, for example, with acute infection. More often, chronic infectious diseases of the mother do not lead to the intrauterine death of the fetus, but cause fetopathy, contributing to intrauterine death under the influence of other factors. Extremely visual example is the vices of the heart.

If we estimate the sensitivity of the embryo and the fetus to damaging factors, it can be said that the less the term of pregnancy, the fact that this sensitivity is higher. However, it decreases uneven throughout the intrauterine development. The so-called critical periods are distinguished during pregnancy, when a fruit egg, embryo, fruit is especially sensitive to unfavorable factors: the period of implantation (7-12th day), 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 fetal functional systems (20-24 weeks).

Measuring Pregnancy - Consequences

Pathogenesis. The main pathogenetic moment of undeveloped pregnancy is the stop in the first phase of FPK with continuing uterine-placental blood circulation. The following pathologic processes characteristic of underdeveloped pregnancy are distinguished.

1. Reducing and termination of embryochorial blood circulation in combination with involutional changes in chorion vice. The borderline state between disturbed and underdeveloped pregnancy is considered the absence of erythrocytes in the selection of separately preserved vessels. This indicates an undoubted death of the embryo and the complete termination of the metabolic processes necessary for the development of pregnancy.

2. Termination of the IPC against the background of involutional changes of decidual tissue.

3. Perifocal leukocyte-fibrinous exudative endometrial reaction caused by the presence of the dead elements of the fetal egg in the uterine cavity. Its feature is a pronounced fibrinic component, due to which the biological "preservation" of embryotrofrocal residues occurs.

With undeveloped pregnancy, the phenomenon of the "reverse development of endometrial", associated with the long-term persistence of the yellow bodies of the ovary in the conditions of the gradual fetal hormone activity of the deceased fetus, can take place.

Endometrium, adjacent to the location zone of the regressive fruit bubble, can save a decidual transformation for some time, but at a greater distance has an oil refinement or hypoplastic look. With the full regression of the yellow body, the ripening of the next follicles in the ovary can begin, and then the endometrium will have signs of early, moderate or late phase of the proliferation phase. On long-term persistence of undeveloped pregnancy shows the signs of iron-cystic hyperplasia endometrial.

After the death of the embryo and stop the FPK of the walls of the vessels, the erythrocytes are found in the lumen of the capillaries, the hydropic edema (secondary) and fibrosis of stromas are noted. If there are no erythrocytes in the vessels, it can be assumed that the stopping of embryoplacementar blood circulation has arrived to 4-5 weeks of gestation; If nuclear erythrocytes prevail, the death of the embryo occurred during the yield circulation (5-9th week of pregnancy). The presence of nuclear-free erythrocytes indicates a violation of the development of the embryo already in a later date of the gestation.

Measuring Pregnancy - Signs

Clinic. The clinical sign of undeveloped pregnancy is the erased picture of the subjective manifestations of pregnancy disturbance against the background of stabilizing the size of the uterus and their inconsistency of gravidar amenorrhea. The uterus may have normal dimensions, can be reduced, can even be increased in the case of the hematoma cavity.

At the same time, as a rule, a woman in the blood in the blood is located on a maximum low level or even completely absent. The subjective signs of pregnancy are gradually disappearing (although some time after death of the embryo or fetus, a patient can feel pregnant), periodically marine bleeding outlets from sex tract, pain in a spastic abdomen.

Measuring Pregnancy - Diagnostics

Diagnostics. The diagnosis of undeveloped pregnancy is established on the basis of ultrasound scanning data in the absence of a fetal heartbeat. With ultrasound, several variants of underdeveloped pregnancy are determined.

The most commonly encountered anambrium, i.e., the absence of an embryo in the cavity of the fetal egg after 7 weeks of pregnancy. A smaller fruit egg than the proposed gestation age, the decidual shell has an intermittent circuit, the embryo is not visualized or the fruit egg in size corresponds to the period of gestation, the embryo can be visualized, but very small sizes and without heartbeat. Often there is a retrochorial hematoma. If the study is carried out on time to 8 weeks, it is necessary to repeat it after 7 days.

Another echographic picture of the underdeveloped pregnancy is "frozen fruit", in which the fruit egg and the embryo of ordinary shape and sizes without signs of fetal life is visualized. As a rule, such signs are characteristic of the recent death of the embryo, which may not be accompanied by clinical signs of the threat of interrupt.

With a longer stay of the deceased embryo in the uterus, the embryo visualization is impossible, there are no signs of its livelihood. The dimensions of the uterine are lagging behind the period of pregnancy, the structure of the fetal egg is changed sharply - the deformation, fuzzy contours and the form of the fetal egg, the presence of multiple breathtaking and individual disparate ehostructures are noted.

Of particular importance is the establishment of an echographic picture of undeveloping pregnancy, when the normal fetal may be observed transient bradycardia or syncopal lack of heartbeat, so it is necessary to observe for a few minutes. Other signs of fetal death are pronounced lowland, as well as damage to the bones of the skull with the end of bone fragments one after another.

With ultrasound, it is possible to identify a special form of undeveloped pregnancy - multipleness in early terms. Often, such women have resorption of one of the embryos in the normal development of the other. More often the regression of the fetal egg occurs by the type of anambrium, less as the type of intrauterine death of one of the fruits (with dichorial double).

Differential diagnosis of undeveloped pregnancy should be carried out with the beginning spontaneous miscarriage and trophoblastic disease.

Measuring Pregnancy - Outcome

Exodus of underdeveloped pregnancy. The death of the embryo (fetus) is not always accompanied by a rapid spontaneous exile from the uterus. The absence of any proliferative and metabolic processes on the part of the cell-fabric elements of the fetal bubble in connection with their far-closed dystrophic and necrobiotic changes are aggravated by the ashability of the uterus, which does not rejected dead fruit. There are often cases when the deceased Fercent Egg is delayed in the uterus for indefinitely for a long time.

To date, the reasons for such long-term prolongation of underdeveloped pregnancy and factors resulting in the pathological inertness of the uterus are not enough. Apparently, the ashautility of the uterus can be associated with the following factors.

1. Deep invasion of chorion vigor, providing a dense attachment or true increment of the forming placenta due to:

o enhanced proliferative activity of invasive chorion in the area of \u200b\u200bthe placental site;

o of the initial structural-functional inferiority of the endometrium in the implantation zone in connection with the preceding scraping of the uterus;

o Implantation of a fruit egg in places of incomplete gravidar transformation of the mucous membrane of the uterus.

2. The inferiority of the reactions of immunocloty rejection of the deceased frenule bubble. A cascade of immunocloty reactions aimed at rejection of the "allogenic transplant", which has lost all immunoblocating factors in connection with its death. With a certain genetic identity of the spouses (related marriage), the biological compatibility of the mother and the fetus may be so close as it necessarates the state of the immunological asure of the uterus in relation to the deceased germin.

3. The apeactivity of the uterus. The contracting hypofunction of myometrium may be due to:

o biochemical defects in the system of enzymatic-protein metabolism;

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

o The lack of hormonal support from the dead fetus and the undeveloping placenta.

Most often, there is a gradual rejection of the deceased egg with a fibrin-leukocyte exudative reaction in response to necrotic fabric. During this process, along with fibrinis and leukocytes from endometrial vessels, trophoblastic, thromboplastic substances, and red blood cells are distinguished, which leads to permanent separating bleeding out of the uterus. The body of the uterus becomes soft, myometrium tone disappears, the neck opens. All signs of pregnancy (cyanosis of the vagina, cervix) disappear.

Measuring pregnancy - the consequences of staying dead embryo in the uterus

With long-term (2-4 weeks or more) finding a dead embryo in the uterus there are autolysis, the flow of thromboplastic substances in the patient's blood flow and develops in DVS syndrome. All this is the risk of developing severe coagulopathic bleeding while trying to interrupt pregnancy. The most unfavorable uterine hemostasis conditions occur in patients who have phase hemochaguing changes are in a state of hypocoagulation and is expressed by myometrics.

The difficulties arising from the removal of a dead fetus can be due to the preservation of chorion, placenta located in the field of the inner domestic uterine. Before scraping the uterus, it is necessary to investigate the state of the hemostasis system (deployed coagulogram). With the identified disorders (hyperagregation, hypercoagulation, DVS syndrome), corrective therapy is necessary (freshly frozen, and other components). The binding of hemostasiological disorders at the level of vascular-plateitarian facilities contributes to the use of dicinos and ATP. In the postoperative period, antiagregative and anticoagulant therapy (, kuralutyl,) is shown. The energy potential of the uterus is reduced by the purpose of glucose, vitamins, calcium chloride in combination with antispasmodic preparations.

Measuring Pregnancy - Treatment

Treatment. The delay in the dead embryo in the uterine cavity is a threat not only to the health, but also the life of a woman and therefore requires active tactics. As soon as the diagnosis of underdeveloped pregnancy, long-term conservative patient maintenance is risky.

After a thorough examination and appropriate preparation of a woman (conducting medical and preventive measures aimed at reducing the risk of development of possible

complications) Need an interruption of underdeveloped pregnancy. In the first trimester of pregnancy:

1. Expansion of the cervix and vacuum aspiration.

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

3. Use of antiproatagennes in combination with prostaglandins.

In the II trimester of pregnancy:

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

2. Therapeutic abortion with the help of intra-and extraimotic administration of prostaglandins or hypertensive agents.

3. The use of antiprogestogen in combination with prostaglandin.

4. Isolated use of prostaglandins.

Directly during the abortion or immediately after its completion, it is necessary to carry out ultrasound scanning to make sure that the fetus and placenta are removed.

After removal of the fetal egg with undeveloped pregnancy, regardless of the chosen interrupt method, it is advisable to carry out a complex anti-inflammatory treatment, including a specific antibacterial, immunocorrorizing and generalifying therapy.

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

Measuring Pregnancy - Medical Events

The tactics of conducting patients with undeveloped pregnancy is as follows.

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

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

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

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

o differentiated individually selected hormone therapy in the endocrine genesis of undervolving pregnancy;

o Determination of autoimmune disorders (determination of the lupus anticoagulant, anti-xg, anti-kardolypin antibodies, etc.) and the individual selection of antiagregants and / or anticoagulants and glucocorticoids under the control of hemostasiograms.

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

Pregnancy after frozen pregnancy

Tactics of conducting patients with subsequent pregnancy as follows.

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

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

3. Conducting medical and preventive measures aimed at:

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

o Suppression of autoantile products - intravenous drip administration of gammaimmunoglobulin at 25 ml in day No. 3;

o The elimination of hemostasiological disorders - antiagregants, direct action anticoagulants.

Spontaneous abortion (miscarriage)

Spontaneous abortion (miscarriage) is a spontaneous interruption of pregnancy until the fruit of a viable gestational period is achieved.

According to the determination of WHO, the abortion is spontaneous expulsion or extraction of an embryo or fetus weighing up to 500 g, which corresponds to the period of gestation less than 22 weeks.

Code of the ICD-10

O03 Spontaneous abortion.
O02.1 The failed miscarriage.
O20.0 Threatening abortion.

EPIDEMIOLOGY

Spontaneous abortion is the most frequent complication of pregnancy. Its frequency ranges from 10 to 20% of all clinically diagnosed pregnancies. About 80% of these losses occurs up to 12 weeks of pregnancy. When taking into account pregnancies to determine the level of hCG, the frequency of losses increases to 31%, and 70% of these abortions occurs until the moment when pregnancy can be recognized clinically. In the structure of sporadic early miscarriages of 1/3 of pregnancies, it is interrupted in the period of up to 8 weeks by the type of anambrony.

CLASSIFICATION

Clinical manifestations distinguish:

· Threatening abortion;
· Abortion started;
· Abortion in the go (full and incomplete);
· NB.

The classification of spontaneous abortions, adopted by WHO, is slightly different from the such used in the Russian Federation, combining the beginning of the miscarriage and abortion in the go to one group - the inevitable abortion (i.e., the continuation of pregnancy is impossible).

ETIOLOGY

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

The most frequent variants of chromosomal pathology with early spontaneous miscarriages are autosomal trisomy (52%), monosomy X (19%), polyploidy (22%). Other forms are noted in 7% of cases. In 80% of cases, death is at first, and then the expulsion of the fruit egg.

The second most important among etiological factors is metronendometritis of various etiology, which causes inflammatory changes in the mucous membrane of the uterus and preventing normal implantation and the development of the fruit egg. Chronic productive endometritis, more often autoimmune genesis, was noted in 25% of the so-called reproductive healthy women who have interrupted by the pregnancy by artificial abortion, in 63.3% of women with habitual unbearabity and in 100% of women with NB.

Among other causes of sporadic early miscarriages, anatomical, endocrine, infectious, immunological factors, which, mostly serve as the causes of familiar miscarriage, are distinguished.

RISK FACTORS

Age is one of the main risk factors in healthy women. According to data obtained in the analysis of 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 - 20%, at 40 years - 40%, at 45 years old - 80%.

Parity. In women with two pregnancies and more in history, the risk of miscarriage is higher than that of born women, and this risk does not depend on age.

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

Smoking. Consumption of more than 10 cigarettes per day increases the risk of spontaneous abortion in the first trimester of pregnancy. These data are most indicative when analyzing spontaneous interruption of pregnancies in women with a normal chromosomal set.

The use of non-steroidal anti-inflammatory funds in the period preceding conception. Data obtained indicating the negative impact of the oppression of GHG synthesis for the success of implantation. When using non-steroidal anti-inflammatory funds in the period preceding conception, and in the early stages of pregnancy, the frequency of miscarriages was 25% compared with 15% in women who did not receive drugs of this group.

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

Injury, including invasive methods of prenatal diagnostics (choriocentesis, amniocentesis, corecentesis), risk is 3-5%.

Caffeine use. With daily consumption of more than 100 mg of caffeine (4-5 cups of coffee), the risk of early miscarriage increases reliably, and this trend is valid for the fetus with a normal karyotype.

The effects of teratogen (infectious agents, toxic substances, teratogenic effects) also serves as a risk factor in spontaneous abortion.

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

Hormonal disorders, thrombophylastic states are more reasons for not sporadic, but the familiar miscarriage, the main reason for which the defective lutein phase acts.

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

Clinical picture and diagnostics

Basically, the patients complain about the bleeding of sex tract, pain at the bottom of the abdomen and in the lower back when menstruation delay.

Depending on clinical symptoms, there is a threatening spontaneous abortion, which began, abortion in the go (incomplete or complete) and NB.

A threatening abortion is manifested by pulling pain at the bottom of the abdomen and lower back, there may be scarce bleeding from sex tract. The tone of the uterus is raised, the cervix is \u200b\u200bnot shortened, the inner zev is closed, the body of the uterus corresponds to the term of pregnancy. With ultrasound, the fetal heartbeat is recorded.

With the abortion of pain and bleeding from the vagina more pronounced, the cervical channel is ajar.

With abortion in the go, regular grapple-shaped reductions of the myometrium are determined. The magnitude of the uterus is less than the alleged period of pregnancy, in a later date of pregnancy it is possible to leak. Inner and outer zev are open, elements of a fetal egg in the cervical channel or in the vagina. Blood discharge can be of different intensity, more often abundant.

An incomplete abortion is a condition conjugate with a delay in the uterus of the elements of the fetal egg.

The absence of a complete reduction in the uterus and the closure of its cavity leads to continuing bleeding, which in some cases the cause of large blood loss and hypovolemic shock is caused.

More often, an incomplete abortion is observed after 12 weeks of pregnancy in the case when the miscarriage begins with an effusion. With a bimanual study of the uterus, there is less than the estimated period of pregnancy, bleeding from the cervical cervical channel, with the help of ultrasound in the uterus, the remains of the fetal egg are determined, in the II trimester - the remains of placental tissue.

A complete abortion is more often observed in the late period of pregnancy. A fruit egg is completely from the uterus.

The uterus is cut, bleeding stops. With a bimanual study, the uterus is well contacted, less than the period of gestation, the cervical channel can be closed. With full miscarriage using ultrasound, the uterus is determined. There may be small bleeding.

An infected abortion is a condition accompanied by fever, chills, ailments, pain at the bottom of the abdomen, bloody, sometimes with fidelled seals from the genital tract. In physical inspection, tachycardia, tachipne, defans of the muscles of the anterior abdominal wall, with a bimanual study - painful, soft consistency with the uterus; The cervical channel is expanded.

With an infected abortion (with a mixture of bacterial radiation infections and autoimmune disorders in women with familiar non-obscure, burdened by the antenatal death of the fetus by an obstetric history, recurrent flow of genital infections) are prescribed immunoglobulins intravenously (50-100 ml of 10% solution of Hamimun, 50- 100 ml of 5% octagam solution and etc.). Also the extracorporeal therapy is also carried out (plasmapheresis, cascade plasmailtration), which lies in the physicochemical blood purification (removal of pathogenic autoantibodies and circulating immune complexes). The use of cascade plasmailtration implies disintellation without plasma removal. In the absence of treatment, it is possible to generalize infection in the form of salpingitis, local or spilled peritonitis, septicemia.

Untrectable pregnancy (the antenatal fetal death) - the death of an embryo or fetus during pregnancy for a period of less than 22 weeks in the absence of an expulsion of the elements of the fetal egg from the uterine cavity and often without signs of the threat of interrupt. For the diagnosis, an ultrasound is carried out. Pregnancy interrupt tactics are chosen depending on the period of gestation. It should be noted that the antenatal fetal death is often accompanied by violations of the hemostasis system and infectious complications (see chapter "Untrevive Pregnancy").

In the diagnosis of bleeding and developing tactics of reference in the I trimester of pregnancy, the speed of the speed and volume of blood loss plays a decisive role.

With ultrasound, unfavorable signs in terms of the development of a fruit egg in a uterine pregnancy consider:

· The lack of the heartbeat of the embryo with the CTR is more than 5 mm;

· Lack of embryo in the sizes of the fetal eggs measured in three orthogonal planes, more than 25 mm during transabdominal scanning and more than 18 mm during transvaginal scanning.

Additional ultrasound signs indicating an adverse outcome of pregnancy include:

· Anomalous yolk bag, not appropriate gestation (more), irregular shape, offset to the periphery or calcified;

· Embrycos CSS less than 100 per minute on time 5-7 weeks;

· Large dimensions of retrocharial hematoma (more than 25% of the surface of the fetal egg).

Differential diagnosis

The spontaneous abortion should be differentiated with benign and malignant diseases of the cervix or vagina. During pregnancy, bleeding from ectropion is possible. To eliminate the diseases of the cervix, a cautious inspection in the mirrors, if necessary, colposcopy and / or biopsy.

Blood sections when miscarriage differentiate with those with an anoint cycle, which are often observed when menstruation delay. There are no symptoms of pregnancy, the test on the BSUBID HCG is negative. With a bimanual study of the uterus of normal sizes, not softened, the neck is dense, not cyanotic. Anamnesis may be similar disorders of the menstrual cycle.

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

With bubble drift in 50% of women there may be characteristic allocations in the form of bubbles; The uterus may be more sense of pregnancy. Characteristic picture with ultrasound.

With ectopic pregnancy, women may complain about bleeding, bilateral or generalized pain; Frequently unforgettable states (hypovolemia), a sense of pressure on a straight intestine or bladder, a test for BXHch positive. With a bimanual study, there is a soreness when moving over the cervix. The uterus of smaller sizes than should be on the period of the proposed pregnancy.

You can proper a thickened uterine tube, often swelling of the arch. When ultrasound in the uterine tube, a fruit egg can be defined, with its break to detect the blood cluster in the abdominal cavity. To clarify the diagnosis, the puncture of the abdominal cavity through the rear vaginal arch or diagnostic laparoscopy is shown.

An example of the formulation of diagnosis

Pregnancy 6 weeks. The started miscarriage.

Treats of treatment

The goal of treating the threat of abortion is the relaxation of the uterus, stopping bleeding and prolongation of pregnancy in the case of a viable embryo or fetus in the uterus.

In the USA, Western European countries, the threatening miscarriage up to 12 weeks are not treated, believing that 80% of such miscarriages are "natural selection" (genetic defects, chromosomal abbrasions).

In the Russian Federation, the other tactic of pregnant women with the threat of miscarriage is generally accepted. With this pathology, the bed regime (physical and sexual peace) is prescribed, a full diet, gestagens, methylxantins, and as symptomatic treatment - antispasmodic preparations (, candles with papaverine), vegetable sedative drugs (dustwater decoction, valerian).

Non-media treatment

In the diet of pregnant, oligopeptides, polyunsaturated fatty acids, must be included.

Medicia treatment

Hormone therapy includes natural micronized 200300 mg / day (preferable) or Didrogesterone 10 mg twice a day, vitamin E of 400 me / day.

DROTAVERINA is prescribed with expressed pain intramuscularly at 40 mg (2 ml) 2-3 times a day, followed by a transition to oral administration from 3 to 6 tablets per day (40 mg in 1 tablet).

Methylxantins - (7 mg / kg body weight per day). Candles with papaverine at 20-40 mg twice a day apply rectally.

Approaches to therapy for the threat of pregnancy interrupt fundamentally vary in the Russian Federation and abroad. Most foreign authors insist on the inexpediency of pregnancy to pregnancy for a period of less than 12 weeks.

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

Purpose in the bleeding discharges of pregnant agents affecting hemostasis (ethimsite, viscasol, transkamic acid, aminocaproic acid and other drugs), does not have grounds and proven clinical effects due to the fact that bleeding during miscarriages is due to the chorion detachment (early placenta), And not coagulation violations. On the contrary, the task of the doctor is to prevent blood loss leading to hemostasis violations.

When entering the hospital, blood test should be carried out, determine the blood group and resusperation.

In case of incomplete abortion, abundant bleeding is often observed, in which it is necessary to provide emergency care - to immediately instrumental removal of the residual eggs and scraping the walls of the uterine cavity. More careful is the emptying of the uterus (preferably vacuumspiration).

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

In the process of operation and after it, it is advisable to introduce an intravenously isotonic solution of sodium chloride with oxytocin (30 units per 1000 ml of solution) at a rate of 200 ml / h (in the early period of pregnancy, the uterus is less sensitive to oxytocin). It is also carried out antibacterial therapy, if necessary, treatment of postgemorrhagic anemia. Women with resound negative blood is introduced immunoglobulin antveusus.

It is advisable to control the state of the uterus by the Uzi method.

With a complete abortion during pregnancy, less than 14-16, it is advisable to conduct an ultrasound and, if necessary, scraping the walls of the uterus, since the likelihood of finding parts of the fetal egg and decidual fabric in the uterine cavity. In a later dates, with a well-cutting uterus, scraping are not produced.

It is advisable to appoint antibacterial therapy, treatment of anemia according to the testimony and administration of immunoglobulin antveusus women with resound negative blood.

SURGERY

Surgical treatment of NB is presented in the chapter "Untrevive Pregnancy".

Postoperative period

Women with aite in history (endometritis, salpingitis, ooforite, tubarial abscess, pelvioeritonitis) Antibacterial therapy should be continued for 5-7 days.

In resuscant-negative women (during pregnancy from the resuspend partner) in the first 72 hours after vacuumspiration or scraping during pregnancy, more than 7 weeks and in the absence of massate, the anti -usus in a dose of 300 μg (intramuscular) is carried out in the absence of resusat.

Prevention

Methods of specific prophylaxis of sporadic miscarriage are absent. For the prevention of nervous tube defects, which partially lead to early spontaneous abortions, recommend the appointment of folic acid for 2-3 menstrual cycles before conception and in the first 12 weeks of pregnancy in the daily dose of 0.4 mg. If a history of the woman's nervous tube defects are noted in history during previous pregnancies, the preventive dose should be increased to 4 mg / day.

Information for the patient

Women should be informed about the need to appeal to the doctor during pregnancy when the abdominal appearance appears at the appearance of the abdomen, in the lower back, in the occurrence of bleeding out of the genital tract.

Further maintenance

After the scraping of the uterine or vacuumspiration, it is recommended to exclude the use of tampons and refrain from sex contacts for 2 weeks.

As a rule, the forecast is favorable. After one spontaneous miscarriage, the risk of losing the next pregnancy increases slightly and reaches 18-20% compared with 15% in the absence of miscarriage in history. In the presence of two consecutive spontaneous interruptions of pregnancy, it is recommended to conduct a survey before the occurrence of desired pregnancy to identify the causes of unbearable from this marital pair.

A frozen pregnancy can develop as a result of many reasons. Most often, the fruit freezes in the later dates, and this is due to the fact that the body of pregnant has been subjected to various infections (flu, rubella, hepatitis) or the future mother suffers from chronic diseases, such as heart disease, disease of the endocrine glands, or the fetus has anomalies who are not compatible with his life. Also, this pathology can develop the body with mercury couples, lead, aniline compounds.

Also in gynecological practice there are cases of fetal fetal cases in multiple pregnancy, when it is first developing or triple, and then one embryo dies and exists in a frozen state in the stomach of the mother, remove it at the time of birth. However, this situation is fraught with complications, the threat of the mother's life and the remaining fetus. Therefore, doctors carefully follow the state of health pregnant and the development of the fetus.

In the case of Disteres, artificial childbirth is caused. In early terms in the ninety percentage of cases, such pregnancy ends with a spontaneous abortion. If this did not happen, doctors make scraping, vacuum extraction or cause abortion. In any case, it is impossible to engage in self-medication or cause a miscarriage during measurement pregnancy, it is fraught with further infertility or the development of inflammatory diseases in the uterine cavity.