Frozen early and late pregnancy: causes and prevention. How to live after a failed pregnancy

Failed miscarriage is a condition in which intrauterine fetal death occurs at a gestational age of up to 28 weeks without expulsion of the ovum from the uterus.

If the fetus dies during gestation later than 28 weeks, they talk about a failed birth.

The frequency of the condition ranges from 2 to 9% of all spontaneous abortions of pregnancy. It is noted that repeated pregnant women are more susceptible to miscarriage.

In case of miscarriage, the ovum can be in the uterine cavity for several weeks or even months. There are known cases of a longer finding of the ovum in the uterus (up to 30 years).

Risk factors for miscarriage are the presence in the obstetric history of complicated childbirth, induced and spontaneous abortions, miscarriage, the woman's presence of chronic diseases of the genital tract, genetic pathologies, endocrine diseases (diabetes mellitus, hyperthyroidism).

Failed miscarriage is a condition that requires hospital treatment.

Causes

The etiology of miscarriage is not fully understood.

The reason for the death of an embryo in early pregnancy (up to 6-8 weeks) is most often gross malformations, hidden mutations, which lead to the fact that the embryo becomes unviable.

Other causes of fetal death are:

• TORCH infections (rubella, toxoplasmosis, chlamydia, etc.);
• acute infectious diseases and intoxication;
• anomalies in the development of the uterus (two-horned uterus);
• infectious and inflammatory diseases of the uterus and appendages;
• dyshormonal conditions of the female genital area;
• endocrine diseases;
• immune causes (Rh-conflict);
• isthmic-cervical insufficiency, etc.

All these reasons can cause spontaneous abortion, which in some cases ends in miscarriage.

Normally, the dead fetus is perceived by the body as a foreign body and is expelled from the uterus (i.e., an abortion occurs). In the pathogenesis of miscarriage, they matter;

• a decrease in the sensitivity of the uterus to stimuli, which determines the passivity of the myometrium in the presence of an ovum with a dead embryo in the uterus cavity;
• a change in the hormonal balance in the body of a pregnant woman, leading to the suppression of excitation processes and the predominance of inhibition processes in the myometrium.

A fetus with a missed abortion can be resolved by non-bubble drift, mummification, petrification. In the early stages, the embryo can dissolve on its own.

Symptoms

In case of miscarriage in early pregnancy, a woman may not know that she is pregnant. There may be cramping pains in the lower abdomen, sometimes bloody discharge.

In case of miscarriage at a later stage of pregnancy, the woman notes the absence of fetal movements or the cessation of fetal movements, a decrease and softening of the mammary glands. The abdominal circumference does not increase, and further decreases. Sometimes there is bloody discharge from the genital tract, which then stops.

In some cases, general symptoms are observed: weakness, nausea, loss of appetite, there may be an increase in temperature to subfebrile numbers, pulling pains in the abdomen.

Important! In most cases, miscarriage is asymptomatic.

In the future, the clinic is due to the peculiarities of the resolution of the ovum.

When the fetal membranes and tissues of the fetus are soaked with blood, a non-bubble drift occurs. The leaching of hemoglobin further leads to the formation of a fleshy drift. In turn, the fleshy drift is able to transform into lithokelifopedion, in which the tissues of the fetus and the ovum are calcified. With this outcome, there may be no complaints.

Mummification of the fetus is possible, in which the amniotic fluid is resorbed and the tissues of the fetus dry out. There may also be no complaints.

Putrefactive decay of the soft tissues of the fetus is possible. In this case, a fetid vaginal discharge is noted. Infectious complications often occur in this case.

Diagnostics

In the early stages of pregnancy, a miscarriage is often detected only when a woman is examined by a gynecologist.

Important! If a miscarriage is suspected in the early stages of pregnancy, it is necessary to monitor the woman in dynamics.

In late pregnancy, complaints of a pregnant woman, clarification of the obstetric history (features of the course of past and current pregnancies, the number of births and abortions, delivery features), an objective examination with a mandatory gynecological examination, data from instrumental, laboratory research methods allow to suspect a miscarriage.

During a gynecological examination, attention is paid to the consistency of the uterus, the condition of the cervix, the size of the body of the uterus in relation to the expected duration of pregnancy, the presence of vaginal discharge. Auscultation of fetal heart sounds is performed.

A general blood test, a general urinalysis is prescribed, if necessary - determination of the level of β-subunit of hCG in serum and urine, determination of the level of placental lactogen, progesterone, estradiol. In late pregnancy, a phonocardiogram and an ECG of the fetus are recorded.

An ultrasound of the uterus is performed. As a rule, ultrasound examination in combination with the registration of the fetal heartbeat makes it possible with one hundred percent probability to confirm the diagnosis of a miscarriage that did not take place.

Additionally, a blood test for the group and Rh factor, coagulogram, immunological studies with various groups of antigens are prescribed.

Differential diagnosis is carried out with cystic drift, incomplete abortion, chorionepithelioma, uterine myoma.

Complications

The ovum lingering in the uterus can become infected. More often, infection occurs ascending from the vagina. In the future, chorioamnionitis, endometritis, metroendometritis develop. At the same time, the general condition of the woman suffers, there are pains in the lower abdomen, fever, general weakness, appetite disorders, tachycardia.

In the absence of treatment, after a while, self-induction by the uterus of fetal expulsion is possible. In this case, bleeding occurs, often profuse, associated with a decrease in blood clotting. DIC develops, which can threaten a woman's life.

A rare complication is chorionepithelioma, which occurs when the chorionic villi remaining in the uterus become malignant. With chorionepithelioma, the prognosis in most cases is favorable.

Forecast

In case of miscarriage, the prognosis is determined by the adequacy of the treatment. Uterine curettage and medical abortion allow the ovum to be removed from the uterus. In the future, there are no obstacles for repeated pregnancy.

With infectious complications, the prognosis is determined by the degree of damage to the uterus. It is noted that the transferred metroendometritis further increases the risk of developing a miscarriage.

Since fetal death, especially in late pregnancy, is often a psychological trauma, a psychologist should work with the family in some cases.

Prevention of the condition is careful planning of pregnancy, treatment of genital infections before pregnancy, and giving up bad habits. Women at risk are subject to mandatory examination in order to identify the cause of a miscarriage that did not take place.

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 (7-12th 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 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 of 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 agents that affect hemostasis (etamsylate, vicasol, 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.

The fetus froze - this is perhaps one of the most terrible words from a doctor for a couple dreaming of children. You can hear them for various reasons at the very beginning of the development of a new life (the most dangerous are considered from 3 to 4, from 8 to 11 and from 16 to 18 weeks from conception). Sometimes the diagnosis is made at a later date, but the likelihood of hearing it is significantly lower. An analogue is the development of an empty ovum: in this case, fertilization has occurred, but the embryo does not develop. Pathology occurs spontaneously, maybe several times in a row throughout a woman's life. Unfortunately, no one is immune from her. Nevertheless, it is better to know the causes and signs of a frozen pregnancy in the early stages in order to take timely measures and consult a doctor, as well as prevent the development of pathology before conception. Anything can influence the development of a small life. And the worst thing is that it is not so easy to notice the changes.

Read in this article

Reasons why pregnancy does not develop

Why is there a frozen pregnancy in the early stages? This question worries and scares young mothers. There are actually quite a few reasons:

• Genetic abnormalities are in the lead. They are diagnosed in 70% of cases for up to 8 weeks. They are associated with many factors, including hereditary diseases, as well as the result of taking drugs by one of the partners. That is why it is important not to give up screenings and other examinations suggested by a geneticist and gynecologist.

• Excessive use can also provoke a developmental arrest. It is especially dangerous if the mother cannot give up bad habits after conception.
• Medicines are also capable of provoking the development of abnormalities. That is why the doctors themselves strongly recommend giving up any medication. An exception can only be serious diseases, the treatment of which with folk remedies is simply impossible. It is worth noting that for up to 10 days and after 8-10 weeks, when the fetus becomes partially protected by the placenta, the effect of the drugs is not so significant. As for herbs, they also need to be taken only under the supervision of a doctor, because some of them can provoke a breakdown or stop in the development of the embryo.
• The causes of a frozen pregnancy in the early stages may lie in the mother and child. If a woman has had abortions before, then the chances of a happy development are not so great. Antibodies produced by the mother's body towards the baby build up over time. And after several abortions, it is very difficult for a conceived baby to resist such an attack.
• Infections of both genital organs and viral (, influenza) are a serious threat at the very beginning of the birth of life. The mother's body is already weakened by the new position, so it is not at all difficult to get sick. But the consequences of a high temperature, a viral attack can be very serious. Rubella is a formidable enemy, in the event of which pregnancy not only freezes, the fetus may develop severe anomalies. And already in this case, the mother will have to decide whether she can raise a special child or whether it is better to terminate the pregnancy.

The consequences of congenital rubella for a child

• Hormonal Disorders. Moreover, a non-developing pregnancy in the early stages, the reasons for which lie precisely in this factor, can freeze both due to a lack of prolactin and an excess of testosterone. If a woman has regular menstrual irregularities, then it is imperative to be examined during planning, and also to regularly check the state of the hormone after conception.
• Harmful factors at work, diabetes mellitus, weight lifting, stress - all these factors can also cause the development of pathology.

Women who have a higher risk of developing pathology

But this is not the only answer to the question of why pregnancy freezes at an early stage. Doctors identify a certain risk group, which includes:

• old-born or expectant mothers over the age of 35;
• if you have multiple abortions in the past;
• if during a previous pregnancy were ectopic;
• in the presence of a congenital anomaly of the uterus.

If one or all of the factors are present, the woman will be under constant medical supervision.

The risk group also includes expectant mothers who do not want to visit a gynecologist in the early stages. There may be many reasons for such a decision, but the result will be a serious threat to the health of not only the woman, but also the child.

What signs will indicate a frozen pregnancy

The saddest thing is that the symptoms of a frozen pregnancy in the early stages are not pronounced. Therefore, the expectant mother may not even suspect about the change in the state of the fetus. Only a qualified doctor, after examination and appointment of an additional examination, can state the absence of embryo development.

You should not look for symptoms of a missed pregnancy in your early stages, and even more so, ask your friends for advice or on the forums. In each case, everything is purely individual and depends on many factors.

Symptoms of an impending disaster

At a later date, it is easier for a woman to navigate, because she already feels the movement of the child. In the early days, this is very problematic. A frozen pregnancy, the signs in the first trimester of which may be similar to less serious abnormalities, manifests itself as follows:

• passes;
• no more ;
• lowered;
• cramping pains began to appear;
• smearing appeared (discharge during a frozen pregnancy in the early stages has exactly the same consistency and red-brown color);
• the overall body temperature has increased.

If any of the listed symptoms are detected, a woman needs to urgently consult a doctor! If the signs of pregnancy have disappeared, then this should also alert mommy and become a reason to visit a specialist!

What does a pregnant woman feel with the development of pathology

Feelings of a frozen pregnancy in women are very different. They are even influenced by the fact whether this happened for the first time or a similar situation happened before. Fatigue, apathy, fever - all this, in any case, should alert the expectant mother.

It is worth noting that all symptoms that indicate the development of pathology may turn out to be false! There is no need to immediately set yourself up for the approach of disaster. Quite often, they turn out to be similar to less serious ones, or the body is simply undergoing a readjustment.

Diagnostics of the fact of fetal freezing

Only a doctor knows exactly how to recognize a frozen pregnancy at an early stage. To do this, he will do the following:

1. , will assess the state of the secreted mucus, ask to measure the basal temperature.
2. If there is a suspicion of a deviation from the norm, the doctor will send the pregnant woman to hand over. However, it is worth noting that hCG with a frozen pregnancy in the early stages can be completely within the normal range for several weeks after the death of the fetus. And yet, more often, urinalysis will show an underestimated level of the hormone, uncharacteristic for the first trimester.
3. The last stage of the examinations will be an ultrasound scan. With the help of an ultrasound examination, it will become clear whether the heart is beating in the embryo or not.

Tellingly, a test with a frozen pregnancy in the early stages may show all the same two stripes. This is again related to the level of hCG in the urine.

After the specialist makes sure of the diagnosis, he will choose the necessary set of procedures for the mother, and also help her in the future to prepare for a new pregnancy.

What do doctors do if the fetus is frozen

Depending on how a frozen pregnancy manifests itself in the early stages, as well as directly on the number of days from the moment of conception, the doctor will choose the most alternative method of treatment. Indeed, when establishing such a diagnosis, it is already a question of preserving the life and health of the mother. There are two main methods of treatment:

• With the help of drugs that provoke. It is used for up to 8 weeks.
• (vacuum aspiration). Under anesthesia, a woman is cleansed of the uterine cavity using a vacuum suction.

In any case, professional help will be required, since in order to avoid adverse consequences, it is necessary to clean the uterine cavity (the remnants of the amniotic egg, which will be indicated by an ultrasound scan).

There is a third option, in which even the woman herself does not have time to realize that she was pregnant. This is a spontaneous abortion. If the fetus froze almost from the first days of life, then the body can reject it like a foreign body. In this case, a woman will simply notice a delay in menstruation. Sometimes doctors prefer to observe the patient's condition, waiting for a spontaneous abortion, so as not to interfere with the body once again.

Why is it so scary not to see a doctor in time?

Sometimes a woman does not fully realize how severe the consequences of a frozen pregnancy at an early stage can be for her. But the organism does not always reject the fetus itself. If the embryo, which has stopped developing, is in the womb for a long time, then it is quite likely that intoxication will develop. In this case, not only the temperature rises, the woman begins to suffer from acute pains and weakness, it is quite possible to delay the time until the blood becomes infected with the elements of fetal decay.

If the gestation period is more than 6 weeks, then in this case the woman has every chance of earning desseminated intravascular coagulation (disseminated intravascular coagulation syndrome). The danger is that the blood loses its ability to clot. As a result, the woman may die from bleeding.

How to prevent fetal freezing during pregnancy

A couple, regardless of whether they are preparing to become parents for the first time or have children, must be examined. It is he who will be able to reduce the risks and give an answer on how to avoid a frozen pregnancy in the early stages in their case. The doctor will offer to pass several tests: hormones, genetic tests, ultrasound of the pelvic organs, blood for infections and other additional tests that will be prescribed taking into account the parents' anamnesis. It is also recommended to refrain from conceiving for up to six months after diseases such as ARVI, flu, chickenpox.

If a woman works in a children's team, then she will be asked to get preventive vaccinations. Additional hormones will need to be adjusted. A visit to a geneticist should not be ignored. A healthy lifestyle will only increase your chances of becoming a parent. In the first months, it is recommended to refrain from flights, abrupt climate change and prolonged exposure to the sun.

If the previous pregnancy ended in stopping the development of the embryo - do not give up! With the right planning, the chance of having a normal delivery and childbirth is 80% -90%. And how to prevent a frozen pregnancy at an early stage will be advised by a gynecologist who is managing a couple.

Pregnancy after stopping fetal development

Doctors predict good chances of conception only on the condition that the couple does not ignore visits to specialized specialists, undergo a course of treatment, and also give up thinking about the child for the next six months after an unsuccessful experience. On average, such a period is necessary not only for a detailed examination and finding out the cause of the pregnancy fading, but also for the physical recovery of the mother's body.

Sadly, but with 100% certainty, it is quite rare to say exactly about the reasons for stopping pregnancy. However, parents do not need to despair! Try to avoid stress, harmful factors, and also do not forget to get tested - and may you succeed, and the baby will be born healthy and happy!

A frozen pregnancy is a pathological condition of the fetus when the embryo stops developing in the womb. Most often, this phenomenon is observed at 5-6 weeks, when the placenta has not yet taken root in the uterus.

There are many reasons for the anomaly. The growth of the fetus is influenced by both external and internal factors. The disease proceeds without pronounced symptoms. There are only symptoms of normal pregnancy: toxicosis, breast enlargement and halo, there are no periods. It would seem that a healthy bearing of a baby should not provoke any problems, but sometimes the fetus freezes, which entails serious consequences.

What is a frozen pregnancy

Frozen pregnancy (FG) is an abnormal development of the embryo. When the pathology begins to progress, the child stops growing and freezes inside the mother, as a result of which the death of the baby is observed. The pathological condition is also called a failed miscarriage, since fetal death occurs arbitrarily without clinical signs.

An abnormal condition occurs in any trimester of bearing a baby. Most often, the diagnosis occurs in women over 40 years of age. The pathological condition is advantageous in the first trimester at 7–8 weeks of development. If the problem is not immediately identified, this will entail inflammatory processes in the reproductive organs and provoke serious consequences.

Symptoms of the disease can not always be determined in time, since at the initial stages of fertilization, they are similar to the usual signs of a normal pregnancy.

With each trimester, the signs change and become more pronounced. Most often, the pathology can be detected after 9 weeks of development, since the woman's well-being begins to deteriorate rapidly.

Why the fetus can "freeze"

There are many ST causes and triggers. At the initial stages, there is an asymptomatic course of the disease, which is detected by clinical examination. If the process develops, then at 15–20 weeks of progression, the girl will develop severe symptoms. In this case, the pregnant woman is hospitalized and provided with emergency medical care.

To avoid the appearance of abnormal fetal development, you should know the main causes of the onset of the disease. Having eliminated the negatively influencing factors in time, it is possible to avoid the pathological process.

The pathogenic factors that provoke the disease include:

1. Genetic abnormalities during fetal development.
2. Infectious diseases.
3. Improper IVF administration or complications after the procedure.
4. Damage to the placenta during gestation with sexually transmitted infections.
5. Consumption of alcohol, cigarettes, drugs.
6. Late conception of a child.
7. Placental abruption due to poor attachment to the walls of the uterus.
8. Endometriosis
9. Endometritis.
10. Antiphospholipid syndrome.
11. Constant stress, anxiety, nervous breakdowns.
12. Chronic diseases.
13. Heredity.
14. Physical fatigue.
15. Chromosomal and genetic abnormalities

According to doctors, the death of a baby in the womb happens for a variety of reasons. However, there are the most significant factors that can cause the disease. These include:

Infections

Infectious lesions of the body are the most dangerous for the unborn child. For the most part, it is viral infections that can destroy the embryo at the initial stages, especially if the girl has not previously suffered from such types of ailment.

The most popular viral diseases include:

• herpes;
• rubella;
• toxoplasmosis;
• cytomegalovirus;
• thrush;
• gardnerella;
• urealitikum.

Particles of viruses such as herpes and cytomegalovirus are in remission in the human body throughout their life. The chronic form of the disease is less dangerous for the unborn child, since the woman's immunity already knows how to resist it. But sometimes the exacerbation of the disease leads to disastrous consequences.

Directly sexually transmitted infections significantly increase the likelihood of embryo death. Viruses such as HPV, chlamydia, mycoplasma and ureaplasma cause severe inflammation of the genital and reproductive organs. In addition, flu and colds will negatively affect the development of the fetus and the health of the expectant mother. Such diseases are especially dangerous from 3 to 5 weeks of gestation, when the egg has not yet matured.

Death of an embryo due to infection is observed for several reasons:

1. Once inside, harmful bacteria have a direct effect on the egg, affecting its membrane.
2. When the body is damaged by microbacteria, it produces additional biological components that help fight the virus. This process disrupts blood flow to the egg, oxygen deprivation occurs and the embryo dies.
3. With chronic inflammation, the walls of the uterus weaken, the placenta cannot fully gain a foothold. Because of this, the required amount of nutrients does not reach her.

Due to the high risk of losing a baby in the early stages of fertilization, a woman after repeated fertilization should be more attentive to her health. Do not overcool, walk in wet and damp weather, visit places where there is a high probability of contracting the flu, and use contraceptives during sex.

Hormonal Disorders

When a girl is carrying a child, cardinal changes are observed in her body. In the 1st trimester, the hormonal background changes, therefore, its jumps and disruptions can be observed. Because of this, there is a lack of progesterone and estrogen. These components transport nutrients to the fetus. With their deficiency, the outflow of oxygen and trace elements decreases.

Sometimes the pathological condition of the egg occurs due to malfunctions of the ovaries or thyroid gland. Failures in the work of organs worsen the condition of the uterus, and the fetus does not take root in the womb.

Autoimmune pathology

Autoimmune disorders are observed due to the large amount of antibodies in the blood plasma. The disease is the cause of the manifestation of the disease in almost 6% of cases. If fertilization is observed for the second time, then the disease is observed in 35% of women.

Due to autoimmune pathology, thrombophilia is formed in the body, and most often a diagnosis is made of the genetic predisposition of the fetus. Complications with such a diagnosis occur if the woman is over 30 years old. The older the woman, the higher the likelihood that the embryo will not be able to develop normally inside. Therefore, before getting pregnant, it is worth undergoing a full medical examination and finding out if there are any health problems that could be a threat to the life of the mother and the unborn child.

Teratozoospermia

Teratozoospermia is an abnormal condition of sperm cells. With the progression of the disease, the sperm is deformed and its structure changes. Pathology is characterized by a thickening or strong curvature of the tail. And also the sperm sometimes lacks a chromosome.

Problems with the growth of a baby in the womb are often caused by poor sperm counts. The development of teratozoosperia subsequently leads to male infertility. But sometimes not all sperm cells die in the ovaries, and a woman can become pregnant. Such fertilization will eventually lead to miscarriage or premature birth. The progression of the disease due to the presence of teratozoosperia in a man is observed in 55-60% of cases of the development of an anomaly.

Wrong way of life

When planning and carrying a baby, do not forget about such an important factor as the lifestyle of the expectant mother. Bad habits, improper nutrition, non-compliance with the daily routine - all this can adversely affect the health of the mother and the unborn baby.

The presence in the body of toxic substances or some active components of the drug can negatively affect the placenta and destroy it. Therefore, before taking the pills, you need to consult with a gynecologist and find out if this will harm the baby. And also you need to adjust your meager diet and completely abandon bad habits, stress, hard work.

Other factors

The growth of the embryo is negatively affected by: climate, stress, nervous breakdown. Any negative emotions throw enzymes into the body that delay the growth of the baby.

Do not forget about previous abortions. If the girl has already had several abortions and mechanical cleaning after miscarriages. There is a chance that the uterus, ovaries, or fallopian tubes have been damaged. The laxity of the uterus can also be the reason why the fetus did not take root and die. In cases where a girl had IVF, the subsequent natural pregnancy is usually difficult and the fetus runs the risk of dying even in the last weeks of pregnancy.

Who is at risk

Girls are at risk of embryo freezing during gestation:

1. Age who is over 30 years old.
2. Abortions at an early age.
3. If there were multiple abortions and arbitrary miscarriages.
4. Who have had a previous ectopic pregnancy.
5. With the presence of pathological diseases of the reproductive organs.

It is impossible to determine that an anomaly is developing on your own at home. During this period, nausea and vomiting often occur, as in the normal course of gestation.

Treatment methods

Only a gynecologist can make a final diagnosis after examining the girl and conducting a laboratory test. The doctor examines and feels the woman's belly. When deviating from the norm, a small expansion of the uterus is observed. A diagnostic method such as ultrasound helps to make an accurate diagnosis.

Sometimes anembryonia is diagnosed (the absence of an embryo in the ovum). With this diagnosis, pregnancy also does not develop. It is also worth noting that a sign of a frozen pregnancy in late gestation is the absence of a baby's heartbeat. Low hCG levels and increased prolactin in the blood also indicate problems.

If, nevertheless, such a diagnosis was established, then the treatment is carried out within the walls of the hospital. In the hospital, doctors carry out different therapeutic measures depending on the length of the pregnancy.

Treatment is as follows:

• In the 1st trimester, a medical abortion is performed.
• In the 2nd trimester - oxytocin is used to expand the uterus and the baby's natural exit (in rare cases, a cesarean section is performed).
• In the third trimester, vaginal delivery or cesarean section.

If antennal death of the embryo was established, then a spontaneous miscarriage is observed. If the loss of a child occurs within 10-16 weeks of gestation, then the girl is prescribed medication.

In cases where the fetus has left the body partially or severely damaged the uterus, surgery can be performed and the body is cleaned of the remainder of the placenta. After the operation, the woman is prescribed a medication course of rehabilitation in the hospital, if necessary, psychological assistance may be needed.

How to avoid a frozen pregnancy

If a girl has problems carrying a baby, and the pregnancy is interrupted, then there is no need to despair. There is always a chance to get pregnant again. But you need to know how to avoid the negative consequences of ST and give birth to a healthy baby next time. Women need to undergo a complete examination at the clinic. It is important that both parents pass, since the reason for the interruption of gestation may lie in the man.

A woman needs to reconsider her lifestyle. Eliminate alcohol and nicotine. Nutrition should be balanced and healthy. It is best to give up fatty, salty and junk food. Play sports and move more.

It is important to regularly visit a gynecologist. This minimizes the risk of contracting infections and prevents the development of serious diseases in the body. A girl's life should have positive emotions and a warm atmosphere. Only then the risk that two frozen pregnancies will arise in a row will be minimal.

You can find out in more detail about the reasons for the appearance of abnormal development of the embryo in the womb by watching an educational video for expectant mothers:

Conclusion

A delay in the development of the fetus in the womb can occur at any period of gestation. This serious pathological condition leads to the death of the embryo, the causes of the onset of the disease are different. Therefore, it is important to plan for the future baby, responsibly approach the new position and regularly visit the gynecologist to prevent problems during gestation.