What are the signs of a missed pregnancy in the early stages. What diagnosis of a missed pregnancy will be the most accurate? Consequences and prognosis after a missed pregnancy

Many couples dream of trying on the role of young parents. Unfortunately, this desire is not always realized. One of the reasons for this problem is missed pregnancy. Both the father and the mother can be to blame for this pathology. That is why it is so important at the planning stage to go through full examination both partners. What if it's early? How to prevent this pathology?

general information

A missed pregnancy is a condition in which the fetus stops growing and developing, as a result of which it dies. Signs of spontaneous abortion may be absent, but the embryo remains in the uterine cavity. That is why such a pathology is also called a failed miscarriage. Fading can happen at any time, but most often it occurs in the first trimester. The most dangerous are the 3-4th and 8-10th weeks.

What happens during a missed pregnancy? The fertilized egg travels to the uterus, where it is implanted. After some time, the growth of the embryo stops. Another variant of a missed pregnancy is the empty egg syndrome. In this case, the fetal membranes develop, chorionic gonadotropin synthesized, but the embryo itself is absent. If you take a pregnancy test, the result will be positive. Among the main causes that affect the occurrence of empty egg syndrome, doctors distinguish various chromosomal pathologies.

How often is a missed pregnancy diagnosed?

According to statistics, every second woman's pregnancy "freezes" and ends in spontaneous abortion. This usually happens before the lady finds out about her interesting position. The risk of developing this pathology after the test shows positive result, is not more than 20%.

How to determine a frozen pregnancy in the early stages?

The development and growth of the fetus over nine months depends on many factors. Sometimes a certain set of circumstances can lead to a stop in this process and the death of the embryo. The symptoms of freezing are very obvious, and medical diagnosis usually does not cause difficulties. The first in the early stages is the disappearance of a condition that is characteristic of a woman in a position. In this case, you must consult a doctor. A specialist in the results of an ultrasound examination will be able to determine the presence or absence of pathology. After that, appropriate treatment is prescribed.

Causes of pathology

Why does pregnancy freeze at an early stage? This is the question asked by women who have already had to face this problem. Doctors identify a number of factors that can affect the formation of the pathological process.

1. Chromosomal and genetic abnormalities. This is the most common cause of a missed miscarriage. When an embryo inherits a pathological gene or an extra chromosome, various defects appear in the development process. Most often they are incompatible with life, so the fetus dies inside the womb. This is where the rule of natural selection comes into play. Nature decides what to produce disabled baby wrong, therefore "terminates" the pregnancy. A genetic anomaly can also occur against the background of smoking or drinking alcohol.
2. Infections. A huge role in the genesis of missed pregnancy belongs to infectious diseases. These include rubella, toxoplasmosis, herpes infection. Sexual diseases and common colds should not be ignored. Infection in the first trimester is especially dangerous. Infectious agents after penetration through the placenta affect the fetus. They can interfere with normal implantation and nutrition of the embryo. As a result, it turns out that the pregnancy froze at an early stage.
3. Hormonal disorders. Deficiency of the main pregnancy hormone progesterone can serve as one of the causes of fading.
4. Autoimmune pathologies. With such diseases, antibodies begin to be produced in the mother's body. They fight not with foreign elements, but with their own cells. It is known that the embryo inherits about 50% of the mother's genes. As a result, antibodies begin to kill the cells of the fetal body, which entails its death.
5. Teratozoospermia. In a missed pregnancy, sometimes the father himself is to blame. Teratozoospermia usually causes male infertility. If you still manage to conceive a child, usually its development stops for early stages. Teratozoospermia is a pathology of spermatozoa, which is expressed in their abnormal structure. It can manifest itself as an irregularly shaped head, a short tail or its inflection.
6. Wrong way of life. The occurrence of a missed pregnancy is affected by the nutrition of the future woman in labor, her work and rest regimen, and addictions. We should not forget about the possible adverse reactions after the use of drugs. The age of the woman also plays an important role. The older she is, the higher the likelihood of pathology.

Only the most common causes are listed above. In fact, there are a great many of them. In each case, only a doctor can determine what caused the pregnancy to fade.

Signs of a missed pregnancy

Many women are concerned about the question of how to recognize a missed pregnancy at an early stage at home? The whole insidiousness of this condition lies in the fact that it is often asymptomatic. From the moment of death of the fetus to the actual miscarriage, several days, and sometimes weeks, may pass. What signs of a missed pregnancy in the early stages should I pay special attention to?

First of all, the symptoms that characterize pregnancy disappear in a woman: toxicosis, weakness, malaise. Nausea and vomiting, intolerance to certain odors disappear. However, if the signs were weak, you should not pay attention to this parameter.

downgrade basal body temperature is also a sign of fetal death. Such changes appear against the background of a decrease in the level of progesterone, since it is this hormone that is responsible for maintaining pregnancy. Basal temperature is recommended to be measured in the morning in the rectum. Before and immediately during measurements, it is necessary to be motionless for several hours. The basal temperature during a frozen pregnancy in the early stages usually decreases and does not exceed 37 degrees.

Softening of the breast may also indicate the fading of the fetus. From the moment the baby is conceived in women, the mammary glands almost immediately swell and become painful. After his death, the chest relaxes, but you should not immediately panic. According to many women, during the entire nine months of pregnancy, the breasts can tighten and relax several times. Doctors explain this fact by hormonal changes.

Pulling pain in the lower abdomen and spotting rarely signal this pathology. This is its main difference from spontaneous miscarriage. In any case, if there is a discharge or a feeling of discomfort, you should consult a gynecologist.

These signs do not always indicate the fading of the fetus. They can occur during normal pregnancy. If you have the above symptoms of a missed pregnancy in the early stages, it is recommended to seek help from a doctor to clarify the diagnosis.

Medical diagnostics

Only a specialist can confirm or refute the diagnosis of "missed pregnancy" after conducting an appropriate examination. The first step is an ultrasound examination. Using ultrasound, you can check the viability of the embryo and determine its approximate size. The doctor also measures the degree of increase in the uterus, the thickness of the chorion. If the results of the examination are doubtful, the specialist appoints a second visit after 12 days. It should be noted that the quality of the equipment plays an important role in obtaining reliable and most informative data. Sometimes older ultrasound machines can "not notice" the presence of a heartbeat in the fetus, which leads to an incorrect diagnosis.

Then the woman is prescribed a blood test for beta-hCG. With a frozen pregnancy in the early stages, a decrease in this indicator is observed, which indicates that a gradual increase in the content of this hormone in the blood is considered normal.

Treatment of a missed miscarriage

If a miscarriage is suspected, a woman is hospitalized. If the pregnancy froze at an early stage, all the efforts of doctors should not be aimed at preserving the fetus, but at restoring the health of the woman.

After a complete examination (ultrasound, hCG), the evacuation of the fetal egg is prescribed. If the embryo is dead for no more than 14 days, doctors resort to expectant tactics. Another indication is the absence of signs of spontaneous abortion and infection of the uterus. The level of the hormone in the early stages gradually decreases. The uterus begins to contract and push out fertilized egg.

However, most often doctors resort to surgical intervention. The fetal egg and its membranes are removed by scraping. For up to 7 weeks, a medical abortion is usually used. After surgery, a hysteroscopy is mandatory. In the postoperative period, women are prescribed antibacterial agents for the prevention of endometritis and chorionamnionitis.

Recovery period

After identifying the cause of the fading pregnancy and the course of treatment, the woman needs to restore her strength. This usually takes no more than six months. During this period, you should adhere to a healthy lifestyle and be sure to use contraceptives. Some women require psychological counseling. The specialist helps to overcome all fears regarding future pregnancy planning.

What tests to take after a failed miscarriage?

Before conceiving a child after a pregnancy fades, doctors recommend taking the following tests:

• vaginal smear for STDs;
• ultrasound examination of the pelvic organs;
• a blood test to assess progesterone and estrogen levels;
• histological examination of the biological material of the uterus.

If a missed pregnancy has been diagnosed several times already, both partners need to undergo genetic testing for compatibility. If the test results do not show serious violations, you can think about conception.

Prevention of missed pregnancy

To prevent the recurrence of such a situation, doctors recommend that certain preventive measures be observed even before the moment of conception. In the presence of infections that are transmitted directly sexually, it is necessary to undergo a course of treatment. If you did not have rubella or chickenpox as a child, you should get all vaccinations before conception. This is especially true for those women whose work is related to children.

Symptoms of a missed pregnancy in the early stages inspire fear in many of the fair sex. In order not to face the manifestations of this pathology, doctors recommend adhering to a healthy lifestyle and eating rationally. In addition, it is necessary to refuse bad habits more time to be physically active.

Summing up

Absolutely any woman can find out that the pregnancy froze at an early stage. This pathology does not always indicate pathological disorders in the functioning of the body, but it is still worth undergoing an examination. According to its results, the doctor can prescribe the necessary treatment and give useful recommendations.

Frozen pregnancy in the early and late stages: causes and prevention

- this is the cessation of fetal development 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 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 missed pregnancy in the early stages are different from the late ones. Let us consider in more detail such a phenomenon as frozen pregnancy causes and preventive measures.

So, even during the planning of pregnancy, it is necessary to abandon the use of alcoholic beverages (especially in large quantities) and smoking. Alcohol and smoking do not always lead to missed pregnancy, but the risk of its onset in such women increases.

Absolutely precisely during the planning period and most pregnancy(to avoid miscarriage and frozen) do not use drugs without a doctor's prescription. And before you start taking them, you should carefully read the instructions for the drug, perhaps there is 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 what has come pregnancy and take any medicine and as a result - frozen. The embryo is highly susceptible to teratogenic effects. But, meanwhile, will taking medications at a very early date cause harm - 7-10 days from the day 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 placenta partially protects the child from teratogenic effects and, accordingly, the number missed pregnancies decreases somewhat over long periods. If you work in a hazardous industry, then you also have an increased risk missed pregnancy.

It may lie in violations of the hormonal background of a woman, most often, this is a lack of progesterone - the hormone of pregnancy. If you have a history of missed pregnancy, miscarriage, frequent delays in menstruation and male-pattern hair growth, then before planning a pregnancy, you need to take hormone tests and, if necessary, undergo treatment, so you will reduce the likelihood missed pregnancy in future.

The next reason missed pregnancy not only in the early, but also in the later stages 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 chicken pox and rubella) can lead not only to missed pregnancy, but also, worst of all, developmental anomalies 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 missed late pregnancy.

How to avoid missed pregnancy due to an exacerbation or infection with an infectious disease? First, 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 your childhood. If not, and besides, you are at risk (working with children), then in order to avoid infection with them and as a result missed pregnancy or miscarriage, it is better to vaccinate against them 3 months before planning a pregnancy. If you have STIs (sexually transmitted infections), you should first of all get rid of them and only then plan a pregnancy.

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

To all women, without exception, for prevention missed pregnancy and other troubles, it is necessary to strengthen your immunity during the happy expectation of the baby. There are a lot of ways, it is not necessary to drink dietary supplements and vitamins. Proper, nutritious nutrition will suffice. During pregnancy, immunity always decreases, this is due to the production of a special hormone - human 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 a "foreign" object that needs to be disposed of, here's another possible one for you.

However, the most common reason missed pregnancy are genetic abnormalities in the fetus. Nature itself does not allow the “sick” embryo to develop and frozen pregnancy. Typically, if there is cause of missed pregnancy in a woman, that is, there is a high probability that this will not happen again if the parents themselves are healthy.

Symptoms of a missed pregnancy and its diagnosis

Unfortunately, missed early pregnancy may not make itself known. Later, symptoms of missed pregnancy a woman may become cramping pains and spotting spotting. This usually occurs at the beginning of the detachment of the fetal egg, that is, the beginning of a miscarriage.

to subjective symptoms. missed early pregnancy also include a sharp cessation of toxicosis (if any). Also, the soreness of the mammary glands and the basal temperature may decrease. Usually these missed pregnancy symptoms women do not go unnoticed. Frozen late pregnancy characterized by the absence of movements of the child.

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

At missed pregnancy the hCG level is lower than it should be at this stage of pregnancy. Ultrasound shows no 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 frozen pregnancy, know that symptoms are a minor sign. The main thing is medical evidence, so to speak ... With such a phenomenon as frozen pregnancy symptoms at different women may be different or even absent.

Usually frozen pregnancy ends with a "cleansing" of the uterine cavity in stationary conditions. But in the early stages, it is possible to conduct a vacuum aspiration or induce a miscarriage with the help of certain medications (under the supervision of a doctor). Sometimes when missed early pregnancy 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 fetal egg are diagnosed by ultrasound in the uterus, then curettage (curettage) of the uterine cavity is performed.

Pregnancy after a missed pregnancy

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

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

A woman who has experienced such a state as frozen pregnancy treatment may not be required at all if all test results are normal. As we wrote earlier, frozen pregnancy, most often happens due to a genetic error, which is unlikely to happen again ... But if frozen pregnancy happened not for the first time, then treatment, most likely, will be 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 pregnancy, missed miscarriage, missed abortion) 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 amounts to 10-20% of all desired pregnancies.

Frozen pregnancy - causes

Reasons not developing pregnancy numerous and often complex. In everyday practice, it is often difficult to establish a specific factor that led to this pathology, as this is prevented by tissue maceration after the death of the fetus, which makes their genetic and morphological studies difficult.

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

A feature of the etiological structure inflammatory diseases currently there are various associations of microorganisms, including anaerobic bacteria, facultative streptococci, viruses. This is due to a certain extent to the peculiarities of the mother's immune response, 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 for certain 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 capable of causing 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, mycobacteria.

4. The simplest - toxoplasma, plasmodia, fungi of the genus Candida.

With viral and mycoplasmal 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 due to 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 entry of microorganisms, the 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 disease of the mother and other factors.

The ascending route of infection of the embryo (fetus), which prevails in the first trimester of pregnancy, is caused by opportunistic bacteria, as well as mycoplasmas, chlamydia, fungi of the genus Candida, and 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 condition of the embryo (fetus): chorion 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 broken or not. The fetus swallows 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 lesions of organs 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 caused by gonorrhea and chlamydial infection. 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 fetal death can be associated not only with the direct damaging effect of the infectious agent, but also with inadequate development of immune responses in the placental tissue.

Frozen pregnancy - immunological causes

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 is secreted by gamma, IL-2, and beta-TNF, while TX2 is secreted by IL-4, -5, and -10. TNF-alpha is secreted by both cell subpopulations, but predominantly by TX1. Cytokines are mediators in the development of inflammatory and immune responses in the mother-placenta-fetus system. Tx-secreted cytokines by mechanism feedback regulate the function of these cells. It has been established that TX2, which provides predominantly humoral immune reactions, 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 is a huge number of cells of the immune system, all of which are capable of secreting cytokines. Violation and termination of pregnancy can occur as a result of an impaired immune response to antigens. As a result of this, 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 have an effect 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 cause of non-developing pregnancy. The death of the embryo may be due to the pathological development of the zygote, embryo, fetus, or structural disorders in the genetic program for the development of the placenta. In observations of spontaneous miscarriages caused by chromosomal pathology, various disturbances in the development of the embryo, up to its complete absence, are very characteristic.

Frozen pregnancy - genetic causes

A special role in the etiology of non-developing pregnancy belongs to chromosomal aberrations. The majority of embryos with 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 chromosome aberrations in abortuses, 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 malformations; the chorionic cavity is empty and small. Most autosomal trisomies are the result of the absence of chromosome segregation during the first mitotic division of the oocyte, and the frequency of this phenomenon increases with maternal age. It should be noted that the age of the mother does not crucial for other chromosomal abnormalities that cause a stop in the development of pregnancy.

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

Triploidy and tetraploidy occur with moderate frequency, but those cases of triploidy in which there is a dual parental component usually result in partial mole, clinically manifesting later in pregnancy.

An important structural pathology 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 the history of the spouses has indications of repeated non-developing pregnancies or spontaneous miscarriages. Among other types of karyotype disorders - various forms 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 due to blastopathy and are associated mainly with chromosomal abnormalities or malformations caused by adverse external factors. Blastopathy, leading to the death of the fetus 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 embryo sac due to aplasia or resorption of the embryoblast (without amnion, amniotic stalk and yolk sac).

3. Hypoplasia of the amniotic cavity with partial or complete extra-amniotic location of the embryo in the whole.

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

5. Twin defects: thoracopagi, ischiopagi, etc.

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

The most common forms with gross chromosomal pathology are empty embryo sacs, 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 an 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 cases, changes occur that affect the entire embryo and thus lead to its death.

Embryopathies are more often manifested by congenital malformations, usually in the form of gross violations of 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 causes of 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 weak decidualization of the endometrial stroma. Incomplete or weak invasion of the cytotrophoblast into the adjacent endometrium helps to reduce the number and volume of gestational changes in the uteroplacental arteries and reduce uteroplacental circulation. This may result in the death of the embryo and detachment of the trophoblast.

The 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 overall genetic program for the development of the embryo and placenta.

Not with all endocrine diseases, intrauterine death of the embryo (fetus) is observed. Hyperandrogenism (Stein-Leventhal syndrome, adrenogenital syndrome), hypo- and hyperfunction of the thyroid gland contribute to insufficient 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. One of the variants of autoimmune disorders is APS.

Antiphospholipid antibodies alter the adhesive characteristics of the pre-implantation 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 trophoblast decidual invasion. Antiphospholipid antibodies directly interact with syncytiotrophoblast and cytotrophoblast and inhibit intercellular fusion of trophoblast cells. In addition, antiphospholipid antibodies suppress CG production and enhance thrombotic tendencies by providing templates 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 early abortions are related to maternal illness, 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. A very clear example in this regard are heart defects.

If we evaluate the sensitivity of the embryo and fetus to damaging factors, then we can say that the shorter the gestational age, the higher this sensitivity. However, it decreases unevenly throughout fetal development. There are so-called critical periods during pregnancy, when the fetal egg, embryo, fetus are especially sensitive to adverse factors: the implantation period (7-12th day), the embryogenesis period (3-8 weeks), the period of placental formation (up to 12 weeks) , the period of formation of the most important functional systems fetus (20-24 weeks).

Frozen pregnancy - consequences

Pathogenesis. The main pathogenetic moment of non-developing pregnancy is the first stop of FPC with continued uteroplacental circulation. Allocate the following pathomorphological processes characteristic of non-developing pregnancy.

1. Decrease and cessation of embryochorionic circulation in combination with involutional changes in the chorionic villi. The borderline state between disturbed and 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 the metabolic processes necessary for the development of pregnancy.

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

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

With a non-developing pregnancy, the phenomenon of "reverse development of the endometrium" may occur, associated with the long-term persistence of the ovarian corpus luteum in the conditions of the gradually fading hormonal activity of the deceased fetus.

The endometrium, adjacent to the zone of location of the regressing fetal bladder, may retain 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 have signs of an early, middle or late stage of the proliferation phase. Signs of glandular-cystic hyperplasia of the endometrium testify to the long-term persistence of a non-developing pregnancy.

After the death of the embryo and the stoppage of FPC, 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 stroma of the villi are noted. If there are no erythrocytes in the vessels of the villi, then it can be assumed that the arrest of the embryo-placental circulation occurred before 4-5 weeks of gestation; if nuclear erythrocytes predominate, then the death of the embryo occurred during the period of yolk circulation (5-9th week of pregnancy). The presence of non-nuclear erythrocytes indicates a violation of the development of the embryo already at a later gestational age.

Frozen pregnancy - signs

Clinic. A clinical sign of a non-developing pregnancy is an erased picture of subjective manifestations of pregnancy disorders against the background of stabilization of the size of the uterus and their inconsistency with the term of gravid amenorrhea. The uterus may be of normal size, may be reduced, may even be enlarged if there is a hematoma in the cavity.

In this case, as a rule, hCG in the blood of a woman is at an extremely low level or even completely absent. Gradually disappear subjective signs pregnancy (although for some time after the death of the embryo or fetus, the patient may feel pregnant), spotting 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 anembryony, i.e., the absence of an embryo in the cavity of the fetal egg after 7 weeks of pregnancy. The fetal egg is smaller than expected for the estimated gestational age, the decidua has a discontinuous contour, the embryo is not visualized or the fetal egg is the same size as the gestational age, the embryo can be visualized, but very small in size and without a heartbeat. Often there is a retrochorial hematoma. If the study is carried out before 8 weeks of pregnancy, then it is necessary to repeat it after 7 days.

Another echographic picture of a non-developing pregnancy is a “frozen fetus”, in which the fetal egg and embryo are visualized. regular shape and size without signs of vital activity of the fetus. As a rule, such signs are characteristic of the recent death of the embryo, which may not yet be accompanied by clinical signs interrupt threats.

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 fetal egg is sharply changed - deformation, fuzzy contours and shape of the fetal egg, the presence of multiple constrictions and separate scattered echostructures are noted.

Of particular importance is the establishment of a variant of the echographic picture of an undeveloped pregnancy, when normal fetus there may be transient bradycardia or syncope without a heartbeat, so observation for a few minutes is necessary. Other signs of fetal death are pronounced oligohydramnios, as well as damage to the bones of the skull with the entry of 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 fetal egg 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

Outcome of non-developing pregnancy. The death of the embryo (fetus) is not always accompanied by rapid spontaneous expulsion from the uterus. The absence of any proliferative and metabolic processes on the part of the cellular and tissue elements of the fetal bladder due to their advanced dystrophic and necrobiotic changes is exacerbated by the areactivity of the uterus, which does not reject the dead fetus. Often there are cases when a dead fetal egg lingers in the uterus for an indefinitely long time.

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

1. Deep invasion of chorionic villi, providing dense attachment or true increment of the developing 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 area of ​​implantation due to previous curettage of the uterus;

o implantation of the fetal egg in places of incomplete gravid transformation of the uterine mucosa.

2. Inferiority of reactions of immunocellular rejection of the dead fetal bladder. A cascade of immunocellular reactions unfolds, 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 fetus can be so close that it determines the state of the immunological unreactivity of the uterus in relation to the dead embryo.

3. Areactive uterus. Contractile hypofunction of the 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 contracting substances are not formed;

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

Most often, a gradual rejection of a dead fetal egg occurs with the help of a fibrinous-leukocyte exudative reaction in response to necrotic tissue. During this process, along with fibrin and leukocytes, trophoblastic, thromboplastic substances, erythrocytes are released from the vessels of the endometrium, 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 long (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 develops. All this is the risk of developing severe coagulopathy bleeding when trying to terminate the pregnancy. The most unfavorable conditions of uterine hemostasis occur in patients in whom phase hemocoagulation changes are in a state of hypocoagulation and hypotension of the myometrium is expressed.

Difficulties arising from the removal of a dead fetus may be due to the previa of the chorion, the placenta, located in the region of the internal os of the uterus. Before curettage of the uterus, it is necessary to examine the state of the hemostasis system (detailed coagulogram). If violations are identified (hyperaggregation, hypercoagulability, DIC), corrective therapy (fresh frozen, and other components) is necessary. The use of dicynone and ATP contributes to the relief of hemostasiological disorders at the level of the vascular-platelet link. In the postoperative period, antiplatelet and anticoagulant therapy is indicated (, chimes,). 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 the diagnosis of non-progressive pregnancy is established, long-term conservative management of the patient is risky.

After a thorough examination and appropriate preparation of the woman (carrying out therapeutic and preventive measures aimed at reducing the risk of developing possible

complications) it is necessary to terminate an undeveloped pregnancy. In the first trimester of pregnancy:

1. Cervical dilation and vacuum aspiration.

2. Cervical preparation with prostaglandins or hydrophilic dilators and vacuum aspiration.

3. Use of antiprogestogens in combination with prostaglandins.

In the second trimester of pregnancy:

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

2. Therapeutic abortion with intra- and extra-amniotic administration of prostaglandins or hypertonic agents.

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

4. Isolated use of prostaglandins.

An ultrasound scan should be performed immediately during the abortion or immediately after it is completed to ensure that parts of the fetus and placenta have been completely removed.

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

Each case of non-developing pregnancy requires an in-depth examination in relation to genetic, endocrine, immune and infectious pathologies.

Frozen pregnancy - medical measures

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

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

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

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

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

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

o determination of autoimmune disorders (determination of lupus anticoagulant, anti-CHG, 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 missed pregnancy

The tactics of managing patients during subsequent pregnancy is 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 preventive measures aimed at:

o elimination of the infectious process, 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 hemostatic disorders - antiplatelet agents, direct-acting anticoagulants.

SPONTANEOUS ABORTION (MISCARRIAGE)

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

According to the WHO definition, abortion is the 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 Missed miscarriage.
O20.0 Threatened abortion.

EPIDEMIOLOGY

Spontaneous abortion is the most common complication of pregnancy. Its frequency is 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 definition hCG levels the loss rate rises to 31%, with 70% of these abortions occurring before the pregnancy can be recognized clinically. In the structure of sporadic early miscarriages, 1/3 of pregnancies are interrupted in a period of up to 8 weeks according to the type of anembryony.

CLASSIFICATION

By clinical manifestations distinguish:

threatening abortion;
initiation of an abortion
abortion in progress (complete and incomplete);
NB.

The classification of spontaneous abortions adopted by WHO differs slightly from that used in the Russian Federation, combining a miscarriage that has begun and an abortion in progress into one group - an inevitable abortion (i.e., continuation of the 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 trisomy (52%), monosomy X (19%), polyploidy (22%). Other forms are noted in 7% of cases. In 80% of cases, death occurs first, and then expulsion of the fetal egg.

The second most important among the etiological factors is metroendometritis of various etiologies, which causes inflammatory changes in the uterine mucosa and prevents normal implantation and development of the fetal egg. Chronic productive endometritis, more often of autoimmune origin, was noted in 25% of the so-called reproductively healthy women who terminated their pregnancy by artificial abortion, in 63.3% of women with habitual 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 the causes of habitual miscarriages.

RISK FACTORS

Age is one of the main risk factors in healthy women. Based on data from an analysis of the outcomes of 1 million pregnancies, in age group women from 20 to 30 years old, 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 two or more pregnancies have a higher risk of miscarriage than nulliparous women, and this risk does not depend on age.

History of spontaneous abortions. The risk of miscarriage increases with the number of miscarriages. In women with one 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 whose previous pregnancy 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 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 have been obtained indicating a negative effect of the 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 prenatal diagnosis(choriocentesis, amniocentesis, cordocentesis) - the risk is 3-5%.

The use of 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, teratogenic drugs) 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 pregnancy, which is associated with a higher frequency of abnormal fetal karyotype formation.

Hormonal disorders, thrombophilic conditions are to a greater extent the causes of not sporadic, but habitual miscarriages, the main cause of which is an inferior luteal phase.

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

CLINICAL PICTURE AND DIAGNOSIS

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

Depending on the clinical symptoms, there are threatening spontaneous abortion that has begun, an abortion in progress (incomplete or complete) and NB.

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

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

During abortion, regular cramping contractions of the myometrium are determined in the course. The size of the uterus is less than the estimated gestational age; in the later stages of pregnancy, leakage of the OM is possible. The internal and external pharynx are open, the elements of the fetal egg are in the cervical canal or in the vagina. Bleeding may be of varying intensity, often abundant.

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

The absence of full uterine contraction and closure of its cavity leads to continued bleeding, which in some cases causes large blood loss and hypovolemic shock.

More often, incomplete abortion is observed after 12 weeks of pregnancy in the case when the miscarriage begins with the outflow of OB. In a bimanual examination, the uterus is less than the expected gestational age, spotting from the cervical canal is abundant, using ultrasound in the uterine cavity, the remains of the fetal egg are determined, in the II trimester - the remains of placental tissue.

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

The uterus contracts and the bleeding stops. On bimanual examination, the uterus is well contoured, less time gestation, the cervical canal may be closed. With a complete miscarriage, ultrasound determines the closed uterine cavity. There may be small bleeding.

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

With infected abortion (with mixed bacterial and viral infections and autoimmune disorders in women with recurrent miscarriage aggravated by antenatal fetal death obstetric history, recurrent course of genital infections) intravenous immunoglobulins are prescribed (50-100 ml of 10% Gamimun solution, 50-100 ml of 5% Octagam solution, etc.). They also carry out extracorporeal therapy (plasmapheresis, cascade plasma filtration), which consists in physicochemical blood purification (removal of pathogenic autoantibodies and circulating immune complexes). The use of cascade plasma filtration implies detoxification without plasma removal. In the absence of treatment, generalization of 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 for a period of less than 22 weeks in the absence of expulsion of elements of the fetal egg from the uterine cavity and often without signs of a threat of interruption. To make a diagnosis, an ultrasound is performed. The tactic of abortion is 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, the assessment of the rate and volume of blood loss plays a decisive role.

With ultrasound, unfavorable signs in terms of the development of the fetal egg with uterine pregnancy consider:

Absence of embryonic heartbeat with CTE more than 5 mm;

Absence of an embryo with the size of the fetal egg measured in three orthogonal planes, more than 25 mm with transabdominal scanning and more than 18 mm with transvaginal scanning.

Additional ultrasound signs that indicate an unfavorable outcome of pregnancy include:

anomalous yolk sac, not corresponding to the gestational age (more), irregular in shape, displaced to the periphery or calcified;

HR of the embryo is less than 100 per minute in the period of 5-7 weeks;

large retrochorial hematoma (more than 25% of the surface of the fetal egg).

DIFFERENTIAL DIAGNOSIS

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

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

Differential diagnosis is also carried out with hydatidiform mole and ectopic pregnancy.

With a hydatidiform mole, 50% of women may have a characteristic discharge in the form of vesicles; the uterus may be longer term and the intended pregnancy. Typical picture on ultrasound.

At ectopic pregnancy women may complain of spotting, bilateral or generalized pain; fainting (hypovolemia), a feeling of pressure on the rectum, or bladder, test for bhCG is positive. On bimanual examination, there is pain when moving the cervix. Uterus smaller sizes than it should be at the time of the proposed pregnancy.

You can palpate a thickened fallopian tube, often bulging of the vaults. With ultrasound in the fallopian tube, you can determine the fetal egg, if it breaks, you can detect the accumulation of blood in the abdominal cavity. To clarify the diagnosis, a puncture of the abdominal cavity through the posterior fornix of the vagina or diagnostic laparoscopy is indicated.

Diagnosis example

Pregnancy 6 weeks. Started miscarriage.

GOALS OF TREATMENT

The goal of treating a threatened miscarriage is to relax the uterus, stop bleeding and prolong pregnancy if there is a viable embryo or fetus in the uterus.

USA, Western European countries threatened miscarriage up to 12 weeks are not treated, considering that 80% of such miscarriages are “natural selection” (genetic defects, chromosomal aberrations).

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

NON-DRUG TREATMENT

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

MEDICAL TREATMENT

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

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

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

Approaches to the treatment of threatened abortion are fundamentally different in the Russian Federation and abroad. Most foreign authors insist on the inexpediency of maintaining a pregnancy for 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 regimen) - has not been proven in randomized multicenter studies.

The appointment of drugs that affect hemostasis (etamsylate, vicasol, tranexamic acid, aminocaproic acid and other drugs) in case of bloody discharge to pregnant women has no basis and proven clinical effects due to the fact that bleeding during miscarriages is due to 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 performed, the blood group and Rh status should be determined.

With incomplete abortion, profuse bleeding is often observed, in which emergency care is necessary - immediate instrumental removal of the remnants of the fetal egg and curettage of the walls of the uterine cavity. More gentle is the emptying of the uterus (preferably vacuum aspiration).

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

During the operation and after it, it is advisable to administer an intravenous isotonic sodium chloride solution with oxytocin (30 IU 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). Antibacterial therapy is also carried out, if necessary, treatment of posthemorrhagic anemia. Women with Rh-negative blood are injected with immunoglobulin anti-Rhesus.

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

With a complete abortion during pregnancy for a period of less than 14-16 weeks, it is advisable to conduct an ultrasound scan and, if necessary, curettage of the walls of the uterus, since there is a high probability of finding parts of the fetal egg 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".

Management of the postoperative period

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

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

PREVENTION

Methods of specific prevention of sporadic miscarriage are absent. To prevent 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 at a daily dose of 0.4 mg. If a woman has a history of neural tube defects during previous pregnancies, the prophylactic dose should be increased to 4 mg/day.

INFORMATION FOR THE PATIENT

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

FURTHER MANAGEMENT

After curettage of 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 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, it is recommended to conduct an examination before the desired pregnancy occurs to identify the causes of miscarriage in this married couple.

Not always a successful pregnancy ends with a positive outcome. IN medical practice The most dangerous period of time when carrying a child is the first trimester, during which various complications can occur, leading to the death of the fetus.

A frozen pregnancy is a pathology in which the fetus stops growing and developing, it dies in the womb. Sometimes this complication ends in spontaneous miscarriage. However, quite often the dead embryo remains in the uterine cavity, which can cause inflammation, and if the process worsens, sepsis is a serious infectious disease in which microorganisms circulate in the blood.

10 Signs of Missed Pregnancy

No toxicosis

The cessation of morning sickness and vomiting is a sign of a missed pregnancy in the first trimester. However, women do not always pay attention to this phenomenon, because they believe that the unpleasant symptoms have simply passed, and the body has adapted to the appearance of a child. As a rule, toxicosis during a frozen pregnancy ends very abruptly. Usually, this symptom does not appear immediately after the death of the fetus, but after a few days or even weeks.

Return of the breast to the state before the conception of the child

The absence of swelling of the mammary glands and hyperpigmentation of the nipples is another sign of a missed pregnancy. These changes in the chest are also dramatic. In addition, the signs of a missed pregnancy include a one-time cessation of colostrum secretion, if it was secreted earlier.

Decrease in basal body temperature

If a pregnant woman follows her own, then when it decreases, a missed pregnancy can be suspected. When the fetus dies, the thermometer displays a temperature of less than 37 degrees Celsius (usually 36.4-36.9). However, on this basis of a missed pregnancy in the first trimester, it is impossible to accurately diagnose, since an incorrect measurement or thermometer error is possible.

The appearance of pain

The appearance of pain similar to menstrual pain in the lower abdomen may indicate a missed pregnancy. However, this symptom appears after a long period of time, sometimes up to several weeks after the death of the embryo. On the contrary, pulling pains in the lower abdomen, accompanied by spotting, often speak of.

Pathological discharge from the vagina

The appearance of spotting vaginal discharge streaked with blood or red may be a symptom of a missed pregnancy. But much more often this symptom indicates the beginning of a spontaneous miscarriage.

Increase in body temperature

In the presence of an infectious process in the uterus due to the decay of a dead fetus, a woman has an increase in body temperature to subfebrile values ​​​​(up to 38 degrees). However, if this process begins to be systemic, hyperthermia is possible up to very high values ​​​​(40-41 degrees) and the general serious condition of the woman's body.

Frozen pregnancy is not a rare complication and can occur in completely healthy woman, therefore, when making this diagnosis, one should not despair much, since the probability of the next successful bearing of a child and subsequent births is 80-90%.

Lack of drowsiness, fatigue

With a decrease in progesterone due to the death of the fetus, its effect on the woman's body decreases. She no longer feels tired and sleepy. This sign of a missed pregnancy is extremely unreliable, however, if there are other symptoms, a woman should be examined.

No rise in hCG

With a frozen pregnancy, chorionic gonadotropin ceases to increase after the death of the fetus, and then it begins to decrease altogether. Therefore, if this pathology is suspected, the dynamics of hCG should be monitored by passing a second analysis after 2-3 days.

Gynecological examination

During the examination, the obstetrician-gynecologist measures the volume of the uterus. During a frozen pregnancy, there is a lag in size, which can serve as a diagnostic criterion for pathology. However, this sign cannot be used in the first weeks of the gestational age, since at this time the volume of the uterus practically does not differ from its dimensions before conception.

ultrasound

During an ultrasound examination, the doctor can detect a missed pregnancy. This method is considered the "gold" standard in the diagnosis of this pathology. The absence of heartbeats and the lag of the fetus in size are the main symptoms of a missed pregnancy with ultrasound.

Behavior during a frozen pregnancy

If subjective symptoms of a missed pregnancy appear, you should immediately consult a doctor for a thorough diagnosis. If this diagnosis is confirmed with the help of a blood test for hCG and ultrasound, measures are taken to remove the embryo from the uterine cavity.

Sometimes doctors take expectant tactics, the purpose of which is the spontaneous onset of a miscarriage. When this does not happen, or the fetus died a long time ago and there is a possibility of infection of the uterus, an abortion is performed. With a period of less than 8 weeks of pregnancy, it is possible to use artificial miscarriage with the help of.

At short gestational ages, it is possible to use vacuum aspiration, the safest method of surgical abortion. For more late weeks pregnancy, cleaning of the uterine cavity is used. This procedure held under general anesthesia the resulting materials are sent for histological examination.

Risk group

A frozen pregnancy can occur in any, even a completely healthy woman. It is usually associated with congenital anomalies of the embryo that are incompatible with life, or due to increased emotional and physical activity. The risk group for this pathology includes those with untreated genital infection, as well as those who have a history of abortion, or habitual miscarriage. In addition, the chances of developing a missed pregnancy in people with somatic diseases such as diabetes, thyroid dysfunction and thyrotoxicosis are increased.

Any woman can experience a frozen pregnancy, the causes and consequences of a negative condition are being studied by specialists from all countries to prevent a pathological situation and prevent the death of the fetus in the womb. The development of the fetus due to its death can stop at any time. The woman's body rejects non-viable tissue, miscarriage or spontaneous abortion is inevitable.

According to world medical statistics, the symptoms of a missed pregnancy are observed in 20% of women who decide to conceive. Most of the situations occur before the delay of menstruation, so pregnancy does not always become obvious. At risk are women who have crossed the threshold of 35 years and experienced a similar condition earlier.

Why pregnancy freezes

Among the provocateurs of a missed pregnancy, the causes of which are not fully understood, are:

Among the provocateurs of a missed pregnancy, one can also note diabetes mellitus, increased physical activity of the mother, stress and depression. The 8th week is considered the most dangerous, when the fetus acutely perceives any teratogenic effects.

For a long time, doctors argue about the use of alcohol during the period of gestation. Someone allows you to make small deviations from the recommended rules, someone categorically prohibits the intake of alcoholic beverages, even in small doses. Their action is detrimental to the fetus. Drinks easily provoke a missed pregnancy, and not every woman knows what to do after the death of the embryo. Many give up on themselves, fearing a repetition of the situation, but this is unreasonable. The main thing is to follow the recommendations during subsequent pregnancy, so as not to encounter pathology again.

One of the indisputable truths is to exclude alcohol for a 9-month period. The mechanism of action of the fiery liquid is simple - after taking it, it easily penetrates the placental barrier, saturating the child's body with the action of negative components. Since the baby's liver has not yet been formed, the level of alcohol molecules is detrimental to him - it exceeds the concentration in the blood of an adult by 10 times. At the same time, its preservation in the amniotic sac is long. Large doses of alcohol during pregnancy threaten:

• fading of the embryo, the cessation of its development;
• abnormal defects of the heart muscle, underdevelopment of the brain;
• miscarriage, spontaneous abortion;
• premature birth;
• the birth of a child at term with low weight indicators.

It is a mistake to assume that beer labeled “non-alcoholic” bypasses the taboo imposed on alcohol and does not cause adverse reactions. Each composition released by modern manufacturers contains an alcohol-containing formula. Product safety due to low concentration dangerous substance not scientifically proven, therefore, the inclusion of a drink in the list of prohibited items - the right move on the way to having a healthy baby. Recent studies have shown that in addition to beer, it is also worth abstaining from kvass, which contains up to 2.6% alcohol.

The timing of a missed pregnancy may vary, but it is most likely for the early development of the embryo. The above are the main reasons why an anomaly occurs. There are psychological factors for the fading of a child in the womb. The main provocateurs of the state of experts include:

• emotional instability, psychological and intellectual overload;
• family quarrels, nervous atmosphere at work;
• personality traits of a pregnant woman;
• psychological immaturity for the appearance of a child, unwillingness or unwillingness to give birth, to bind oneself with obligations, the bonds of motherhood;
• a state of chronic, ongoing stress, depressive psychosis.

Science has proven that emotional condition mothers - one for two with a child. All experiences, feelings and sensations are easily transferred to the baby. Psychologists have even identified certain relationships. For example, a woman with increased internal anxiety is more likely to have a low birth weight baby.

The risk of losing a child increases due to the unstable psychosomatic state of the expectant mother. An analysis of the social factors of women who have experienced fading pregnancy indicates that most of them have difficulties in family life, at work, and misunderstandings with loved ones. Doctors also talk about the adverse effects of stress on pregnancy. Financial dissatisfaction, unresolved housing issues, fears and phobias lead to depression.

It is known that mood swings, lack of self-confidence, low self-esteem cause pressure and pulse fluctuations in a wide range, which provokes fetal hypoxia and may result in a fading of its development. For those women who did not want to conceive, what happened is a lot of stress. Using unconscious strategies for solving the problem, a woman is able to program the body to get rid of an unwanted baby. There are a lot of options for doing this. Leaving for active work, poor nutrition, heavy loads. If in the past the pregnancy had an unsuccessful resolution, the pregnant woman is full of fears for a repetition of the situation, which worsens the quality of her life and the development of the child.

Signs of a missed pregnancy

A woman can notice the first signs of a missed pregnancy by listening to her own well-being. At home, it is impossible to diagnose a fetal growth retardation. Searching the forums for information and advice is a waste of time. When in doubt, it is better to visit a doctor. Should be alert:

• Abrupt cessation of toxicosis if nausea and dizziness were previously manifested with any foreign smell, movement;
• Softening of the mammary glands, stopping their increase. After swelling and soreness, the breast becomes immune to mechanical stress. Separately, these signs of a frozen pregnancy do not say anything. Many women note that a similar condition often occurs during normal, uncomplicated gestation;
• Decreased basal body temperature. Decreasing progesterone levels provoke similar symptoms. Measurements are taken immediately after waking up through the rectum. However, this method is not a panacea in determining what happened. Third-party factors and concomitant phenomena can affect the decrease in temperature - sexual contact the day before, taking certain medications, maternal illness

Additional symptoms may include an increase in body temperature, pain in the lower abdomen, and spotting. If the fading of pregnancy occurred at a later date, the expectant mother ceases to feel the movements of the fetus. negative state insidiously, not always alarming symptoms are manifested brightly. Before the detection of frightening signs, it can take a long time. Sometimes the visit to the doctor is delayed for several weeks. Symptoms can also occur during the normal development of the embryo, during an ectopic pregnancy. The doctor will be able to establish the diagnosis after the examination.

Frozen pregnancy and miscarriage

Both states are different from each other. The fading of pregnancy is characterized by a delay in the womb of the deceased fetus. A dead embryo can stay in the uterus for a long time, eventually it will be removed with the help of a doctor. These conditions can last for months or even years. A failed child is subjected to maceration, mummification. In the first case, we are talking about wet necrosis of cells that does not cause putrefactive processes. Up to 90% of all situations go this way. At first, there are no signs of infection, later they develop rapidly, which in especially severe cases leads to the death of the mother. Outwardly, the fetus looks wrinkled, lethargic, flabby and wrinkled on palpation. The skin collects on it in bubbles, exfoliating and accumulating in certain places. With the advent of infection, the dead embryo turns green.

Mummification involves the natural withering of an unborn child. Most often this process affects one of the twins. A multiple pregnancy can cause the umbilical cord to wrap around the neck of one of the babies. Then the embryo shrinks, dries up, the amniotic fluid located near it dissolves. When a dead fetus survives the process of petrification, it becomes petrified and can remain in the body indefinitely. Often this condition is characteristic of an ectopic pregnancy.

Diagnostics

You cannot rely on a test to determine your own state. Sometimes the analysis gives two strips after the death of the fetus. For several weeks, the body contains hCG. If you track its content in dynamics, you will notice the fading of the level, its gradual decrease. The right decision is to consistently pass several tests that can be compared. The basal temperature is sensitive to changes, the level of which decreases. But this method is available only when maintaining a daily diary, where appropriate marks are put.

It is necessary to take tests after a frozen pregnancy with the obligatory inclusion in the list of ultrasound studies. This is the most accurate diagnostic technology. In addition to stating the fact of the death of the pod, the method will show the term for stopping development. On early stage pregnancy, an ultrasound examination is performed no earlier than 7 weeks. If the results are questionable, a second examination is carried out in a week or two. It's better to give preference modern models Ultrasound devices, on old equipment, early development may not diagnose cardiac activity. Making an unreliable diagnosis will cause unnecessary panic, harm the psychological state of the subject.

Therapeutic treatment of the condition begins after the diagnosis is made. If the pathology is confirmed, there are several options for responding:

1. Waiting for a miscarriage is a natural process of ridding the body of a foreign body. Ideally, if the fetal bladder comes out completely with the embryo and amniotic fluid contained in it.
2. Prescribing specialized drugs, the action of which is aimed at contracting the uterus and pushing out of the internal cavity of the deceased fetus. The method is applicable if the pregnancy did not last more than 8 weeks.
3. Surgery intervention is carried out in different ways. These include gynecological cleaning and vacuum aspiration.

After the procedures, a control ultrasound is done, which allows you to assess whether the internal space of the uterus is completely cleared, whether there are any foreign tissues left in it that can cause inflammation, and subsequently become the cause of developing sepsis.

Gynecological cleaning

Several weeks may pass from the moment of fetal death to rejection by the uterus. The remaining traces of the deceased embryo provoke the development of the inflammatory process, bleeding and other complications. To eliminate risks, doctors recommend undergoing a gynecological cleaning, in which a specialist will clean the top layer of the internal cavity of the uterus.

The woman does not feel any discomfort from the procedure, as she is under the influence of anesthesia. Cleansing after a frozen pregnancy rarely lasts more than an hour, usually 15-20 minutes is enough for a doctor. You should not be afraid of complications after it, although they may occur in rare cases. Tissue samples obtained from the uterus are sent to a laboratory for histological analysis. It is prepared for two weeks, after which the results are returned to the attending physician. Causes of miscarriage helps to find out genetic testing. Histology determines the presence or absence of atypical cells in the uterus.

vacuum aspiration

In addition to scraping, the vacuum aspiration method can be performed, which allows you to get rid of the remnants of the embryo in the uterus in a more delicate way. The indications for the procedure are:

• getting rid of signs of unwanted pregnancy if 12 weeks have not passed since conception;
• if signs of missed pregnancy found confirmation by additional examination methods;
• incomplete exit of parts of the embryo from the uterus, the presence of foreign elements in the body;
• childbearing for certain reasons contraindicated. Usually, the cause is a threat to the life of the mother or the risk of developing fetal pathology;
• with lagging placental tissue at the time of childbirth, when its remains are found in the uterine cavity;
• accumulation in the uterus blood clots or fluids;
• if for further diagnosis a biopsy is needed to take endometrial materials for analysis.

The procedure is ineffective:

• with inflammatory processes developing in the uterus;
• to neutralize the risks of ectopic pregnancy;
• if there is a change in the uterus due to neoplasms or a tumor.

Aspiration is carried out in several ways:

• Under intravenous vacuum anesthesia. The special suction has high power and copes with the task of removing residues in a few minutes. The technology is not practiced when the four-week gestation period is exceeded.
• Under local anesthesia with manual vacuum. Used up to 12 weeks of gestation.

Before aspiration, a woman undergoes a visual examination by a specialist, passes the recommended tests, a smear to determine the microflora of the vagina. Among the examination methods are ultrasound, blood and urine tests, tests for latent infections in the body. IN without fail consultation with a therapist is required. 30 minutes before surgery, tablets are taken, the action of which is aimed at softening the cervix. After visiting the operating room, at least an hour should pass to monitor the patient's condition. This time she lies on her stomach, followed by a follow-up examination.

How is aspiration performed?

The doctor treats the reproductive organs with antiseptics that block the infection from entering through the genital tract. Specialized instruments (mirrors) are inserted inside the vagina. After treating the neck with an antiseptic, it is fixed, freeing access to the internal cavity. A carefully inserted probe helps to examine the walls. Then, an aspirator tube is inserted into the cavity, departing from an electrical appliance or a manual “syringe”. By rotating the catheter, the doctor removes the upper layer of the mucosa, stores it in a test tube to be sent for histology.

The consequences of aspiration can be complicated by the following conditions:

• menstrual irregularities;
• disruptions in the hormonal system;
• incomplete cleaning of the uterine cavity.

After the procedure, you can not have sex for a month, catch a cold, go to the bath or sunbathe under the open rays of the sun. It is not recommended to take a bath, go to the pool, it is advisable to confine yourself to a shower if personal hygiene is observed. Medicines should be taken in accordance with the schedule drawn up by a specialist.

After curettage or aspiration home, the patient is released on the day of the operation. To neutralize pain, antispasmodics are prescribed. Day should not be active, use physical labor. Loads can provoke the onset of bleeding. Pain in the lower abdomen and in the lumbar region persists for several days. This is a normal condition, since the upper layer of the internal cavity of the uterus is damaged. Pronounced pain is suppressed by painkillers, the intake of which must be agreed with the doctor.

Abundant discharge should also not be alarming. They can last up to 2 weeks. Tampons are strictly prohibited. The only available remedy is sanitary pads. If this rule is violated, the situation can lead to serious inflammation in the tissues of the reproductive organs. Resuming sexual contacts, it is worth consulting with a gynecologist for the selection of contraceptive drugs.

A new pregnancy can occur after a frozen pregnancy immediately after stabilization of the condition. Leaving it to chance is stupid. First you need to find out what led to the pathological condition and the loss of the child in order to exclude the root cause of the anomaly in order to prevent it in the future. Menstruation occurs after a couple of weeks, sometimes after a month and a half.

Immediate medical attention is required if after surgery:

• there was a sharp increase in body temperature;
• the gasket is changed hourly - the hygiene product gets wet through immediately after the start of use;
• blood is released for more than two weeks, its volume does not decrease and does not become less intense;
• take off pain even taking strong drugs does not help;
• vaginal discharge exudes an unpleasant putrid odor.

It is impossible to say with confidence that a thorough examination after a frozen pregnancy is necessary. It is recommended by doctors, but the decision is made by each couple on their own. If a woman has a second missed pregnancy, the diagnosis of the underlying causes is mandatory. In most situations, the condition is the result of random factors, errors in the development of the fetus in the early stages.

Frozen pregnancy, the causes and consequences of which negatively affect the emotional background of a mother who has lost a child, are also found in completely healthy couples. In the West, the practice of a thorough examination is recommended only after 3 repetitions of the arrest of the development of the fetus in the womb. As for the tests after the anomaly has occurred, their list is quite extensive: KLA, OAM, blood for hormone levels, a smear for microflora, a study for latent sexually transmitted infections, tests for TORCH infections, transvaginal ultrasound. If necessary, the list can be supplemented with other diagnostic procedures. It is mandatory to get advice from a geneticist, endocrinologist and immunologist.

Likely consequences

If a frozen pregnancy is detected on time, and the traces of what happened are painlessly eliminated, there are no negative consequences. Another thing is if a woman has 2 missed pregnancies in history and a third is planned. With a primary tragedy, the risk of repeating the negative scenario does not exceed 20%, with repeated pathology, the danger occurs in 35% of cases, the third stop in the development of the embryo in the womb threatens 40% of violations in the subsequent period.

Planning for a new conception

Chances of being normal repeated pregnancy after the fading of the embryo in the previous time are great. The main thing is to listen to the recommendations of the doctor and follow the instructions issued by the specialist. The opinion of most gynecologists comes down to one thing - to plan new pregnancy should be no earlier than three to four months after the frozen one. During this period, the woman's body is restored, gaining strength, accumulates a positive potential. The hormonal background stabilizes, the stress factor from experienced unrest decreases.

Before conception, the specialist advises the use of hormonal birth control pills that prevent the risk of pregnancy at an unplanned date. Taking oral remedies, a woman unloads the ovaries, providing them with additional rest. Cancellation of OK increases the chances of fertilization of the egg by spermatozoa. If a missed pregnancy occurs, folic acid should be started three months after it. The drug is of great importance for the normal development of the fetus. Vitamin B 9 - a DNA-forming substance that promotes harmonious development nervous system child.

If pregnancy occurs immediately after the fetus fades in the womb, the chances of a successful delivery are also high. However, a consultation with a good specialist in the field of gynecology is necessary, it is likely that the passage of profile therapy to reduce the risk of miscarriages.

Folic acid

Science has proven that taking vitamin B9 a month before conception and the first three months after it reduces the risk of developing anomalies in the development of the embryo by 50%. Folic acid intake is mandatory at the stage of pregnancy planning and at the time of its inception in the body. Daily dose the drug is limited to 400-800 mcg. It is important to know this, because some women limit themselves to taking multivitamins, forgetting to evaluate the content of B9 in them. If the dose is less than recommended, it should be increased by additional intake of the drug. What kind of dosage will be acceptable in a particular case, the attending physician determines, based on the situation, the health of the pregnant woman, and the characteristics of her body.

Additionally, you need to include in the diet foods containing folic acid. These are spinach, citrus fruits, broccoli and White cabbage, kiwi, strawberry. Allergy sufferers should be careful with food ingredients that cause a reaction. If there is a tendency to allergies, oranges and tangerines are replaced with cabbage and spinach. You can not think that the folic acid contained in the products is enough to cover the daily requirement. Taking drugs based on it is necessary.

Do not be afraid of an overdose of the vitamin, it has a water-soluble basis. Therefore, it is easily excreted from the body with urine. However, cases of overdose caused by long-term use of large doses of the drug have been noted in medical statistics. The excess of the norm was 37 times. The result - anomalies of the nervous system of the child.

The doctor's appointment of an excess of B9 is justified in the following cases:

• if the mother has already given birth to a baby with an anomaly of the nervous system;
• when the expectant mother is overweight;
• while taking anticonvulsants;
• anemia, revealed as a result of blood tests, which was provoked by a lack of folic acid in the body.

In these situations, the dose of the drug can be increased to 5000 mcg.

How to prevent a frozen pregnancy - the causes and consequences of the threat

After analyzing the causes of pathological conditions and the threats that it poses to health, the doctor draws up an individual protocol for monitoring a woman who has experienced misfortune and is planning a new conception. General recommendations include:

• Contacting a gynecologist at the stage of pregnancy planning, getting advice from a geneticist, endocrinologist, immunologist, taking tests and undergoing specialized examinations to identify health conditions.
• Rejection of bad habits including smoking and drinking alcoholic beverages.
• Balanced diet with the inclusion in the composition of the food taken beneficial vitamins and micronutrients. Exclusion from the diet of semi-finished products, fast food, exotic cuisine, coffee and strong tea.
• Exclusion from the list of certain categories of drugs, which the doctor will tell you about. Among the prohibited drugs is aspirin, it can be painlessly replaced with paracetamol.

Nutrition during pregnancy planning

Regardless of the reasons for a missed pregnancy in the past, planning a new conception requires following certain rules. One of the main ones is a balanced diet. Having studied the recommendations of AGOG, we share our experience:

• It has been proven that a woman does not need to consume a double norm of healthy foods either at the time of conception planning or during pregnancy. After the doctor confirms the fertilization of the egg and the development of the fetus in the body, you should increase the daily diet by only 300 kcal.
• The best option for proper nutrition is eating in fractional portions up to 6 times a day.
• At the planning stage of conception, include foods containing vitamins A, C, B9, and iron in the number of foods consumed.

Drinking coffee is controversial. The question of whether it is possible to drink a delicious drink with a high content of caffeine after a frozen pregnancy does not have a single point of view. Previously, experts unanimously argued that coffee provokes a miscarriage. Today it is recognized that up to 150 mg of a drink per day is not capable of harming a developing fetus.

Psychological rehabilitation

The grief that has happened brings family members closer together, but this does not happen in all cases. Sometimes a frozen pregnancy becomes a stumbling block, the reason for a woman's distrust of others, the repulsion of her husband and attempts to survive what happened alone. It is absolutely impossible to do this. Important:

• Stop beating yourself up for what happened, transfer evil and irritation to loved ones - parents, husband. What happened is able to bring together, help to establish warmth and trust in the family;
• Don't confine yourself to your grief don't hide feelings. It is better to cry, to speak out, releasing the negative accumulated in the soul. It is known that to a stranger trust problems are often easier. The “fellow-traveller effect” is triggered when a person realizes that he will never see his interlocutor, therefore he actively sets out his own problems to him. Use as a vest loved one. So it will be easier for you to understand yourself and him, to restore the lost warmth in relationships.
• If after a few months after the incident, the situation does not stabilize, it is necessary to contact a professional family psychologist. A good specialist will put the situation on the shelves, help you look at it from the outside, redirect the orientation of actions towards achieving new goals.
• Learn clip removal techniques and relaxation techniques. Feeling the rolling of negative emotions, you need to relax and be distracted. The skill will come in handy in simple life in the subsequent period.

It is good if a woman goes to a psychologist together with her husband. Coping with a common misfortune is always easier. Joint work will help to look at each other in a new way, to find out the unknown secrets of the soul of a partner. It is difficult to survive a pathological condition. Ideally, you need to be distracted by something else - go on vacation, get a job new job, change your place of residence. These steps nullify past life, allow you to forget about the negative and tune in to success.

Frozen pregnancy and TORCH infection

One of the main causes of missed pregnancy is TORCH infection. They cause up to 90% of violations in the program of gestation. The statistics are relentless. The risk of fading for nulliparous women is below 10%. After stopping the development of the fetus, which occurred for the first time, the lack of control of TORCH indicators increases the risk to 25%, after 2 losses - up to 40%. Surviving the state of pregnancy fading more than 4 times due to fetal infections are rarely ready to give birth again. However, they may well experience the joy of healthy motherhood if the control of infectious lesions of the body is carried out.

It is difficult to rank the most dangerous diseases that provoke a missed pregnancy. Laboratory studies using ELISA and PCR show results if carried out in the first few days after the incident. After a week or two, it is difficult to determine the causative agent of the provocateur. It is necessary to undergo a full examination for TORCH infection at the planning stage future pregnancy. Upon examination, the woman receives a mother's passport, which remains valid for the entire period of the reproductive age of the applicant.

Frozen pregnancy in questions and answers

Summarizing the above, we should once again briefly dwell on the main postulates:

1. When does it occur? Frozen pregnancy can occur at any stage of embryo development. Most often, the anomaly is found out in the first trimester.
2. Why is it happening? Among the disorders occurring in the early stages of fetal development, hormonal imbalance, infectious processes, menstrual irregularities, and genetic changes were noted. This may be due to chromosomal abnormalities or the fact of a blood connection when the father and mother are relatives. Nature itself applies the filter of natural selection, rejecting the unviable fetus and provoking its death. The risk of embryo freezing increases if a woman with negative Rh factor There were several abortions before the desired pregnancy. According to statistics, abortions often become a kind of harbinger of pathology. They grossly violate the hormonal status, cause trauma to the uterus and infection of the cervix. At a later date, a missed pregnancy occurs more often due to a chronic disease of the mother, which occurs in severe form - diabetes mellitus, heart muscle disease, kidney disease. The threat can be reduced if you start treatment at the stage of pregnancy planning.
3. What should be of concern? Pain in the lower back and abdomen, spotting blood, a decrease in basal temperature, and the lack of growth dynamics of hCG should cause concern for the well-being of the child. If during pregnancy you felt toxicosis, dizziness, nausea and other similar symptoms, followed by their rapid disappearance, this is a good reason to be wary and visit a gynecologist with complaints. The doctor will conduct an examination on a gynecological chair, if necessary, send to ultrasound diagnostics. Another symptom that characterizes a missed pregnancy is the cessation of swelling of the mammary glands. If the chest is limp, has lost elasticity, you should carefully listen to your inner state.
4. Why is a missed pregnancy dangerous? If female body pushed out through the birth canal an embryo with a fetal egg and water after a fading of development - this is good. Soon the organs of the reproductive system will return to normal, gain strength and be ready for a new conception. If this does not happen, you should undergo an ultrasound scan to fix the remnants of the material in the uterine cavity. To remove them, the method of scraping with a curette and vacuum aspiration is used. The attending physician will recommend the technology, taking into account the clinical picture and the individual characteristics of the patient. Waiting tactics can also be used, in which the body will miscarry some time after the pregnancy fades. In order to release the remains of the embryo and membranes, drugs are also used, the action of which is aimed at reducing the walls of the uterus. Seeing a doctor earlier eliminates the risk of complications. With a long stay of the fetal sac in the uterus, blood loss may develop due to DIC, when the blood stops clotting, and abundant blood flow poses a threat to the woman's life.
5. What are the prospects? After what happened, it is important not to give up, but to do everything necessary so that the next pregnancy ends in a successful birth. Doctors allow conception to be carried out after 4-6 months, but everything is individual. Visit a doctor, go through the recommended examinations, eliminate dangerous factors for pregnancy, take care of yourself, put yourself in order physically and psychologically. Get advice from a geneticist, endocrinologist and immunologist. A powerful medical tandem will reduce the likelihood of errors in planning a new pregnancy.

Frozen pregnancy is intrauterine death fetus that occurred before 20 weeks of gestation. Since a frozen fetus is rejected sooner or later during pregnancy, an inevitable consequence of a frozen pregnancy is a miscarriage or spontaneous abortion.

How common is a miscarriage?

According to world statistics, every second pregnancy “freezes” and ends in a spontaneous (spontaneous) abortion. In the vast majority of cases, this happens even before it happens and the woman finds out that she is pregnant.

The risk of a missed pregnancy after the second line shows is about 15-20%

An increased risk of missed pregnancy is observed in women older than 35-40 years, as well as in women who have already had a missed pregnancy once.

At what time can a missed pregnancy occur?

The fetus can “freeze” at any time, however, in the vast majority of cases of missed pregnancy, this occurs in the early stages (up to 13 weeks of pregnancy). Frozen pregnancy in the later stages (closer to the 20th week of pregnancy) happens much less frequently.

The longer the pregnancy, the lower the risk that it will be interrupted. So, for example, the risk of missed pregnancy at 9 weeks will be higher than the same risk at 10-12 weeks, etc.

Why does a frozen pregnancy occur?

Every woman who is faced with the problem of a missed pregnancy asks the question why this happened to her. There are a number of possible causes of miscarriage, but the cause of each competitive case often cannot be determined.

So, the most common causes of miscarriage are:

• Chromosomal or genetic errors

In most cases, the cause of a missed pregnancy in the early stages is a “mistake” in the development of the embryo. It is in the first weeks of pregnancy that the most important processes in the formation internal organs, and therefore even a small mistake can lead to the death of the embryo. Problems with chromosomes or genes can occur even if both parents are completely healthy.

As a rule, if the embryo has serious chromosomal or genetic abnormalities, a miscarriage occurs at a period of 2-4 to 7-8 weeks. However, with some deviations, the fetus can remain viable for much longer, in which case a miscarriage can occur for a period of 13 to 20 weeks.

• Anembryony (anembryonic pregnancy)

Sometimes in the early stages of pregnancy, the cells responsible for the development of the embryo stop dividing, and the cells responsible for the formation of the future placenta continue to multiply. This condition also applies to missed pregnancy. At the same time, a frozen pregnancy for a period of 5 weeks can already be determined using ultrasound.

In this case, the doctor will see a fetal egg on an ultrasound scan, but the embryo will not be visible inside it. The absence of an embryo in the fetal sac (empty fetal sac or empty fetal egg) is called anembryony in medicine. Anembryonic pregnancy sooner or later ends in a miscarriage.

• Pathology of the uterus

The normal position, structure, size and shape of the uterus is essential for maintaining pregnancy. Underdevelopment of the uterus (“baby uterus”), a bicornuate uterus, septa in the uterus, can cause a missed pregnancy in the second trimester of pregnancy (for a period of 12 to 20 weeks). For example, a missed pregnancy for a period of 14 weeks can be caused by a pathology of the structure uterus.

• Taking certain medications

Taking non-steroidal anti-inflammatory drugs (aspirin, ibuprofen, etc.), birth control pills and others hormonal drugs in early pregnancy, it can provoke a missed pregnancy for a period of 4-5 weeks or even earlier.

• Intoxication with vapors of chemicals

Women forced to inhale vapors of certain chemicals (formaldehyde, benzene, ethylene oxide, gases used in anesthesia) are at increased risk of miscarriage. In this case, a frozen pregnancy can occur at any time in the range from 4 to 20 weeks.

• Chronic diseases in pregnant women

Severe chronic diseases of the kidneys, heart, liver, as well as disorders of the hematopoietic system (anemia) can cause miscarriage in early and late pregnancy.

• Multiple pregnancy

Despite the fact that in most cases, pregnancy with twins or triplets ends in the birth of healthy children, the risk of miscarriage in the case of multiple pregnancies is slightly higher than in women bearing one child.

• Pregnancy with IVF

For reasons yet unknown, pregnancies that occur with the help of in vitro fertilization (IVF) techniques often “freeze”. If this happens, then usually a missed pregnancy is detected already in the first trimester (up to 9-12 weeks of pregnancy).

How to recognize a frozen pregnancy?

Many pregnant women are concerned about the question of how to determine a missed pregnancy. The insidiousness of this condition lies in the fact that it is often asymptomatic: from the death of the fetus to a miscarriage, it can take several days, and sometimes several weeks.

What are the first signs of a missed pregnancy? You may suspect that the pregnancy is no longer developing if you have the following symptoms of a miscarriage:

• emerged from the vagina
• Pain in the back or lower abdomen
• If the symptoms of toxicosis (nausea, vomiting, dizziness, etc.) suddenly stop
• Breasts during a frozen pregnancy can stop hurting
• Body temperature during a missed pregnancy usually remains within the normal range, but during inflammatory processes it can rise to 37.5 ° C and above

The signs of a missed pregnancy listed above are not reliable and can occur with a normally developing pregnancy, as well as with. Therefore, if you have the warning signs listed above, you need to see a doctor and undergo an examination to clarify the diagnosis. The diagnosis of a missed pregnancy is never made only by the presence of the symptoms listed above.

What will a pregnancy test show?

Many women who suspect they have a missed pregnancy run to the pharmacy for a test. Will the test show a frozen pregnancy or is it a waste of money?