The fetus died at a late stage. Birth of a stillborn fetus (stillbirth)

Antenatal fetal death is a fairly common occurrence in gynecology (1 case in 200 pregnancies), occurring between 9 and 3 months. Often a child dies in the womb during an absolutely normal pregnancy in a healthy woman who does not have any complaints.

According to medical statistics, the most common cause of antenatal fetal death is an immunobiological factor when the child and mother have . The female body perceives the fetus as a potential threat and rejects it. About 5% of cases of antenatal fetal death occur due to antiphospholipid syndrome (a disease accompanied by the formation of blood clots), which is hereditary.

The following factors can also provoke fetal death, which lead to the fact that vital substances and oxygen cease to flow to the fetus:

• past infectious diseases during pregnancy;
• sexual and venereal diseases - chlamydia, genital herpes, gonorrhea, syphilis, ;
• pathological development of the umbilical cord or placenta;
• stressful situations, air travel;
• prolonged exposure to the sun, irradiation;
• alcoholism and drug addiction;
• hormonal imbalance, resulting in decreased progesterone production;
• injuries and falls of a pregnant woman;
• taking medications prohibited for expectant mothers.

In isolated cases, a child dies due to suffocation from the umbilical cord. Unfortunately, the doctor cannot always say exactly why antenatal fetal death occurred, so a woman needs to be as honest and frank as possible in order to prevent such unpleasant consequences in the future. Do not refuse to autopsy a dead fetus, examine the umbilical cord and placenta - this will allow you to determine the most accurate causes of antenatal fetal death and correctly determine the next pregnancy.

Antenatal fetal death in numbers

According to medical research, every sixth woman who experienced antenatal fetal death was not registered at the women's clinic. 4.8% of children died during multiple pregnancies. During the study, during pregnancy the following abnormalities were identified in the observed women: placental abruption - in 14.3%, incompatible with life - in 9%, hemolytic disease - in 4.8%, oligohydramnios - in 11.1%, polyhydramnios - in 9.5%, isthmic-cervical insufficiency - in 4.8%.

According to the study results, the causes of antenatal fetal death were:

• 42-66, 7% - deep prematurity in combination with intrauterine asphyxia;
• 6 – 9.5% – congenital malformations;
• 7-11.1% - severe placental insufficiency;
• 7-11.1% - intrauterine infection of the fetus;
• 9-14.3% - placental abruption;
• 3-4.8% - hemolytic disease.

6-9.5% of deceased children had underweight, and 2-3.2% had arterial hypertension.

The study took place in the Petrozavodsk maternity hospital; a total of 63 cases of antenatal fetal death among patients aged 19-30 years were studied.

Signs of antenatal fetal death

Not every woman can recognize fetal death on her own, especially in the early stages. But since the pregnancy has stopped, all its signs also disappear. First of all, this is reflected in the chest, which is no longer swollen as before and returns to its previous shape. If the girl was worried about toxicosis, then all its manifestations disappear with the death of the child. In the second, it is easier to suspect the death of the fetus - movements stop, the lower abdomen feels unusually tight.

What happens in a woman’s body during antenatal fetal death?

In case of antenatal death of the fetus, the dead child can remain in the mother's womb for quite a long time (from 1-2 days to several years). Sometimes, after just a few weeks, decomposition begins, accompanied by bleeding and a deterioration in the general well-being of the woman, who may experience high fever, weakness, and dizziness.

In most cases, a dead child in the womb does not decompose, but putrefactive tissue necrosis occurs. The longer a non-living fetus remains in the mother’s body, the higher the risk of developing an intrauterine infection, which can lead to sepsis. Most often, dry necrosis of the fetus occurs.

Diagnosis of antenatal fetal death

If you have any doubts that something is wrong with your pregnancy, be sure to contact a gynecologist who will examine you and, if necessary, prescribe additional examinations: electrocardiography to listen to the baby’s heart. On an ultrasound, the specialist clearly sees blurry contours of the body and lack of movement.

Therapeutic measures for antenatal fetal death

If fetal death occurred before, normal curettage is performed. In the second and third trimester, the removal of a dead baby occurs either by surgical intervention or by stimulating natural labor with oxytocin. Spontaneous miscarriage or natural resolution of antenatal fetal death occurs in isolated cases. Therefore, you should not wait until spontaneous childbirth occurs; the longer the dead fetus is in the mother’s womb, the greater the risks to her health!

Late antenatal fetal death

Antenatal fetal death can occur several weeks and even days before the expected date of birth. Usually, at this stage, diagnosis is not difficult and the doctor can determine the absence of signs of life through routine examination and palpation. Since the pregnancy has stopped, the uterus will not open and natural labor will not begin, so emergency induction is necessary.

Antenatal fetal death in multiple pregnancies

In medical practice, during multiple pregnancies, there are cases when one fetus dies, while the second continues to grow and function normally. If antenatal fetal death occurs in the first trimester, the probability that the life of the second child will be saved is only 90%. In the second or third trimester, the baby is much more likely to survive, but about a third of these children suffer from serious congenital pathologies and damage to the nervous system. Often, after a certain period of time, the second fetus also dies. This can happen even in the last weeks of pregnancy.

To avoid serious consequences, doctors may prescribe an emergency delivery. Being a baby in the womb with a dead fetus is much more dangerous than being born premature. If a woman’s condition causes concern among doctors, tests are carried out.

If the period for delivery is still too short, doctors use surgical intervention to stop all connections between the children’s bodies and give a transfusion to the living fetus. As soon as the time frame allows for the baby to be removed and placed in a pediatric intensive care unit, the operation will be performed.

Prevention of antenatal fetal death

To give birth to a healthy child, you should be very careful about your health. Any medications during pregnancy should be taken only as prescribed by a doctor. It is necessary to consult a specialist even if you have a common cold. Visit your gynecologist regularly according to the established schedule and report any complaints that concern you. Protect yourself from excessive physical labor, stress, injuries and falls. Completely stop drinking alcohol and cigarettes and pay attention to a balanced diet.

Pregnancy after antenatal fetal death

Antenatal fetal death is by no means a death sentence; in the future, a woman can conceive and give birth to a healthy, full-fledged child. But only with proper planning. You should strengthen your immunity in advance, undergo all the necessary tests, and if dangerous infections are detected, treat them in a timely manner. Be sure to visit a geneticist and hematologist. With antiphospholipid syndrome, the likelihood of antenatal fetal death in subsequent pregnancies increases to 42%. Therefore, before planning the birth of a healthy child, you should undergo complete treatment.

Some women who experience antenatal fetal death suffer from psychological trauma and are afraid to plan and give birth to a child in the future. The situation is aggravated if intrauterine death occurs in the third trimester. Spend more time with your family, find an interesting hobby, don’t isolate yourself, take time for walks in the fresh air. After antenatal fetal death, it is necessary to plan the next pregnancy no earlier than six months later.

Women can experience frozen pregnancy at different stages, but this often happens before the beginning of the twelfth week. Not in every case, doctors are able to determine the causes of this phenomenon. But it is known for sure that due to poor nutrition, bad habits, lack of sleep and various stressful situations, fetal death occurs much more often.

A frozen (non-developing) pregnancy is a condition when the fetus stops growing and developing and dies in the womb. Many pregnant women simply have no idea that this phenomenon often occurs. The baby can die in later stages of pregnancy, but this does not happen often.

• One of the reasons may be chromosomal and genetic disorder. Significant genetic failures lead to the fact that the fetus begins to form incorrectly, after which it dies.
• Also, this situation is repeated due to various infectious diseases (toxoplasmosis, herpes, influenza, rubella, chlamydia, chickenpox, cytomegalovirus infection and other diseases). Doctors say that the greatest danger is caused by those diseases that appear in a woman during pregnancy, while such problems usually do not arise with chronic ones. The presence of pathologies in a child caused by the diseases described above is also a common occurrence.
• With bad habits ( smoking, drinking alcohol, using drugs), lack of sleep, poor nutrition, and frequent stressful situations must be combated.
• Hormonal disorder, which manifests itself as an imbalance of progesterone and estrogen in pregnant women. If this problem is detected in time, the child can be saved with the help of the appropriate medication.
• Late pregnancy, when a woman is over forty years old, and in vitro fertilization can negatively affect the development of the fetus.
• There are problems like autoimmune disorders. Often women experience antiphospholipid syndrome, which leads to the destruction of phospholipids in the cells of the embryo. This in turn leads to destruction of the placenta and fetal death.

The constant presence of hazardous industries on the territory, unfavorable environmental conditions and the use of teratogenic drugs are all factors that lead to the arrest of fetal development.

When a woman is pregnant and in the early stages, she may not feel any special symptoms of fetal failure. When toxicosis with nausea and vomiting passes, real relief is felt. Sometimes the body temperature rises. There is nothing “supernatural” with the other signs. And only the doctor, during the next examination, is able to discover that the child’s heartbeat is absent.

At a later stage, women may already feel a frozen pregnancy, which is accompanied by a dull pain in the lumbar region or lower abdomen, and bloody discharge from the genitals. It is also felt that the child has stopped moving.

At the slightest disturbance in their health, women should consult a doctor as soon as possible. When the embryo’s heartbeat cannot be heard, the doctor immediately prescribes an additional examination. There are cases when good doctors can make an erroneous diagnosis.

Listening exclusively to the subjective symptoms of fetal freezing, it is impossible to diagnose this particular problem. It happens that a pregnant woman’s belly continues to increase, and the blood test is typical for a pregnant woman.

However, this phenomenon should not be associated with the fetus. The reason for this is the empty intrafetal membrane. That's what it is anembryony(not to be confused with embryo freezing, since in this case the embryo is not in the uterus from the very beginning).

When the results of additional clinical examinations indicate that the child is not alive, they are carried out again within a few days. Only repeated confirmation becomes the final diagnosis, after which the pregnancy is terminated.

After the final diagnosis has been established, the dead fetus is removed from the uterus as soon as possible to prevent it from decomposing and poisoning the mother’s body. Blood clotting may be impaired and severe bleeding may occur.

Spontaneous miscarriages often occur. But when this does not happen, the dead embryo is removed as soon as possible, because it is extremely unsafe for a woman to remain in such a state. When a dead fetus remains in the uterus for 4-5 weeks, blood poisoning develops, the uterus and its appendages become inflamed. And here we will talk about a woman’s infertility and her inability to become a mother in the future.

Vacuum extraction in a hospital or inducing a miscarriage using specific medications is done when the fetus fails in the early stages of pregnancy. At a later stage, it is impossible to do without curettage of the uterus, during which the woman is given general anesthesia.

If a spontaneous miscarriage occurs, then curettage is also used to prevent further problems with the woman’s health, since sometimes some parts of the dead fetus remain in the uterus.

Histological studies of an embryo that has died are carried out to find out the reason why the death occurred. A man and a woman are forced to face a cytogenetic examination. Tests will show whether there were chromosomal abnormalities, infectious pathologies or other factors. When an infection is detected, both partners are treated.

Timely removal of a dead fetus does not have a negative effect on the health of the mother. Often, after a missed pregnancy, a woman gives birth to a healthy, normal child, and not even just one.

You cannot plan your next pregnancy immediately after the frozen embryo has been removed. The body will be rehabilitated for some more time (six months to a year) so that there are no problems with physical and psychological health.

During this period, it is important for a woman to establish good nutrition, forget about bad habits, use hormonal contraceptives and take multivitamins.

It wouldn't hurt to undergo psychological rehabilitation. After it, you can plan the next conception.

In cases of repeated embryo freezing, it can be assumed that the cause is some kind of genetic pathology. And here it is necessary to conduct genetic examinations of two partners.

During pregnancy for a period of 1 to 8 weeks, there is an embryo in the woman’s womb, and the death of the unborn baby at this period is called. In the literature you can find a generalized concept of these two states -.

information According to statistics, the fetus dies quite rarely. In the first trimester (up to 12 weeks) - about 5% of all pregnant women, and in the second and third trimester - about 1%.

Causes

There are many reasons and predisposing factors leading to intrauterine death of a baby. The main ones:

• infections and inflammatory diseases of the mother, occurring in a complicated form (rubella, chickenpox, influenza, etc.);
• (negative Rh factor in the mother and positive in the child);
• intrauterine fetal hypoxia;
• alcoholism and drug addiction;
• placenta previa;
• toxicosis (), severe;
• disruption of the hormonal function of a woman’s body;
• radioactive exposure;
• contact with toxins;
• injuries during pregnancy (blows or falling on the stomach);
• heavy expectant mother;
• genetically determined abnormalities of fetal development that are incompatible with life;
• frequent and uncontrolled use of medications that are toxic to the developing fetus;
• hypertonic disease;
• Quite a lot of stress for a woman while carrying a child.

Signs of antenatal fetal death

Antenatal fetal death is characterized by classic signs and symptoms:

• cessation of fetal movement;
• lack of heartbeat of the unborn baby;
• severe general weakness;
• heaviness, discomfort in the lower abdomen;
• lack of uterine tone and uterine contractions;
• cessation of fetal and uterine growth;
• reduction of the mammary glands, disappearance of their engorgement.

In case of late diagnosis of such a condition, when 2 weeks or more have passed after the death of the child in the womb, signs of sepsis appear:

• (temperature over 38-39° C);
• abdominal pain;
• headache;
• disturbances of consciousness;
• death as the final result of an undiagnosed and untreated infection of a woman’s blood with toxins from a dead child.

Diagnostics

After a woman contacts a gynecologist with suspicions of pregnancy pathology or comes for a routine examination, the doctor refers her to diagnostic procedures that will make it possible to make a final diagnosis and decide on the necessary measures. Among the simplest and most accurate methods for diagnosing antenatal death of a baby are the following.

• Ultrasound. Allows you to determine the absence of heartbeat and blood flow, the location of the deceased fetus, its size, the condition of the placenta and amniotic fluid.
• . Allows you to determine the absence of cardiac impulses in the fetus.
• FKG. By analogy with an ECG, it determines the absence of a heartbeat in the fetus.

Treatment of antenatal fetal death

Treatment for antenatal fetal death is its removal from the uterine cavity within no more than 14 days after the development of this pathology.

• In the first trimester (before), curettage of the uterine cavity is performed (classic abortion).
• In the second trimester, labor is most often stimulated with oxytocin. In extreme cases, delivery is possible by.
• In the third trimester, when the fetus dies, labor most often occurs independently.

dangerous In cases where a deceased unborn child cannot independently pass through the mother’s birth canal, fetal destruction operations are performed (decapitation, craniotomy, etc.), and the fetus is removed from the woman’s uterine cavity in parts.

After the baby is removed from the womb, the woman must undergo rehabilitation course. Ceftriaxone or its analogues are prescribed for 7-10 days. Within 4-6 months after the incident, all possible causes of fetal death are eliminated:

• treatment of chronic foci of infection;
• nutrition correction;
• taking several courses and minerals;
• observation at the reproduction center and work with a psychologist.

Consequences

If you seek medical help in a timely manner, intrauterine death of the fetus does not have any consequences for the woman. In 99% of cases, repeat pregnancy that occurs six months or more after artificial birth, ends well.

In cases where a woman consults a doctor late, the development of infectious and bacterial complications, including sepsis, is possible. This is due to the fact that the dead fetus releases a large amount of toxins into the blood and decomposes. In extreme cases, death can occur.

Antenatal fetal death is the term used to describe the death of a child in the womb between the 9th and 42nd weeks of pregnancy.

These words are extremely tragic news for a woman who is carrying a child.

What is antenatal fetal death

A pregnant woman faced with such a situation experiences incredible shock, pain from loss, fear, and misunderstanding of how this could happen. Of course, this is also a lot of stress for the body and a strong blow to health.

Unfortunately, such situations are periodically recorded in obstetric practice. It even happens that nothing portends trouble, but nevertheless a healthy pregnancy without any complications or precursors ends abruptly.

Antenatal fetal death in multiple pregnancies

There is also a risk of intrauterine death in multiple pregnancies. The reasons are completely different, but most often this happens due to abnormalities in fetal development or blood flow disorders (for example, due to pathology of the umbilical cord vessels and the baby's place (placenta) or due to fetal hypoxia and other mechanical factors).

Fetal fading at the beginning of pregnancy (in the first weeks) can result in its resorption or the so-called vanishing twin phenomenon. For a woman and a living embryo, this situation usually goes unnoticed. Sometimes minor bleeding is possible, but this does not affect the health of the second baby. There are also cases of maceration and drying of the fruit.

It happens that one of the babies dies, and the second continues to grow. But this situation is dangerous because it can lead to bleeding of the fetus, and this subsequently provokes anemia, damage to the central nervous system, acute hypoxia, etc.

According to some studies, if one of the fetuses antenatally dies, the risk of death of the second is about 38%. In such a situation, the gestational age at which the fading occurred plays a significant role. So, in the first trimester, the chances of a surviving child for successful development and birth are quite high - 90%.

The second and third trimesters are more dangerous. At 20-27 weeks, the death of one fetus, if it does not lead to the death of the second, can cause damage to its central nervous system (central nervous system), which causes the development of various defects and pathologies.

In addition, a dead fetus located near a living child often leads to damage to internal organs. Therefore, starting from the 30th to 39th week of pregnancy and later, the doctor may decide to urgently deliver by cesarean section.

Factors provoking pathology

There are many reasons and factors that can lead to the death of an embryo, and they are often complex. This is why it is sometimes difficult to determine the exact cause.

Quite rarely, the umbilical cord wraps around the baby’s neck, thereby cutting off the supply of nutrients to the baby’s body. In cases where the situation continues, the risk of suffocation increases.

Also, the causes of antenatal death are pathologies in the development of the placenta, improper positioning of the fetus, abdominal trauma, hematomas, etc.

In addition, the most common reasons include the following:

• toxicosis in late stages;
• history of miscarriage and miscarriages;
• oligohydramnios/polyhydramnios;
• chronic placental insufficiency;
• inflammation of the genital organs;
• unhealthy lifestyle, bad habits;
• taking medications without first consulting a doctor, or abusing them;
• hormonal imbalance;
• stress, nervous breakdowns.

Many of the factors are completely independent of the woman and her lifestyle, so in no case should you blame her for what happened.

Today, medicine also identifies some immune/autoimmune and infectious diseases, as a result of which a pregnant woman can lose her child.

Immune and autoimmune factors

One of the most common causes of child death in the womb is Rh conflict. In such cases, the pregnant woman’s body perceives the fetus as a potential threat and tries to “get rid” of it by producing antibodies that interfere with the development of the fetus and contribute to its rejection.

About 5% of antenatal deaths occur as a result of autoimmune disorders, in particular antiphospholipid syndrome (APS). This is a disease that produces a large amount of antibodies to phospholipids and provokes the formation of blood clots, which causes miscarriage.

With APS, both small capillaries and large veins and arteries are affected, so the symptoms of this disease may differ, depending on the complexity of the situation and the location of the blood clots.

Infectious diseases

Infectious diseases pose a great threat to the life of an infant. Most often, cases of intrauterine death were recorded when a pregnant woman had chlamydia, herpes, mycoplasmosis, etc.

Infections can be detected earlier, but during pregnancy a woman’s body weakens, which is why any disease has more acute symptoms and is much more difficult to tolerate.

Cytomegalovirus poses a major threat. This is a disease that is often confused with the common cold and acute respiratory viral infection, since their symptoms are quite similar: high fever, chills, fatigue, headaches and general malaise.

Infection with the virus in adults occurs through sexual contact, through saliva and blood. If a child becomes infected while still in the womb, this can cause the development of a cytomegalovirus infection, which subsequently leads to central nervous system disorders (mental retardation, hearing loss), and also, in some cases, death.

The first signs of illness

In the early stages, it is very difficult to independently understand that the embryo has died, since each pregnancy is an individual process and proceeds differently for all women. Therefore, a reason for concern and going to the hospital should be the sudden cessation of signs of pregnancy that occurred in a specific clinical situation.

Of all the possible, the most common symptoms of a frozen pregnancy are:

• heaviness in the stomach;
• general weakness of the body, malaise;
• cessation of the baby’s movements, absence of his heartbeat;
• decrease or increase in uterine tone;
• cessation of abdominal growth;
• breast reduction;
• abrupt cessation of toxicosis (in the first trimester);
• sometimes the death of the embryo ends in spontaneous miscarriage.

In cases where more than 2 weeks have passed since death, the above symptoms are also accompanied by symptoms of sepsis:

1. The body temperature of a pregnant woman rises to +38-39C.
2. Pain appears in the abdominal area.
3. Drowsiness, dizziness from time to time.
4. Headache.
5. Disorders of consciousness.
6. Lethal outcome (in cases where infection with toxins of a dead body was not diagnosed and treated).

Any signs require immediate consultation with a doctor and urgent diagnosis to confirm or refute the diagnosis and take action.

How to diagnose

If a specialist has reasons to suspect antenatal death, the woman is immediately hospitalized and a series of studies and tests are performed.

An ultrasound is mandatory in such cases. The study makes it possible to see the most accurate picture and make a reliable diagnosis. Thus, the doctor ascertains the absence of heartbeat and breathing in the embryo.

ECG and PCG also help to record the presence or absence of heart contractions.

The condition of the embryo and amniotic fluid is assessed using amnioscopy. On the first day after freezing, the amniotic fluid may have a greenish tint. Later, the color becomes less intense and an admixture of blood appears. A baby's skin takes on the same shade.

X-rays are performed less frequently. Sometimes such a study is necessary to determine disorders in the baby’s condition.

For example:

• his body size does not correspond to his gestational age;
• atypical arrangement of body members;
• slack jaw;
• rachiocampsis;
• the bones are imbricated on top of each other;
• decalcification of the skeleton, etc.

Actions of medical workers with such a diagnosis

If the death occurred in the first trimester, the removal of the dead embryo is usually carried out through surgery, namely, curettage of the uterine cavity. Spontaneous miscarriages often occur after freezing.

In the second trimester, self-expulsion of a dead embryo is almost impossible: in case of detached placenta in such a situation, delivery is carried out immediately. The method is determined by the doctor according to the degree of readiness of the birth canal.

Antenatal fetal death in the third trimester usually results in spontaneous labor. If this does not happen, doctors use special drugs to stimulate labor.

In some cases, if indicated, specialists resort to fruit-destroying operations.

Consequences of pathology

Of course, the loss of an unborn child is a tragedy and great emotional trauma for a woman. It takes time, and sometimes the help of qualified psychologists, to come to your senses and come to terms with it.

Particular attention should be paid to health status. In cases of urgent medical attention and compliance with all instructions, antenatal death does not have serious consequences for the woman’s health. It is definitely worth diagnosing the cause and undergoing treatment in order to minimize the risk of complications in future pregnancies. It is recommended to plan conception again no earlier than after 6 months.

If you do not seek medical help in a timely manner, there is a high risk of developing bacterial and infectious complications, and even sepsis in severe cases. This happens because dead flesh decomposes in the uterus and a large amount of toxins enters the woman’s blood. In rare cases, deaths occur.

How to prevent intrauterine fetal death

It is very difficult to accurately predict and prevent intrapartum death, since in some situations there are a number of factors that are completely impossible to influence. But in most cases, a competent approach to pregnancy planning and the responsibility of the expectant mother will reduce the risk of fetal failure and allow the safe birth of her baby.

Before planning a conception, doctors recommend that both spouses undergo a series of medical examinations and undergo the necessary tests to make sure there are no infections, diseases or other factors that could negatively affect a future pregnancy. If necessary, appropriate treatment will be prescribed.

A woman who is already pregnant needs to regularly visit a gynecologist at the antenatal clinic, not refuse to undergo tests and follow all the gynecologist’s recommendations. Such measures will help monitor the condition of the woman and her unborn child, as well as detect any deviations in time and take urgent measures if necessary.

And yet, the best prevention of problems during gestation is pregnancy planning. Doctors recommend in advance a herbal complex based on Altai herbs for easy conception and successful gestation - Seraphim's Gathering. The remedy not only facilitates pregnancy, but also cures many chronic diseases.

Also, as a preventative measure, you should adhere to the following recommendations:

1. Get rid of bad habits (drugs, alcohol, smoking).
2. Any medications during pregnancy should be taken only on the recommendation of a doctor.
3. Elimination of injuries, falls, and heavy physical exertion.
4. Minimum stress and worries.
5. If you have the slightest suspicion or symptoms indicating a problem, do not wait - contact your doctor immediately.

Video on the topic of intrauterine embryo death:

Conclusion

The death of an unborn child is a great misfortune that must be overcome psychologically.

In most cases, planning and careful attitude towards pregnancy can protect against such a sad outcome.

– fetal death during pregnancy. It can be provoked by somatic diseases, diseases and abnormalities of the reproductive system, infections, intoxications, abdominal injuries, Rh conflict, multiple births, severe congenital defects of the fetus and other factors. Antenatal fetal death is manifested by cessation of uterine growth, lack of fetal movements and heartbeat, weakness, malaise, pain and heaviness in the lower abdomen. The diagnosis is established based on the results of examination and instrumental studies. Treatment in the first trimester is curettage, in the second and third trimesters - urgent delivery.

Causes of antenatal fetal death
Symptoms and diagnosis of antenatal fetal death
Treatment and prevention of antenatal fetal death
Antenatal fetal death in multiple pregnancies
Antenatal fetal death - treatment in Moscow

Antenatal fetal death (intrauterine fetal death) is the death of the fetus during intrauterine development (before the onset of labor). Causes 39% of stillbirths. Statistical data on the prevalence of this pathology varies significantly, which is due to differences in the classification of fetal deaths in different countries. In the UK, the perinatal mortality rate (including antenatal and intrapartum mortality) is 0.58%, in the USA - 1%, excluding miscarriages before 20-22 weeks of pregnancy. Antenatal fetal death is provoked by various external and internal factors. May pose a threat to the life and health of a pregnant woman. In case of multiple pregnancy, it increases the likelihood of developmental delay and death of the second fetus. Diagnosis and treatment are carried out by specialists in the field of obstetrics and gynecology.

Causes of antenatal fetal death

This pathology can occur under the influence of various endogenous and exogenous factors. Endogenous factors causing antenatal fetal death include infectious diseases (influenza, pneumonia, measles, rubella, hepatitis), hypovitaminosis, somatic diseases (congenital heart defects, cardiovascular failure, severe liver and kidney diseases, anemia of various origins), diabetes mellitus and other diseases of the maternal endocrine system.

In addition, the group of endogenous causes of antenatal fetal death includes gestosis (eclampsia, nephropathy), severe fetal development anomalies, Rh conflict, blood group incompatibility, polyhydramnios, oligohydramnios, placental circulatory disorders (with anomalies of placental attachment, fetoplacental insufficiency and arteriovenous vascular anastomoses common chorion in twins), true umbilical cord knot, entanglement of the umbilical cord around the fetal neck and inflammatory diseases of the mother’s reproductive system.

Exogenous factors that provoke antenatal fetal death are toxic effects (smoking, alcoholism, drug addiction, substance abuse, taking certain medications, acute and chronic poisoning with household and industrial poisons), ionizing radiation and abdominal trauma. According to research, the leading positions in the list of causes of this pathology are occupied by severe fetal malformations, pathology of the placenta, infections, trauma and intoxication. Sometimes the cause of antenatal fetal death remains unclear.

Pathological anatomy

After death, the fetus may remain in the uterus for several days, months or even years. In this case, maceration, mummification or petrification is possible. 90% of fruits undergo maceration - wet necrosis resulting from contact with amniotic fluid. Initially, tissue necrosis is aseptic in nature. Some time after antenatal fetal death, necrotic tissue can become infected. Severe infectious complications, including sepsis, are possible.

The macerated fruit looks soft and flabby. In the early stages of maceration, the skin is reddish, covered with blisters, alternating with areas of exfoliated epidermis. When infection occurs, the fruit turns greenish. The head and body are deformed. An autopsy is performed to determine the cause of antenatal fetal death. At autopsy, tissue permeation with fluid and pulmonary atelectasis are revealed. The cartilage and bones are brown or reddish, the epiphyses are separated from the metaphyses. With a long stay in the uterus, autolysis of internal organs is possible. Sometimes, when retained in the uterus, the fetus becomes saturated with blood, forming a bloody mole, which subsequently transforms into a fleshy mole.

In cases of multiple births and entanglement of the umbilical cord, the fetus often becomes mummified. It is squeezed by the living twin, reduced in size, and wrinkled. Sometimes the mummified fetus is subsequently subjected to petrification (“petrification” as a result of the deposition of calcium salts). Petrification is more often observed with ectopic pregnancy, although it can also occur during normal gestation. A petrified fetus can remain in the uterus or abdominal cavity for years without causing any pathological symptoms.

Symptoms and diagnosis of antenatal fetal death

Intrauterine fetal death is accompanied by cessation of uterine growth. Fetal movements disappear, the tone of the uterus decreases or increases. The mammary glands become sluggish. Possible disturbances in general well-being, unexplained weakness, malaise, pain and heaviness in the lower abdomen. Evidence of antenatal fetal death is the absence of a heartbeat. From 9-10 weeks, the absence of heartbeats is detected by ultrasound, from 13-15 - when using phonocardiography or electrocardiography. After 18-20 weeks, the absence of heartbeat is determined by normal auscultation. To confirm the diagnosis, additional studies are prescribed: ultrasound, cardiotocography, blood tests for hormones.

Characteristic signs of antenatal fetal death are a decrease in the level of estriol, progesterone and placental lactogen. During amnioscopy, greenish amniotic fluid is detected during the first day (the change in color of the water is due to the presence of meconium). Subsequently, the color of the water becomes less intense, and sometimes an admixture of blood is detected. In some cases, radiography is used in the process of diagnosing antenatal fetal death. X-rays reveal gas in the subcutaneous fat, heart and large vessels of the fetus.

The relative position of the bones of the skeleton is disrupted. The edges of the skull bones overlap or diverge, forming a “step.” In the first case, a decrease in the head is observed, in the second – a flattening or a kind of bag-like elongation of the skull. The fetal head may be tilted to the side. The spine is also deformed. Possible straightening, lordosis or angular deformation. The fetal limbs are located chaotically. During petrification, deposits of calcium salts are visible in the area of ​​the amniotic membrane, trunk and limbs. During intravenous urography of the patient, the fetal kidneys are not contrasted.

Treatment and prevention of antenatal fetal death

If the fetus dies in the first trimester, a miscarriage is possible. If a miscarriage does not occur, a medical abortion is performed. In case of death in the second trimester, the fetus is usually not expelled on its own; urgent delivery is necessary. After a comprehensive examination and study of the state of the blood coagulation system, the patient undergoes labor induction. First, estrogens, glucose, vitamins and calcium supplements are administered, then oxytocin and prostaglandins are prescribed. To speed up the first stage of labor, an amniotomy is performed.

In case of antenatal fetal death in the third trimester, spontaneous childbirth is possible. In the absence of labor, stimulation is prescribed. According to indications, fruit-destroying operations are performed. In case of hydrocephalus, frontal and pelvic presentation, threat of uterine rupture and serious condition of the patient, a craniotomy is performed. If the transverse presentation is advanced, decapitation or evisceration is performed; if the shoulders are retained in the birth canal, cleidotomy is performed.

Prevention of antenatal fetal death includes timely detection of genetic abnormalities, diagnosis and treatment of somatic diseases, sanitation of chronic foci of infection, giving up bad habits, stopping contact with household toxic substances, eliminating occupational hazards, preventing injuries and thoughtful prescription of medications during pregnancy.

Antenatal fetal death in multiple pregnancies

Intrauterine fetal death is detected in 6% of multiple pregnancies. The likelihood of development depends on the number of fetuses and chorions. The greater the degree of multiple pregnancy, the higher the risk of death of one of the twins. In the presence of a common chorion, the probability of death of one of the fetuses increases several times compared to dichorionic twins. The immediate causes of antenatal fetal death are intrauterine growth retardation, placental abruption, severe gestosis, chorioamnionitis or the formation of an arteriovenous anastomosis with a common chorion.

The form of the pathology depends on the time of fetal death. In the early stages of pregnancy (up to 10 weeks), the “missing twin” phenomenon is observed. The dead embryo is rejected or absorbed. If there are two chorions, the death of one twin does not affect the development of the other. With a common chorion, the second twin increases the likelihood of cerebral palsy and intrauterine growth retardation. Antenatal fetal death in such cases often remains unrecognized and is regarded as a threat of termination of pregnancy.

If you die at the end of the first or beginning of the second trimester of pregnancy, the dead fetus does not disappear, but is mummified. It is compressed by the enlarging amniotic sac of a brother or sister, “dries out” and decreases in size. With a common chorion, the second twin often develops congenital malformations caused by the entry of decay products into the body through the common circulatory system.

In case of multiple pregnancy and suspected antenatal fetal death, immediate hospitalization is indicated for examination and decision on pregnancy management tactics. During the examination, the gestational age and the number of chorions are determined, the condition of the living fetus is assessed, and somatic diseases and diseases of the mother’s reproductive system are identified. In case of general chorion and antenatal fetal death, diagnosed at the beginning of the second trimester, parents are advised to consider terminating the pregnancy due to the high risk of developing intrauterine pathology in the second twin.

At 25-34 weeks of gestation, a thorough examination of the surviving fetus (ultrasound, MRI) is necessary. If the condition of the fetus is satisfactory, prolongation of pregnancy is indicated. The need for urgent delivery in case of antenatal fetal death is determined taking into account the condition of the mother and surviving child, the likelihood of developing intrauterine disorders and the risk of complications caused by prematurity. Indications for delivery on the part of a pregnant woman include somatic diseases and diseases of the reproductive system that prevent the prolongation of pregnancy. Relative indications from the fetus are anemia, terminal blood flow and the threat of fetal death with arteriovenous anastomoses. Antenatal fetal death after 34 weeks of multiple pregnancy is considered as an absolute indication for delivery.

If there are two chorions, urgent delivery is usually not required. The patient is placed under constant monitoring, which includes daily monitoring of temperature, blood pressure, edema and discharge, as well as regular tests to assess the condition of the blood coagulation system. The condition of a living fetus is assessed based on the results of Doppler measurements, biometry and echography of the brain. After birth, an autopsy of the deceased twin is performed and the placenta is examined to identify the cause of antenatal fetal death.