Why pregnancy does not develop in the early stages. Reliable signs of non-developing pregnancy. Manifestations of non-developing pregnancy. Why is a non-developing pregnancy dangerous for a future mother - the causes of the disease, treatment tactics, possible consequences

Symptoms of an undeveloped pregnancy

Signs of non-developing pregnancy are varied. Conventionally, they can be divided into subjective and explicit (proven with the help of medical examinations). Let's consider both of them.

Likely Symptoms

1. Disappearance of toxicosis. Of course, it should not last throughout the entire pregnancy, but unpleasant symptoms in the form of nausea and vomiting usually disappear gradually, over several days or even weeks. If there was severe toxicosis, which suddenly stopped - this should alert.

2. Disappearance of soreness of the mammary glands- such frozen pregnancy symptoms can have. Moreover, not only the tension of the chest can disappear, but even its size may decrease somewhat. The chest seems to fall off. This symptom is especially noticeable in case of pregnancy of 8-10 weeks or more.

3. Bloody, beige, brown vaginal discharge, abdominal pain- usually such signs of non-developing pregnancy on early dates signify the beginning of a miscarriage. But not in all cases, such a natural ending of a missed pregnancy is possible. Often a miscarriage does not occur for 1-2-3 weeks, and then curettage of the uterine cavity is necessary. In addition, do not forget that these signs can also occur when there is a threat in the case of a normal developing uterine pregnancy, and an ectopic one - which is especially dangerous.

4. Decrease in basal temperature. Many women know that in the second phase of the menstrual cycle and during pregnancy, the temperature in the rectum should be elevated - above 37 degrees. A decrease in temperature may be due to a lack of the hormone progesterone or to the death of the embryo.

5. The first signs of a non-developing pregnancy can also be determined by a doctor during a gynecological examination when he notices a discrepancy between the size of the uterus and the gestational age (it is considered on the first day of the last menstruation). Or if since the last gynecological examination, carried out 1-2 weeks before, the uterus has not grown at all.

Absolute signs

1. The absence of a heartbeat in the embryo(determined from the fifth week of pregnancy during ultrasound examination). If the heartbeat is not detected, the woman is recommended to repeat the examination in a few days. If the heartbeat does not appear, it is recommended to remove the non-developing fetus and its membranes by scraping the uterine cavity.

2. Lack of growth, low human chorionic gonadotropin- this is how a frozen pregnancy always manifests itself in the early stages - the first weeks. Chorionic gonadotropin is a hormone produced by the chorion (future placenta) that rises rapidly during the first trimester. There are its norms, deviation from which indicates pathologies. For women who are at risk of miscarriage, doctors prescribe periodic blood tests for hCG. And in the absence of hormone growth, they are sent for an ultrasound scan.

At the end of the article, it is worth saying that an undeveloped pregnancy is a very common occurrence. According to statistics, approximately every 8th pregnancy ends with the death of the embryo. In most cases, chromosomal abnormalities are the cause, but cases of the detrimental effect of infections, toxic substances and medicines. To minimize the likelihood of this unpleasant pathology, plan your pregnancy, take everything necessary tests, undergo examinations, listen to the doctor's recommendations and do not self-medicate.

Non-developing pregnancy(intrauterine fetal death, miscarriage) - the death of an embryo or fetus without obvious signs of termination of pregnancy. Unfortunately, this can happen to every woman and at any gestational age, but this does not mean that subsequent pregnancies will be complicated (unless this is a repeated case).

information Pregnancy fading in the early stages of development occurs most often. Critical timing for non-developing pregnancy (NB) is most often up to 8 weeks of gestation. It is at this time that all organs and tissues are being laid, so any pathological factor can disrupt the development of the fetus and lead to its death.

The consequences of NB in the early stages, both for the woman's body and for her psychological state, are less than if this happened during the period when the mother already felt a stir. In any case, you should not dwell on what happened and be afraid of a subsequent pregnancy. Try to treat this as a natural selection of nature.

Causes

Unfortunately, even modern medicine is not always able to answer why the death of a child occurred in utero. There are many reasons, but it is not always possible to get to the truth. Moreover, at an early stage, the law is in effect: “all or nothing”. This means that under the influence of adverse factors, the embryo either transfers them and develops further correctly, or dies.

genetic factor

Most often, a frozen pregnancy at an early stage occurs due to a genetic breakdown of the embryo itself, which occurred at one stage or another of its development. The fetus is simply not viable, so it is rejected. This is a kind of natural selection.

infectious factor

Another common cause of NB is infection. Most often it is the herpes simplex virus and various respiratory diseases, sexually transmitted infections (chlamydia, mycoplasmas, gonococci) and others. Under the action of these pathogens in the early stages of development, a violation of cell division can occur, damage to the genetic material of the embryo, which will cause its death.

immune factor

Maternal immunological disease (antiphospholipid syndrome, systemic lupus erythematosus and others), immunological incompatibility of spouses can also cause fetal death, and more often this occurs before 12 weeks of pregnancy.

Endocrinological factor

Inadequate synthesis of progesterone (a hormone that maintains pregnancy), thyroid disease, excessive synthesis of male sex hormones and prolactin can interfere with the normal development of the fetus.

Other factors

We should not forget about the lifestyle of future parents. Bad habits, contact with chemicals, living in a zone of high radiation, stress can affect the favorable course of pregnancy, especially in the very early stages.

Symptoms

important The main signs of abortion at different times are pain in the lower abdomen,. The difficulty with NB is that all these symptoms do not bother the woman. She may not know for several weeks that the fetus has died.

The main signs of an early miscarriage are a decrease in subjective sensations that are characteristic of many women in the position:

engorgement of the mammary glands;
sensitivity to smells;
unusual food preferences;
nausea, vomiting;
drowsiness.

Of course, not every pregnant woman will be wary of such symptoms, and often these signs disappear with the progression of pregnancy (gestation). That is why fetal fading is often not diagnosed immediately, but after a few weeks. Often, spotting from the genital tract can join, which indicates the beginning of pregnancy rejection.

Ultrasound signs of missed pregnancy

The main ultrasound signs of stopping the development of the embryo at the shortest time are the deformation of the fetal egg, uneven contours, and its location in the lower part of the uterus. It is characterized by a discrepancy between the gestational age according to ultrasound and monthly, the absence of a fetal heartbeat (usually from 5-6 weeks it can already be determined).

additionally However, the gestational age and menstrual period do not always coincide. This can happen for various reasons (irregular periods, hormonal disorders, stress, ovarian cysts, and others), and the difference can be up to four weeks.

Therefore, in some cases (for example, for a monthly gestation period of 7-8 weeks, and ultrasound shows only a fetal egg characteristic of 4 weeks), in order not to make a mistake with the diagnosis, it is worth repeating the study after 5-7 days. If during this time the fetal egg does not grow up, the embryo is not visualized, then the fetus freezes.

Signs of NB during gynecological examination

At a gynecological examination, the doctor evaluates the size of the uterus, its compliance with the expected gestational age, and the condition of the cervix. If the uterus is judged to be smaller, an ultrasound should be performed to confirm or refute the suspicion. Some women have physiological features (initially smaller internal genital organs) or there may be a difference in terms for menstruation and for the embryo, so it is important to make sure that the delay in uterine growth is really caused by pregnancy fading.

Determination of human chorionic gonadotropin (hCG)

Determining the concentration of human chorionic gonadotropin helps in making a diagnosis, especially in the very early stages. So, when it is still impossible to see the fetal heartbeat using ultrasound, but there are doubts about its viability, you can donate blood to the level of hCG. It is important to observe the dynamics here, since with a normally developing embryo, the level of the hormone almost doubles every day.

Measurement of basal temperature in case of suspected NB

It should be said right away that this method is only additional and indicative, since it is inaccurate and its results may vary under the influence of many factors. Basal temperature is measured in the rectum, without getting out of bed, at the same time after a night's sleep. Under the influence of the hormone progesterone (preserves pregnancy), this temperature rises by 0.3-0.5 degrees Celsius and is 37.2-37.5. When the embryo freezes, the level of progesterone decreases, and as a result, the basal temperature also decreases.

Treatment

When confirming intrauterine fetal death, a woman must be hospitalized in a gynecological hospital. In the early stages, the main treatment for non-developing pregnancy is the simultaneous removal of the embryo or fetus and its membranes. If the gestational age allows, it is better to do this by vacuum aspiration. This method is more gentle. At a later date, curettage of the uterine cavity is performed (like an abortion). Before the operation, it is worth preparing the cervix, especially in nulliparous women. To do this, use kelp (algae sticks), catheters. This is done to gently and gradually dilate the cervix. Vacuum aspiration of the fetal egg and curettage of the uterine cavity is performed under general anesthesia.

Also, for short periods, expectant management and medical abortion are increasingly used. These methods will allow pregnancy to be terminated more gently (but always under the supervision of doctors).

Rehabilitation

important It is very important to rehabilitate a woman after an undeveloped pregnancy. It includes taking oral contraceptives (at least 3 months), treatment of diseases of the genital organs (infections) and hormonal disorders.

Also, do not forget about psychological aspect. It's good to change the situation, get positive emotions. Try to avoid conflicts. It is important to feel supported by others.

Consequences

The consequences for the reproductive health of a woman are reduced to zero if the removal of the embryo with its membranes is carefully performed, and rehabilitation is also carried out.

Prognosis for next pregnancy

In 90% of cases, women who have suffered early fetal death are able to become pregnant and bear a healthy child. However, if a non-developing pregnancy recurs, it is necessary to undergo a full examination to identify the cause, since violations can be at the hormonal and immune levels.

Planning a pregnancy is not earlier than 6 months. During this time, the body will be able to recover in order to become capable of bearing a healthy child. It is very important during this period to undergo an examination and preparation for a subsequent pregnancy.

The main thing is to believe in the good and not let your fears prevent you from becoming happy parents.

Non-developing pregnancy is a complex of pathological symptoms, including intrauterine death of the fetus (embryo), pathological inertia of the myometrium and disturbances in the hemostasis system.

SYNONYMS

Frozen pregnancy, missed miscarriage, missed abortion.

ICD-10 CODE
O02.1 Missed miscarriage.

EPIDEMIOLOGY

The frequency of miscarriage in the population is 20%. In the structure of miscarriage, the frequency of habitual miscarriage ranges from 5% to 20%, and non-developing pregnancy - 45–88.6% of the number of spontaneous miscarriages in the early stages

PREVENTION OF MISSED PREGNANCY

Prevention consists in correcting violations of the body's immunoreactivity according to the ELIP-Test, restoring the eubiosis of the vaginal microflora.

In the hyporeactive state of the body, the treatment of chronic inflammation is carried out according to traditional schemes: an increase in immunoreactivity (prodigiosan), the appointment of immunomodulators and interferon inducers.

In a hyperreactive state, immunomodulators and plasmapheresis are prescribed.

In order to normalize the hypothalamic-pituitary-ovarian system, to restore hormonal reception of the damaged endometrium, it is advisable to conduct hormone-correcting therapy. Recommend the appointment of microdoses of combined oral contraceptives from the first day of termination of pregnancy for 6 months.

CLASSIFICATION

According to the results of ultrasound, two types of non-developing pregnancy are distinguished: anembryony (Fig. 24-1) and death of the embryo (fetus) (Fig. 24-2).

Echographically distinguish anembryony I and II types. In type I anembryonia, the embryo is not visualized, the average diameter of the fetal egg does not exceed 2.0–2.5 cm, the size of the uterus corresponds to the 5–7th week of pregnancy. Of decisive diagnostic importance is the lag in the size of the uterus and the fetal egg from the gestational age, the cessation of their growth during dynamic observation.

Rice. 24-1. Non-developing pregnancy of the type of anembryony.

Rice. 24-2. Non-developing pregnancy according to the type of embryo death.

In type II anembryonia, despite the absence of an embryo or the visualization of its remains (usually in the form of a vertebral fold), the fetal egg grows at a normal rate. By the 10–11th week of pregnancy, the diameter of the fetal egg reaches 4.5–5.5 cm. In type II anembryony, the laying of the villous chorion is not clearly detected, which is normally determined already from the 8th week of pregnancy.

ETIOLOGY (CAUSES) OF MISSED PREGNANCY

Non-developing pregnancy is a polyetiological complication of pregnancy, the most common cause is chronic endometritis with the persistence of opportunistic microorganisms and/or viruses. It is known that during primary infection in early pregnancy, damage to the embryo is possible, incompatible with life, leading to sporadic spontaneous miscarriage. In most women with missed pregnancy and chronic endometritis, two or three or more types of obligate anaerobic microorganisms and viruses prevail in the endometrium. But there are other factors that contribute to non-developing pregnancy:

anatomical anomalies;

Chromosomal defects

disorders of the blood coagulation system.

Currently, genetic, immune, thrombophilic factors, which are the least studied, are of the greatest interest. Thrombophilic factors are genetically determined.

The fetal egg with the mother's body is a functionally unified hormonal system. The ability of the fetus to take an active part in the synthesis and metabolism of progesterone has been proven. With threatening miscarriage, these processes are violated. Progesterone deficiency leads to the pathology of decidualization of the endometrial stroma, weak invasion of the cytotrophoblast and, as a result, to a decrease in uteroplacental circulation. With miscarriage by the type of missed pregnancy, the fetal metabolism of progesterone ceases - an important distinguishing feature of a missed pregnancy from spontaneous abortion.

Genetic factors include chromosomal abnormalities of the embryo or fetus, formed by the fusion of two parental cells with the presence of point mutations in the chromosome set. When examining the material of miscarriages, most of the detected chromosomal disorders are quantitative (95%).

The shorter the gestational age at the time of the death of the fetal egg, the higher the frequency of chromosomal aberrations. In the presence of chromosomal aberrations, embryogenesis is impossible or is sharply disturbed in the early stages. Assume the relationship of developmental disorders in chromosomal aberrations with a reduced ability of cells to divide. In this case, there is a sharp desynchronization of the processes of development of the embryo, development of the placenta, induction of cell differentiation and migration.

Causes of quantitative chromosomal aberrations.

Failures of meiotic division: cases of non-disjunction of paired chromosomes, this leads to the appearance of monosomy or trisomy. Chromosome nondisjunction in eggs and spermatozoa can occur at any time during meiotic division.

· Failures that occur during fertilization: cases of fertilization of the egg by two spermatozoa (dyspermia), resulting in a triploid embryo.

· Malfunctions that occur during the first mitotic divisions: The complete tetraploidy that occurs during the first division of mitosis leads to chromosome doubling and the absence of division of the cytoplasm. Mosaics arise in the case of such failures at the stage of subsequent divisions.

PATHOGENESIS

The leading place in the etiology of miscarriage is occupied by a persistent viral-bacterial infection. The pathogenesis of the development of missed pregnancy is chronic endometritis. In acute or chronic viral infection, local and general immunity is activated in the body. Increased synthesis of damaging cytokines, reduced synthesis of growth factors contributes to abnormal invasion and damage to the trophoblast in early pregnancy. Some viruses, such as human papillomavirus (HPV), CMV, infect the trophoblast and vascular endothelium, causing an increase in the production of prothrombinase, contributing to the further destruction of the endothelium. At the same time, protective mechanisms that contribute to the preservation of pregnancy are violated: the expression of HLA-- by trophoblastomas decreases, the secretion of growth factors decreases, and the activation of the TH-2 pathway of lymphocyte differentiation does not occur. Study of the species and quantitative composition of vaginal microcenosis and cervical canal revealed the relationship of the dysbiotic state of these microecosystems with the persistence of opportunistic microorganisms in the endometrium. Viral diseases of the female genital organs, which develop against the background of immunodeficiency conditions, contribute to the development of complications in secondary immunodeficiencies. That is why the presence of a chronic viral infection is considered an important provoking factor in the development of chronic endometritis.

The main reason for the chronic course of the inflammatory process is considered to be the inadequacy of the ongoing antibacterial treatment due to the etiological structure of infectious morbidity that has changed in recent years.

The inflammatory process can develop as a result of the activation of the normal microflora of the vagina, for example, when general or local immunity is weakened.

An important role in the pathogenesis of missed pregnancy is assigned to the cytokine system. With excessive deposition of circulating immune complexes in tissues, immunopathological processes occur, accompanied by pronounced disturbances in the microcirculatory bed. In patients with non-developing pregnancy, there is a lack of activity of lymphocytes and an imbalance in the cytokines produced by them. A shift in the balance leads to an increase in the production of pro-inflammatory cytokines, excessively pronounced manifestations of the inflammatory process, even with the persistence of the infectious agent. This disrupts the interaction of cells, as a result - implantation becomes defective, the depth of penetration is insufficient or excessive.

The frequency of structural chromosomal aberrations in the material of miscarriages reaches 80%. Approximately half of the cases of these anomalies are inherited from parents, the other half of the cases arose de novo.

The integrin heterodimer a-V;b-3, which appears on the 20th day of the menstrual cycle and opens the “implantation window”, is of the greatest importance for the implantation process. The appearance of the a-V;b-3 heterodimer is due to the activation of growth factors HB-E-F (heparin-bindin- - rowth factor) and E-F (epidermal - rowth factor). The connection of the a-V;b-3 heterodimer with the osteopontin ligand indicates the beginning of the interaction between the embryo and the endometrium, i.e. start of invasion. Progesterone stimulates the synthesis of osteopontin and the production of endometrial calcitonin, which increases the intracellular content of calcium ions. Calcium potentiates the adhesion of the trophoblast to the endometrium by redistributing the protein molecules of the receptors and their ligands. With a frozen pregnancy, a violation of the structure of the endometrium occurs - the ratio of the components of the extracellular matrix (collagens of different types) changes.

The consequence of the Leiden mutation is a disruption in the functioning of the protein C system, which is the most important natural anticoagulant pathway: protein C, inactivating factor Va, does not affect it; activated factor V, connecting with factor Xa on the phospholipid surface, accelerates the reaction of thrombin formation by tens of thousands of times, this leads to the development of thrombophilia. With APS in the mother's body, antibodies (I-A, I-, I-M) are produced and circulate in the blood to the phospholipids of platelet cell membranes, resulting in an imbalance in the anticoagulant blood system.

The main manifestations of APS:
arterial and venous thrombosis;
miscarriage;
infertility.

Mechanisms of thrombophilia in APS:
Violation of the prostacyclin-thromboxane A2 ratio;
Changes in the content and activity of antithrombin III;
Expression of endothelial procoagulants (tissue factor, von Willebrand factor, platelet activating factor);
Violation of the activation of protein C and the development of resistance to it.

The retention of a non-developing fetal egg or a dead fetus in the uterus affects the maternal organism.

The absorption of the products of autolysis of the tissues of the fetal egg into the mother's bloodstream (due to the increased permeability of the membranes) violates the intravascular conditions of hemostasis. A long stay of a dead fetal egg in the uterus significantly reduces the hemocoagulation activity of tissue and vascular factors of the placenta, this is caused by degenerative changes in the placental tissue. Prolonged exposure of the autolysis products to the uterus reduces the contractility of the myometrium.

The inertia of the uterus in NB is explained by a violation in the "mother-placenta-fetus" system. The uterus is deprived of a universal inhibitor of the start of contractile activity and the elimination of pregnancy - the fetal endocrine factor.

Inhibition of the contractile function of the uterus in this pathology is associated with regressive changes in the functional bioenergetics of the myometrium due to the lack of hormonal reinforcement from the fetus. In the classic hormonal chain of labor induction, key fetal links - oxytocin, DHEAS, cortisol - fall out.

CLINICAL PICTURE (SYMPTOMS) OF FAILED PREGNANCY

The clinical picture of a failed miscarriage is characteristics. The subjective signs of pregnancy disappear in the patient, the mammary glands decrease in size and become soft. Menstruation does not return. In the expected period, no movement of the fetus is noted. However, if fetal movements appear, they stop.

When a dead fetus is retained in the uterus for more than 3–4 weeks, 10% of women report general malaise, weakness, dizziness, and fever. The disappearance of nausea, vomiting, salivation are characteristic subjective signs of the death of the fetal egg in the first 12 weeks of pregnancy. In the second half of pregnancy, a woman notes the cessation of fetal movement. The symptom of softening of the mammary glands occurs on the 3-6th day after the death of the fetus. Milk appears in the mammary glands instead of colostrum. Breast engorgement and the release of a significant amount of colostrum are observed in women with fetal death that occurs after 25 weeks of development.

Clinical signs of a missed pregnancy (pain, bleeding from the genital tract, lagging behind the size of the uterus from the expected gestational age) appear 2-6 weeks after the cessation of embryo development. The stages of termination of a non-developing pregnancy correspond to the stages of spontaneous abortion:
threatened miscarriage;
A miscarriage that has begun
Abortion in progress
incomplete abortion.

A complete abortion during a missed pregnancy due to pathogenetic reasons is not isolated.

DIAGNOSIS OF MISTAKE PREGNANCY

Early diagnosis of non-developing pregnancy is of great practical importance, since it helps to reduce the time of examination of patients and reduce the risk of complications associated with a long stay of a dead fetal egg in the uterine cavity. The diagnosis of non-developing pregnancy is established on the basis of echographic data, revealing the absence of an embryo in the cavity of the fetal egg after 7 weeks of pregnancy or the absence of an embryo's heartbeat.

ANAMNESIS

Risk factors for chronic endometritis are identified: the presence of two or more medical abortions in history; sexually transmitted diseases, inflammatory diseases of the genital organs. It is necessary to conduct ultrasound, analysis of AFP, hCG proteins in the most informative terms.

PHYSICAL EXAMINATION

A decrease in cyanosis of the mucous membrane of the vagina and cervix occurs 4-5 weeks after the death of the fetus for up to 16 weeks of pregnancy and after 6-8 weeks with the death of the fetus at a later date. A decrease or lagging of the uterus from the proper size is detected with the death of the fetus up to 20 weeks and especially up to 12 weeks. In early pregnancy, this occurs as a result of resorption of the fetal egg. At long periods - due to the absorption of organic matter, maceration and wrinkling of the fetus. A change in the consistency of the uterus, its compaction or softening is not considered a reliable symptom of a missed pregnancy. The opening of the cervical canal in nulliparous by 1–1.5 cm, and in those who have given birth - by 3 cm or more, is observed when a dead fetus is retained in the uterine cavity from 12 to 20 weeks. In the event of the death of the fetus for a period of more than 14 weeks and its presence in the uterine cavity for more than 4 weeks, when examining the uterus with the help of mirrors, a discharge of thick brown mucus from the cervical canal is detected. When the fetal bladder is opened, brown OM is poured out. If the death of the fetus occurred after 30 weeks and it was in the uterus for more than 2 weeks, when using the third external obstetric examination, crepitus is determined, which occurs due to the friction of the bones of the skull among themselves.

INSTRUMENTAL STUDIES

Ultrasound is considered the most informative method for diagnosing a non-developing pregnancy, which makes it possible to detect a missed pregnancy long before the onset of clinical symptoms. With anembryony, an “empty” fetal egg is found, its diameter does not exceed 2.0–2.5 cm, and the size of the uterus corresponds to 5–7 weeks. pregnancy (type I anembryony), the absence of an embryo or visualization of its remains, given the normal growth rate of the fetal egg from 10–11 weeks of gestation (type II anembryony).

Ultrasound allows in the II and III trimesters to establish the death of the fetus immediately after its death. Signs of intrauterine fetal death, detected on ultrasonograms.

Change in the fetal head.
- Tile-like overlapping of the edges of the skull bones.
- Divergence of the edges of the bones of the skull.
- Flattening of the vaults of the skull.
- Asymmetry of the contours of the skull.
- Disappearance of the contours of the head.
- Sagging of the lower jaw.
- On the 4-5th day after the death of the fetus, the disappearance of the median structures of the brain is noted. An important sign of the length of stay of a dead fetus in the uterus is the figures of the cranial index (Y) characteristic of this pathology: the ratio of the biparietal size (BPR) of the fetal head to the frontooccipital size (LZR) x 100. Normally, it exceeds 83. When a dead fetus is retained in the uterus up to 3 weeks cranial index is 74-64, with a delay of more than 3 weeks - 64.

· Change of a backbone.
- Deviation of the fetal head at an angle.
- Abnormal rotation and flexion of the head.
- Excessive curvature of the spine in the form of kyphosis.
- Pathological curvature of individual sections of the spine in the form of an arc or angle.
- Arrow-shaped straightening of the spine and the disappearance of the physiological curvature.
- Changes in the bones of the skeleton and limbs of the fetus.
- Change in the shape of the fetal chest.
- "Scattering" limbs.
- Indistinct and vague contours of the skeleton of the fetus.
- Atypical position of the fetus in relation to the center of the uterus.

· Other symptoms.
- Discrepancy between the size of the fetus and the expected gestational age.
- "Crown" around the cranial bones.
- Shadows from free gas in large vessels, cavities of the heart and fetal cranium.

It has been established that the shorter the gestation period (considering the second half of pregnancy) by the time of the death of the fetus and the period of its stay in the uterine cavity, the more strongly the individual parts of the skeleton are changed. The degree of transformation does not depend on the nature of post-mortem changes and the cause that caused the death of the fetus.

Diagnostic and prognostic value in case of missed pregnancy is ultrasonic placentography, which allows to determine the location of the placenta, its size, premature detachment of individual sections, changes in the form of cysts, infarcts, necrosis, calcification, etc.

With a frozen pregnancy, the placenta has a pronounced lobular structure due to an increase in calcification of the outer surface of the maternal part.

LABORATORY RESEARCH

In complex diagnostics, as additional tests, the determination of the levels of AFP, hCG and trophoblastic b-1-glycoprotein in the blood serum is used. With the death of the fetus, a high content of AFP is noted (2–4 times higher than the standard values) and a decrease in the level of trophoblastic b-1-glycoprotein (6–18 times) and hCG (3–9 times).

Prior to termination of pregnancy, it is necessary to carefully monitor the hemostasis system to correct possible violations.

ELISA determination of gravid proteins in blood serum

Trophoblastic b-1-glycoprotein.
- Trophoblastic b-1-glycoprotein is considered a specific marker of the fetal part of the placenta, it is synthesized by cells of cytotrophoblast and syncytiotrophoblast. Trophoblastic b-1-glycoprotein has the function of a transport protein and pronounced immunosuppressive properties. The detection of trophoblastic b-1-glycoprotein in the serum of pregnant women is possible on the 7-14th day after ovulation. In uncomplicated pregnancy, the concentration of trophoblastic b-1-glycoprotein in the blood serum increases from 10.4±1.1 µg/ml at 6–12 weeks to 281.1±4.8 µg/ml at 33–40 weeks. A decrease in the level of trophoblastic b-1-glycoprotein occurs immediately after the death of the fetal egg. A sharp decrease (by 4.3–8.6 times) is noted in pregnant women after 3 weeks of the stay of the deceased fetus in the uterus.

Placentospecific a-1-microglobulin.
- Placentospecific a-1-microglobulin is secreted by the decidua, it is considered a specific marker of the maternal part of the placenta. With an increase in the gestational age, the concentration of a-1-microglobulin gradually increases from 21–25 weeks of gestation (81.35±14.31 ng/ml), by 31–35 weeks it decreases (60.13±9.91 ng/ml) and subsequently reaches maximum values by 40 weeks of pregnancy (111.19±6.13 ng/ml). In women with a missed pregnancy, the concentration of protein in the blood serum is 2.5 times higher than normal. The appearance of a high level of serum a-1-microglobulin is associated with a destructive process in the maternal (decidual) part of the placenta, which explains the increase in the level of protein in the blood plasma.

AFP.
- Determination of AFP plays a minor role in the diagnosis of non-developing pregnancy. A high concentration of protein in the blood serum indicates intrauterine death of the fetus (embryo). The highest serum level of embryonic protein is noted 3-4 days after the death of the fetus (embryo). The high content of AFP in the mother's blood (1.5–3 times higher than during physiological pregnancy) is associated with its diffusion into the OB and the mother's blood flow from the dead embryo or fetus.

· HCG.
- HCG is a specific pregnancy hormone that reflects its development. The production of the hormone serves as an indicator of the normal activity of the trophoblast, a criterion for its functional activity. During physiological pregnancy, the primitive trophoblast begins to produce hCG as early as 1 day after implantation.

The hormone concentration reaches its maximum already at 6–10 weeks of a normal pregnancy (116.01±16.12 IU/ml), then decreases and increases again at 31–35 weeks (34.91±7.36 IU/ml).
- The concentration of hCG in the blood serum in patients with missed pregnancy, compared with physiological pregnancy, is 8.6 times lower at 6–12 weeks, 3.3 times at 13–26 weeks, and 2 times lower at 28–30 weeks .7 times.
- They note a decrease in the level of PL (by 1.8–2.7 times), but in general it remains high. In patients with non-developing pregnancy, the concentration of progesterone in the blood remains at a relatively high level, and the content of estradiol decreases sharply.

The diagnostic value of the study increases with repeated determinations. In a cytochemical study, a feature of the leukocyte formula in women with missed pregnancy is an increase in monocytes, a decrease in basophils and eosinophils, and an increase in ESR.

HEMOSTASIS DISORDERS IN NON-DEVELOPING PREGNANCY

LABORATORY DIAGNOSIS OF BLOOD THROMBOGENIC ACTIVITY (INTRAVASCULAR HEMOSTASIS MECHANISM)

Many authors believe that bleeding that occurs during artificial termination of pregnancy in women with intrauterine fetal death is due to a violation of the vascular platelet and plasma coagulation links of hemostasis, a violation of the fibrinolysis system.

Intravascular conditions of hemostasis in non-developing pregnancy are studied in a complex way: by biochemical and electrocoagulographic methods, while determining the time of blood clotting, the time of plasma recalcification, the activity of the prothrombin complex, the concentration of fibrinogen, fibrinolytic activity of the blood, retraction of the blood clot, evaluate chronometric and structural coagulation.

Express method for diagnosing DIC according to E.P. Ivanov

2 ml of venous blood is drawn into a test tube with an anchor (Fig. 24-3).

Rice. 24-3. Test tube with anchor.

The test tube, constantly warming in the hand, is turned over every 30 seconds. As soon as the blood stops flowing onto the walls, the clot is fixed at the anchor, the time of blood clotting is noted.
Norm: 5–11 min.
Hypercoagulable phase of DIC: 2–4 min.
Hypocoagulation: >11 min.
When a clot forms, the tube is fixed in a vertical position for 1 hour.
If a reddish-yellow transparent liquid with a volume of no more than 1–1.2 ml is released from the clot in the first 30 minutes, fibrinolysis and retraction are normal. If serum is not released, retraction processes (thrombocytopenia) are sharply disturbed in the blood.
If the clot is significantly dissolved in the first 30 minutes (1–2 ml) and the liquid phase differs little in color from the color of the blood clot, then fibrinolysis is increased in the blood.
With a-hypofibrinogenemia and an increase in the anticoagulant properties of the blood, the clotting time is significantly lengthened (more than 15 minutes). To determine the cause of this phenomenon, dry thromboplastin and 0.1 ml of 10% calcium chloride solution are added to 1 ml of blood at the tip of a scalpel, the resulting dense clot indicates anticoagulant activation. If the blood in the test tube does not clot for more than 1-3 minutes, a - or hypofibrinogenemia is ascertained, less often - hyperheparinemia.

To exclude hyperheparinemia, 0.1 ml of a 1% solution of protamine sulfate is added to the test tube. If after 1–2 minutes the blood coagulates, this indicates the presence of hypocoagulation due to hyperheparinemia, the patient must be given intravenous protamine sulfate (1 ml of protamine sulfate neutralizes 1000 IU of heparin).

The pathogenetic basis for the prevention of coagulopathic bleeding is the elimination of the direct cause of the activation of the hemostasis system (dead fetal egg), the relief of thrombinemia, the deficiency of blood coagulation components and their inhibitors.

DIFFERENTIAL DIAGNOSIS

Differential diagnosis is carried out with the onset of miscarriage, trophoblastic disease, ectopic pregnancy, menstrual dysfunction against the background of inflammatory processes of the internal genital organs.

INDICATIONS FOR CONSULTATION OF OTHER SPECIALISTS

Consultation of other specialists is necessary if the patient has extragenital diseases. With pronounced deviations of hemostasis - consultation of a hemostasiologist.

EXAMPLE FORMULATION OF THE DIAGNOSIS

Non-developing pregnancy 8 weeks.

TREATMENT OF MISSED PREGNANCY

Treatment of a non-developing pregnancy consists in the evacuation of a dead fetal egg and the appointment of anti-inflammatory therapy.

GOALS OF TREATMENT

The goal of treatment is the gentle evacuation of the fetal egg, the fight against endometritis.

INDICATIONS FOR HOSPITALIZATION

All patients with an established missed pregnancy are subject to hospitalization as soon as possible.

NON-DRUG TREATMENT

There is no non-drug treatment for non-developing pregnancy.

SURGERY

With a frozen pregnancy up to 14-16 weeks, the fetal egg is evacuated simultaneously with the help of instrumental emptying of the uterine cavity, with the expansion of the cervical canal and curettage, or vacuum aspiration is used. In both cases, hysteroscopic control is necessary. During hysteroscopy, the localization of the fetal egg, the state of the endometrium are assessed, then the fetal egg is removed with the targeted taking of histological material from the placental bed and washing the uterine cavity with an antiseptic solution (Fig. 24-4, see color insert). Antibiotics are given as indicated.

Rice. 24-4. Non-developing pregnancy in the uterine cavity.

MEDICAL TREATMENT

When terminating an undeveloped pregnancy in the second trimester, use:
intraamnial administration by transcervical or transvaginal amniocentesis of 20% sodium chloride solution or PG;
The use of an antiprogestogen in combination with PG;
· isolated application of PG.

One of the most effective methods of emptying the uterus in antenatal fetal death is the intraamnal administration of drugs that trigger labor activity. Apply the introduction of 50 IU of dinoprost by transabdominal access. An alternative scheme is transabdominal amniocentesis with the removal of about 10 ml of water for each week of pregnancy and the introduction of a 20% sodium chloride solution at the rate of 10 ml for 1 week of pregnancy + 10% of the calculated volume. This algorithm is applicable for a normal amount of RH. With polyhydramnios, it is recommended to introduce a smaller amount of hypertonic solution, compared with the amount of water received by 10–15%. With oligohydramnios, the amount of the injected solution may exceed the volume of the excreted fluid, but be 10 ml for each week of pregnancy.

When opening the fetal bladder, this method is appropriate. Manipulation is performed under ultrasound control.

Contraindication - suspicion of adhesions in the pelvis. Curettage of the uterine cavity after 14–16 weeks in the absence of remnants of the fetal egg and signs of a systemic inflammatory response by ultrasound is not advisable.

INDICATIONS FOR CONSULTATION OF OTHER SPECIALISTS

Consultation of a specialist is necessary with the development of coagulopathic complications, the presence of severe extragenital diseases.

APPROXIMATE TIMES OF INABILITY TO WORK

Disability 10-14 days, depending on the severity of endometritis and coagulopathy disorders.

FURTHER MANAGEMENT

The effectiveness of treatment is evaluated echographically. When using hysteroscopic control during emptying of the uterine cavity, complications develop extremely rarely (Fig. 24-5).

Rice. 24-5. Echographic picture on the 3rd day after curettage of the walls of the uterine cavity with an undeveloped pregnancy with hysteroscopic control.

Despite the position of the retroflexio uterus, the cavity is not expanded, the thickness of the M-ECHO is 3 mm. The position of the uterus is anteflexio, the cavity is expanded, M-ECHO is heterogeneous, up to 1.0 cm.

INFORMATION FOR THE PATIENT

Given the low-symptom and latency of endometritis, it is necessary to conduct a standard examination even in the absence of complaints:
microscopic examination of smears;
· bacteriological research;
PCR diagnosis of STIs;
study of the level of hormones;
Determination of the immunoreactivity of the organism;
definition of hemostasiogram;
· Ultrasound of the pelvic organs.

FORECAST

When carrying out rehabilitation therapy in the postoperative period, pregnancy occurs in approximately 85% of cases, childbirth - in 70% of cases. Without rehabilitation therapy - in 83 and 18%, respectively.

Causes, signs, treatment of non-developing pregnancy

A non-developing pregnancy is a pathology in which, for some reason, the embryo (or fetus) stops developing and dies.

There are many reasons for this pathology. In the first trimester, these are serious chromosomal "breakdowns". At any time - infections, lack of progesterone and an excess of androgens, Antiphospholipid syndrome - when a child dies due to blood clots forming in the vessels. In addition, the causes of non-developing pregnancy may lie in various toxic effects on the fetus. Radiation, the use of drugs prohibited for expectant mothers, smoking, drinking alcohol can cause pregnancy loss or severe malformations in the fetus.

How to recognize a frozen pregnancy

1. Stopping the growth of hCG or reducing it. HCG is the hormone that is formed due to the chorion. And according to the dynamics of the increase in hCG, various important conclusions can be drawn. However, not all women usually control the growth of hCG, since there is no practical need for this. Only in cases where the risk of spontaneous abortion is high. For example, when conceiving with the help of IVF or with habitual miscarriage. The level of hCG is determined by a blood test. But a pregnancy test will help draw some conclusions. Signs of a missed pregnancy may show up on a negative pregnancy test (due to low level HCG). However, this symptom is more often expressed in the very early stages of pregnancy.

2. Lack of growth of the uterus. This symptom can be noticed by a doctor during a gynecological examination, when a discrepancy between the size of the uterus and the gestational age is revealed. Or when measuring the length of the uterus on the couch with a centimeter tape - usually such measurements are performed from the second trimester of each pregnant woman during a scheduled visit to the gynecologist. Frozen pregnancy may be suspected with a low location of the bottom of the uterus.

3. Abrupt disappearance of signs of toxicosis. Usually they disappear gradually, by the second trimester of pregnancy. In the event of the death of the embryo, nausea disappears almost instantly. The mammary glands can be soft, painless, which is not typical for pregnancy.

4. Bloody, spotting discharge from the genital tract, pain in the lower abdomen. Usually, these symptoms occur already when the miscarriage has begun. However, it is not at all a fact that with these signs the child is already dead.

5. Decrease in basal temperature. Some expectant mothers measure the temperature in the rectum before and during pregnancy. This method, which is not very accurate, can help determine ovulation, pregnancy, and monitor its development. During pregnancy, the basal temperature is usually above 37 degrees. But its decrease cannot be considered as an absolute sign of a frozen one.

6. Absence of a heartbeat in a fetus on ultrasound or an embryo in a fetal egg. If the baby does not have a heartbeat at 5-6 weeks of gestation, this may indicate the death of the embryo.
There are cases when an embryo is not found in the fetal egg, that is, it dies at a very early date, when it is not yet visible by ultrasound. This pathology is called anembryony.

7. Absence of fetal movements. Primiparas feel fetal movements daily from 20 weeks of pregnancy, multiparous - from the 18th week. In the absence or cessation of movement, the woman is urgently sent for an ultrasound scan.

Whether to terminate the pregnancy and how

Non-developing pregnancy, what to do - abortion or wait for a spontaneous miscarriage? Doctors abroad have a waiting tactic. A woman weekly, in some cases even more often, performs an ultrasound scan and visits a gynecologist in order to recognize the onset of the inflammatory process in time - the basis for surgical intervention. We usually immediately recommend an abortion if there are no signs of an incipient spontaneous miscarriage.

As a rule, doctors “treat” a non-developing pregnancy in the early stages with vacuum aspiration, that is, they suck out the contents from the uterus using a special cannula. This intervention can be performed under local anesthesia, without general anesthesia. Another option is to induce a miscarriage with medication. A woman takes drugs that a doctor gives out, and after 1-3 days she has a spontaneous miscarriage. This procedure is effective in the early stages. The longer the term, the more likely it is that the miscarriage will be incomplete and vacuum aspiration will have to be done.

If a non-progressing pregnancy is proved by examination, curettage is recommended if the fetus is already quite large and will not pass through the cannula (vacuum aspiration is not possible). Curettage (popularly "cleansing") is always performed in a hospital setting. The length of stay in the hospital after the procedure is up to several hours, if there are no complications.

What to do after a frozen pregnancy

In the absence of contraindications, a woman is recommended to take oral contraceptives for at least 3-6 months. It is believed that they help restore hormonal levels and reliably protect against pregnancy. If there are contraindications to taking pills, barrier contraception (condom) is recommended. A child should be planned after undergoing treatment (if necessary), but not earlier than 3 months after a frozen one, otherwise there is a high risk of a recurrence of the situation.

As for the medical examination, doctors consider it mandatory only if an undeveloped pregnancy is repeated more than 2 times (if the embryo stops developing in the first trimester of pregnancy). Since in this case, most often, random chromosomal abnormalities are to blame, which are almost impossible to avoid. It should be noted that chromosomal abnormalities become more frequent the older the woman.

If the situation repeats. It is necessary to undergo an examination to identify and eliminate the cause of pregnancy fading. A woman should take blood tests, smears for various infections and viral diseases, undergo an ultrasound of the pelvic organs, take tests for certain hormones, take a blood coagulogram and an analysis for antibodies to phospholipids, go for a consultation with an endocrinologist.

When planning a pregnancy, she is prescribed an increased dosage of folic acid and potassium iodide.

Undeveloped pregnancy - unfortunately, more and more often such a diagnosis began to overshadow the happy existence of pregnant women. It happens that a very desired and long-awaited pregnancy freezes, stops developing. According to statistics, in the life of about 20% of women expecting a baby, such a tragedy happens, and it can happen at any time. Such a horrific event should be able to survive every woman who has been diagnosed with this. This article will present the symptoms, causes, and all other aspects of a missed pregnancy.

In the process of researching the causes of pregnancy fading, it was found that in a certain period of time, pregnancy is most vulnerable:

The first 12 days of development, during this period, implantation occurs.
After that, at week 3, the period of embryogenesis begins, which lasts until week 8.
All 12 first weeks, when the placenta is formed, is also a vulnerable period.
At 20-24 weeks, the formation and development of the most important functions of the fetus occurs.

Symptoms of non-developing pregnancy

In early pregnancy, one of the symptoms is the cessation of the growth of hCG (human chorionic gonadotropin). This hormone is produced due to the chorion, and various conclusions can be drawn from its indicators. During pregnancy, the growth of this hormone is usually not monitored. But this can be done on your own by donating blood for an hCG analysis. It will also be relevant to do a pregnancy test, with a missed pregnancy it will be negative.
Abrupt cessation of signs of toxicosis. Signs gradually fade away within 2 months, and when the embryo dies, nausea stops immediately.
The swelling of the mammary glands stops, if the swelling was accompanied by pain, they also stop.
Termination of the growth of the uterus. At each scheduled examination, the gynecologist leading the pregnancy takes measurements of the size of the uterus. If the size does not correspond to the term, there are suspicions that the pregnancy has stopped in development. A low-lying bottom of the uterus may also indicate the fading of the fetus.
Pain in the lower abdomen and red or reddish-brown discharge from the genital tract can also indicate the onset of a miscarriage, but this case does not always indicate that the fetus has died.
Absence of heartbeat on examination and ultrasound. In the early stages up to 6 weeks, the embryo can be considered dead if heart rhythms are not detected on ultrasound. Anembryony is a pathology when the fetus dies at a very early stage, when even ultrasound does not fix it. This is evidenced by an empty fetal egg.
Absence or cessation of movement. From 18 to 20 weeks, every pregnant woman should already begin to feel the movements of her baby. If these are not observed, the woman is urgently sent for an ultrasound scan, the same is done with those whose fetus moved, but during the day the woman stops feeling the tremors.

Causes of non-developing pregnancy

The beneficial development of pregnancy depends on many aspects, and a deviation in even one of them often leads to irreparable consequences. The causes of pregnancy fading may be associated with:

Infection in the mother's body. Diseases that a woman had in the past, and with the onset of pregnancy for the first time worsened, these can be viral, bacterial and fungal diseases. The uterus may have been affected by an infection in the past, in connection with which the ovum may not be able to successfully attach to the affected uterus, and the pregnancy will fail. Or an infection that has entered the bloodstream through the genitals, enters the embryo, this leads to its death.
Hormonal background. The hormonal background changes a lot with the onset of pregnancy, and there are times when these fluctuations go in the wrong direction. So, the hormone progesterone can be produced in insufficient quantities. Elevated levels of male hormones can also adversely affect the successful course of pregnancy.
endocrine disorders. The endocrine system is strongly linked to the hormonal system. If, due to a hormonal imbalance, a pregnant woman has problems with weight, an excessive increase or decrease, this affects the functioning of the thyroid gland. The state of pregnancy depends on its proper operation.
Immunological incompatibility of the fetus and mother. When one of the parents has Rh negative blood, the fetus can inherit this trait. Such a combination of circumstances often leads to the fact that the mother's organism sees a foreign body in the developing embryo. This leads to the fact that the fetus is rejected.
Bad habits. These include not only smoking and alcoholic beverages, but also improper, unhealthy diet or lack of nutrition. Pregnancy largely depends on these factors. The circulation of blood in the placenta, the nutrition of the fetus and its development directly depend on the lifestyle of the mother.
Prolonged depression, constant stress is directly related to the development of the baby.
Also at risk are women with an anatomically deformed uterus.
Women who have had several abortions may also face such a problem in the future as a non-developing pregnancy.
According to statistics, a pregnancy that occurs with the help of IVF often ends in fading than natural fertilization.

Complications of non-developing pregnancy

Consequences occur when the dead fetus remains in the body of a woman for a long time.

It could be endometritis. In this case, inflammation of the uterine mucosa occurs.
The process of decomposition of the fetus can lead to sepsis and peritonitis.

Ways to remove an undeveloped pregnancy

When this terrible diagnosis is confirmed, the question arises of how to solve this problem. Several options for further action are possible.

Wait. After the fetus dies, the level of hCG in the blood begins to fall, which after a while leads to the expulsion of the fetus from the body. But a long wait is fraught with consequences, so after a few days another option is considered.
Medical interruption. This option is available up to 8 weeks. The patient takes the drug, and, after a while, a spontaneous miscarriage occurs.
Vacuum aspiration. Vacuum cleaning is a surgical intervention when the pregnancy has stopped for a long time, and threatens with complications for the woman's body.
Curettage or curettage is used in the same cases as a vacuum.
The last two options are performed under local or general anesthesia.

Prevention of non-developing pregnancy

To reduce the likelihood of premature termination of pregnancy to a minimum, you must follow some rules.

Finding out the cause of fetal fading - pathogenetic factors.
It is necessary to eliminate these factors or minimize their manifestation in future pregnancies.
Get your mental and emotional state in order. There is no need to be shy or afraid to consult a psychologist. A positive attitude is essential for a healthy pregnancy. If necessary, sedatives should be taken.
Visits to the gynecologist should be regular.

New pregnancy. When is it possible?

After a pregnancy with a sad end, some women for a long time cannot recover, decide on a new one. But there are those who see their "salvation" in a new pregnancy. Such women almost immediately ask themselves the question “when is it already possible?”.
After a non-developing pregnancy, a woman's body needs time to be rehabilitated. You need to wait for the body to recover and get stronger. This will take from six months to one and a half years.
It is worth taking this time to find out the cause of the fading of the last pregnancy, to actively engage in the restoration and treatment of the body.

findings

Naturally, after such a blow of fate, every woman asks herself: “why with my child? Why with me?" Do not get hung up on this, because nature knows best what to do. Factors such as natural selection, the struggle for existence are the driving forces of evolution, and they apply to everything, including humans!

In 90% of cases, after one missed early or late pregnancy, you can get pregnant again. And it will end with a long-awaited and timely meeting with a dear baby.

It is worth remembering that pregnancy planning is no less important period than the pregnancy itself. Much depends on the quality of planning. It is worth paying special attention to this period and thoroughly preparing for the onset of the long-awaited situation.
A woman in position must be careful and attentive to her condition. You should take all tests in a timely manner, follow the recommendations of doctors and, of course, your intuition.

Never lose hope! The first meeting with the baby is worth all the problems through which life leads us!

How beautiful pregnant women are! But sometimes an inexorable fate brings down terrible and unbearable trials on their shoulders.

One of them is non-developing pregnancy, the death of the unborn baby.

This can happen at any stage of pregnancy. This pathology occurs in 10-20% of cases.

In contact with

Crisis periods are identified when the fetus is most vulnerable to negative impacts:

7-12 days of development (implantation period);
3- development (the period of embryogenesis);
the first (formation of the placenta);
20- development (formation of the most important functions in the body of the fetus).

The most dangerous are the first days and weeks of baby development. In the early stages of its development, the fetus is most sensitive to damaging, destructive factors.

What should alert a pregnant woman?

Diagnosis of the disease

Signs and symptoms

In most cases, a stop in the development of a child is not felt by pregnant women and is not accompanied by pronounced symptoms.

In the early stages:

disappearance;
increase in appetite;
reduction of pain in the mammary glands.

At a later date:

the appearance of bleeding;
increase in body temperature;
drawing pains in the lower back.

Such signals can accompany the normal course of pregnancy. Only a specialist can finally confirm the death of the embryo through ultrasound and research. Who is to blame for failed motherhood?

Causes

As a rule, a frozen pregnancy is the result of a combination of unfortunate circumstances and factors.

The reasons can be divided into several groups.

Genetics. Sometimes, during the formation of an embryo, various changes occur in the chromosomes, genetic disorders (a larger or smaller set of chromosomes).

The reason for this may be hereditary predisposition, the use of drugs, alcohol, living in environmentally unsafe areas.

Genetic disorders are the most important causes of this pathology (up to 70% of all cases). "Wrong" genes can come from both parents.

Infections. Infectious diseases of the expectant mother is the second most common cause of non-developing pregnancy:

viral -, enterovirus;
bacterial - mycoplasmas, streptococci, gonococci, chlamydia, ureaplasmosis.

As a result of the presence of any infection in a pregnant woman, acquired or chronic, infection of the fetal egg occurs.

Infection can occur in three ways:

In the inflammatory process of the uterine mucosa and its appendages(endometritis, salpingoophoritis) microbes penetrate the fetal egg. In this case, the woman’s uterus itself is not ready to bear a child, the fetal egg is not attached tightly enough, and its rejection follows.
With inflammatory processes in the vagina itself(fungi,) bacteria penetrate the ovum through the cervix. Infection of the embryo and amniotic fluid occurs, which is fraught with rupture of the fetal bladder itself.
With past viral infections(, ORZ,) microbes penetrate to the fetal egg with blood flow through the placenta. Significantly deteriorating supply of oxygen and nutrients to the unborn baby

When infected, the fetus stops its development, the child dies.

Do not forget that pregnancy is accompanied by a strong suppression of the entire immune system. An exacerbation of all latent infectious diseases in a woman may begin.

Therefore, it is very important to treat all latent infections in time before planning motherhood and do everything possible so as not to catch a cold while pregnant.

Immunology. Sometimes a woman may have various predisposing factors that can cause the death of the embryo. This is the appearance of protective antibodies to the hormone produced by the fetal egg (antiphospholipid syndrome), incompatibility at the immune level of the father and mother.

Immunological incompatibility can be expressed by increased thrombus formation. In all cases, the nutrition of the embryo is disturbed, its development stops and the fetus dies.

Endocrinology. Pathological condition endocrine system pregnant woman can cause fetal death. There can be many reasons for the disruption of the proper functioning of the endocrine system and hormonal disorders.

The most common of them are:

an increased amount of sex hormones according to the male type (hyperandrogenism). In 20% of cases during pregnancy, there is a sharp jump in the level of male hormones.
an increased amount of a hormone that stimulates milk production (hyperprolactinemia).
violation of the proper development of the ovaries (), which affects the menstrual cycle and the production of female sex hormones.
improper functioning of the thyroid gland (dystrophy, obesity).
underdevelopment of the female reproductive organs (infantilism).

In case of violations of the endocrine system the body produces insufficient amounts of a hormone that is responsible for preparing the entire female body for pregnancy. An embryo that is loosely attached to the uterus does not receive enough nutrients and dies.

Women are at risk who lead an incorrect lifestyle that is harmful to the state of pregnancy. Constant stress, overstrain, long depression. Work in unsuitable conditions (high humidity, constant stuffiness).

All this can lead to the appearance and abruption of the placenta, which disrupts the supply of oxygen and nutrients to the fetus and, as a result, the death of the unborn baby.

Multiple abortions transferred. Woman's age(in case of the first one) features of the anatomical structure of the uterus(saddle-shaped,) - all this refers to the provoking factors for the appearance of pathology during pregnancy.

According to the observations of experts, a pregnancy, compared to a natural one, is more likely to turn into a dead one and end in the death of the embryo.

What awaits a woman who has had one or more unsuccessful pregnancies, what do doctors say about this?

Consequences of non-developing pregnancy

As a rule, the vast majority of women have every chance to conceive a child again and bear it safely.

According to statistics, this is 80-90% of all women who have experienced a missed pregnancy.

If the conception ended in the death of the fetus in two or more cases of pregnancy, then the non-developing pregnancy goes into the category of "habitual".

In this case, in order to safely endure the baby, a thorough examination of both spouses is required.

Pregnancy after an illness

Planning for the next pregnancy resolved six months after the failure.

This break is aimed at the complete restoration of the hormonal status, reproductive functions of the body and includes the following mandatory examinations:

Ultrasound of the pelvic organs;
PCR diagnostics (detection of urogenital infections);
blood test for the level of autoantibodies,;
a blood test to detect the titer of antibodies to;
determination of the level of thyroid hormones in the blood.

This list can have many more items. An individual examination plan is applied to each woman, which is prescribed by a gynecologist.

But how is an undeveloped pregnancy treated, what do doctors do in this case?

Treatment of non-developing pregnancy

If a frozen fetus is found in a pregnant woman, doctors develop tactics for taking measures for delivery, based on each specific case.

Spontaneous. Shortly after the death of the embryo, the level of placental hormones in a woman decreases sharply, which leads to an independent miscarriage.

With the help of medicines. In early miscarriages (before 8 weeks), doctors may use the mifepristone (progesterone) antagonist drug in combination with misoprostol (an analogue of prostaglandin E1). After these two drugs enter the body, the embryo is rejected, it is miscarried.

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Diagnostics

Most often, the diagnosis of NB is made during ultrasound and gynecological examination. As additional methods, you can also use a blood test for chorionic gonadotropin (hCG), as well as measure basal temperature.

Ultrasound signs of missed pregnancy

The main ultrasound signs of stopping the development of the embryo at the shortest time are the deformation of the fetal egg, uneven contours, and its location in the lower part of the uterus. Later periods are characterized by a discrepancy between the gestational age according to ultrasound and monthly, the absence of a fetal heartbeat (usually from 5-6 weeks it can already be determined).

Signs of NB during gynecological examination

Determination of human chorionic gonadotropin (hCG)

Measurement of basal temperature in case of suspected NB

Treatment

Rehabilitation

Also, do not forget about the psychological aspect. It's good to change the situation, get positive emotions. Try to avoid stress and conflict. It is important to feel supported by others.

Consequences

The consequences for the reproductive health of a woman are reduced to zero if the removal of the embryo with its membranes is carefully performed, and rehabilitation is also carried out.

Prognosis for next pregnancy

The main thing is to believe in the good and not let your fears prevent you from becoming happy parents.

the period of formation of the placenta (up to 12 weeks), the period of formation of the most important functional systems of the fetus (20-24 weeks).

Clinical signs

There are a number of consecutive violations, characteristic of non-developing pregnancy: decrease and cessation of uteroplacental circulation against the background of damage to the structures of the placenta; cessation of uteroplacental circulation; violation of the structure of the inner layer of the uterus (endometrium), caused by the presence of dead elements of the fetal egg in the uterine cavity.

Clinical signs of non-developing pregnancy can be extremely scarce against the background of the cessation of the increase in the size of the uterus and their inconsistency with the gestational age. However, the uterus can be of normal size, can be reduced, and can even be enlarged if it is filled with blood during detachment of the fetal egg.

For some time after the death of the embryo / fetus, the patient may feel pregnant. However, over time, the subjective signs of pregnancy gradually disappear. Smearing bloody discharge from the genital tract and spastic pain in the abdomen are periodically noted. Chorionic gonadotropin in the blood of a woman, as a rule, is at an extremely low level or even completely absent.

Diagnosis of non-developing pregnancy

The most reliable way to identify a non-developing pregnancy is by the results ultrasound in the absence of a fetal heartbeat. One of the most common options for non-developing pregnancy is anembryony, i.e. the absence of an embryo in the cavity of the fetal egg after 5-6 weeks of pregnancy. In this case, the fetal egg is smaller than expected, and the embryo is not visualized.

In other variants of a non-developing pregnancy, according to ultrasound, the fetal egg corresponds in size or lags behind in its development, the embryo can be visualized, but without a heartbeat. Often, a retrochorial hematoma can be detected, which is an accumulation of blood at the site of detachment of the fetal egg from the uterine wall.

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, there is a deformation of the fetal egg with fuzzy contours.

Removal of a dead fetal egg

The death of the embryo/fetus is not always accompanied by its spontaneous expulsion from the uterus. Often there are cases when a dead fetal egg lingers in the uterus for an indefinitely long time. The reason for such a delay may be: primary tight attachment of the fetal egg to the uterine wall during implantation, inferiority of immune rejection reactions of the dead fetal egg, and a decrease in the contractile activity of the uterus.

When a dead embryo is in the uterus for more than 4 weeks, the elements of the decay of the fetal egg enter the maternal bloodstream, which can cause massive bleeding when trying to terminate the pregnancy. Therefore, before curettage of the uterus, it is necessary to perform studies of the state of the blood coagulation system and, if necessary, to carry out appropriate treatment.

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 a frozen pregnancy. For this purpose, instrumental or drug-induced dilation of the cervix and instrumental removal of the contents of the uterus are performed. It is also possible to use special medications for non-operative removal of the ovum from the uterus. 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 carry out anti-inflammatory treatment.

In each case, with a non-developing pregnancy, an in-depth examination is required to identify possible causes of abortion with their subsequent elimination or weakening of the effect.

How to reduce the chance of embryo death?

To reduce the likelihood of possible damaging factors on the course of pregnancy, it is necessary to carry out screening examination patients planning pregnancy, as well as women in early pregnancy for urogenital infection. It is also important to conduct medical genetic counseling in order to identify high-risk groups for congenital and hereditary pathologies. In the presence of endocrine causes of miscarriage, appropriate corrective hormonal therapy should be selected.

It is also important to identify various autoimmune disorders and their correction. Re-pregnancy is possible when the identified causes of embryo/fetal death are eliminated, and after the necessary treatment has been carried out. In case of a new pregnancy, an ultrasound examination is carried out, markers of possible developmental disorders of the fetus are determined in the blood, including: - fetoprotein, chorionic gonadotropin, PAPP-A test in the most informative terms. According to indications, invasive prenatal diagnostics is also carried out, including chorion biopsy, amniocentesis or cordocentesis to determine chromosomal and a number of monogenic diseases of the fetus. In addition, they carry out therapeutic and preventive measures aimed at eliminating the infectious process, conduct specific anti-inflammatory therapy in combination with immunocorrectors, correct violations of the blood coagulation system and prevent placental insufficiency from 14-16

Frozen (non-developing) pregnancy in the early stages: symptoms, causes

Many couples dream of having a baby, but for some reason their dreams do not come true. One of these reasons is missed pregnancy.

Not only the mother, but also the father can be to blame for this pathology, therefore it is important to be fully examined at the stage of pregnancy planning and begin to lead a healthy lifestyle for both partners.

According to statistics, missed pregnancy is recorded not so rarely, in 15-20% of cases of all desired pregnancies.

The definition of "missed pregnancy"

A frozen or non-developing pregnancy is a pregnancy that suddenly stops progressing, and the fetus grows and develops, and, accordingly, dies. At the same time, signs of spontaneous abortion are absent for the time being and the embryo is in the uterine cavity, so another name for this pathology is a failed miscarriage. "Fading" of pregnancy can occur at any gestational age (up to 28 weeks), but, as a rule, this happens in the first trimester. Threatened terms of pregnancy for a missed miscarriage are 3-4 weeks, 8-10 and 16-18 weeks.

A failed miscarriage, like other spontaneous abortions, refers to miscarriage. But they speak of habitual miscarriage only in the case of two or more spontaneous abortions.

The essence of a frozen pregnancy is the fertilization of the egg, its transportation to the uterus, where it is implanted and continues to develop for some time, but then the development of the embryo stops. Also, one of the options for a missed pregnancy is anembryony or the "empty fetal egg" syndrome. In this case, the fetal membranes develop, chorionic gonadotropin is synthesized, as evidenced by a positive pregnancy test, but the embryo itself is absent. Often such a pathology is due to chromosomal pathologies.

From what the fetus can "freeze"?

The causes of missed pregnancy are very numerous. They can be divided into several groups:

Chromosomal and genetic abnormalities

This is one of the biggest and main etiological factors of a failed miscarriage. If the embryo inherits an extra chromosome or a pathological gene, then during the development process, multiple malformations are formed that are incompatible with life, and in this case, the pregnancy is terminated. The action of natural selection is evident - nature decides that it is unprofitable to produce an incapacitated baby into the world and depletes the forces of the mother's body, therefore, stops the progression of pregnancy.

But a genetic anomaly can occur precisely during this pregnancy, when exposed to any harmful external factors (radiation, drug addiction, alcohol consumption, smoking), or it can be inherited from parents, for example, if there is a malfunction in the "susceptibility genes". So, if the fetal egg “accepted” the “thrombophilia gene” from the parents, then during its implantation in the uterus and the germination of the chorionic vessels into the mucous membrane, microthrombi are formed in them, which leads to malnutrition and blood supply to the embryo and its death.

infections

Infectious diseases play a huge role in the genesis of both spontaneous abortion and missed pregnancy. First of all, these are viral diseases of the TORCH infection group. These include rubella, toxoplasmosis, herpetic and cytomegalovirus infections. Especially dangerous is the primary infection with the listed infections during the onset of pregnancy.

In the early stages, this leads to a "fading" of pregnancy, in the later stages to the formation of developmental anomalies. Also, sexual infections (gonococcal, chlamydia, ureaplasma and others) do not lose their significance. Even banal colds (flu, SARS) in the early stages are the cause of a failed miscarriage. The death of the embryo is due to three mechanisms.

On the one hand, infectious agents, having penetrated the placenta, have a direct effect on the fetus.
On the other hand, the infection triggers the production of prostaglandins in the maternal body, which either have a toxic effect on the embryo or disrupt the microcirculation between the fetal membranes and the endometrium, as a result, the supply of nutrients and oxygen to the embryo stops.
And on the third hand, a chronic inflammatory reaction in the uterus disrupts the normal implantation of the fetal egg and leads to a deficiency in its nutrition.

Hormonal disorders

The lack of the most important hormone of pregnancy - progesterone is often one of the factors of miscarriage. A high content of androgens, or a violation of the hormonal function of the thyroid gland, also plays a role.

Autoimmune pathology

Autoimmune diseases are characterized by the fact that antibodies are formed in the mother's body that fight not with foreign agents, but with their own cells. Since the embryo inherits 50% of the genes from the mother, maternal antibodies begin to attack the cells of his body, which leads to the occurrence of a missed pregnancy.

For example, with antiphospholipid syndrome, the mother in her body has antibodies to phospholipids, without which it is impossible to build new cells. During pregnancy, these antibodies attack the developing embryo, which leads to its death.

Teratozoospermia

The failed father of the child may also be guilty of stopping the development of the embryo and its death. Such a pathology as teratozoospermia often causes partner infertility, but pregnancy in some cases, although it may occur, is likely to end in a failed miscarriage. Teratozoospermia is a pathology of spermatozoa, which is expressed in their incorrect structure. Anomalies in the structure of spermatozoa can manifest themselves in the form of a short tail, an irregular head shape, vacuole cells present in the head, a missing chromosome, tail kink or thickening.

Teratozoospermia is said to be when a man's ejaculate contains more than 50% (usually 80%) of abnormal spermatozoa. Conception is either impossible at all, for example, due to a short tail, sperm motility is low, or fertilization of the egg occurs if the spermatozoa have anomalies of the head, which leads to abnormal development of the embryo and cessation of pregnancy progression. After examination (see semen analysis) and treatment of a man, many couples are forced to turn to assisted reproductive technologies, such as artificial insemination.

Wrong way of life

Of course, the occurrence of a missed pregnancy can be affected by both nutrition, daily routine, occupational hazards, and bad habits. Also, do not forget about the dangers side effects drugs taken during gestation, especially in the early stages. The age of the woman is also important. The older the expectant mother, the higher her risk of developing a non-developing pregnancy (35 years or more).

Other factors

Constant stress, a sharp change in climate and other factors can lead to a non-developing pregnancy. In addition, numerous abortions in history cause endometrial failure, which leads to malnutrition and oxygen supply to the embryo and the development of the described pathology. After IVF, cases of missed pregnancy are also not uncommon, but the causes of this pathology are due to the diseases that forced the woman to turn to assisted reproductive technologies.

Abortion clinic

Symptoms of a missed pregnancy have characteristic signs. First of all, the probable signs of pregnancy disappear in a woman (in the first trimester). Nausea and vomiting, intolerance to smells disappear, the mammary glands lose tension and become soft. However, the disappearance of these symptoms does not always indicate the death of the embryo.

Early toxicosis may be absent, as well as breast engorgement.
Often the moment of embryonic death goes unnoticed.
The pregnancy test remains positive for another 2 to 4 weeks, since hCG is not immediately excreted from the body.
But the basal temperature will be in the range of 37 degrees and below.
If the dead embryo is in the uterus for more than 3-4 weeks, then an intoxication syndrome occurs (fever, general weakness and malaise) due to decomposition of the embryo and infection of the mother with decay products of fetal tissues and toxins.
If a frozen pregnancy arose in the second trimester, then the first call will be the cessation of fetal movement.
When a dead embryo is in the uterus for more than 2-6 weeks, signs of a spontaneous abortion that have begun (smearing dark discharge, aching pain in the lower abdomen and lower back) join.
Plus, during a gynecological examination, the lag of the uterus in growth from the approximate gestational age is determined. That is why gynecologists perform bimanual palpation of the uterus (examination on the chair) in the first trimester during each woman's visit to the appointment.

Case Study: In the antenatal clinic, a multi-pregnant woman was observed from 6 weeks of pregnancy. From the anamnesis it is known that there were 3 births, abortions and medical-diagnostic curettage were not performed. The pregnant woman and her husband did not have bad habits, there were no chronic diseases. the only negative moment were the woman's age (40 years) and work in night shifts (nurse). During the next visit to the reception, the woman complained of pulling pains in the lower abdomen and periodic "daub". On vaginal examination, the uterus is soft, enlarged up to 12 weeks, painless (estimated period was 16 weeks). After confirming the diagnosis of a missed pregnancy by ultrasound, the woman underwent curettage of the uterus and antibiotic therapy was prescribed. Fortunately, there were no infectious and coagulopathic complications, and after 10 days the patient was discharged home. What caused the missed pregnancy was never established, since parts of the fetus sent for histological analysis were "lost" in the laboratory.

Treatment of a missed miscarriage

A woman must be immediately hospitalized even if a missed pregnancy is suspected.

After the examination (ultrasound, hCG in the early stages and AFP in the second trimester, coagulogram), a careful evacuation of the fetal egg is performed.
Expectant tactics are possible if the embryo is dead for no more than 2 weeks (in the early stages of pregnancy) and there are no signs of an abortion and infection of the uterus. In this case, the level of hCG in the woman's body drops sharply, and the uterus begins to contract, pushing out the fetal egg. But, as a rule, they resort to a surgical method, that is, to remove the fetal egg and membranes by therapeutic curettage or vacuum aspiration.
It is possible to use medical abortion (up to 7 weeks) by prescribing Mifegin (progesterone blocker).

After surgical or medical release of the uterus from the embryo, hysteroscopy is mandatory. In the postoperative period, antibiotics are prescribed to prevent endometritis and chorionamnionitis.

If the death of the fetus occurred after 14-16 weeks of gestation, then its evacuation is carried out by transcervical amniocentesis of a hypertonic solution of sodium chloride and / or prostaglandins or intravenous administration of a solution of prostaglandins.

Frozen pregnancy: what then?

What to do after a frozen pregnancy? - this question is puzzled by all patients. The material obtained after curettage or induced labor must be sent for histology. In some cases (if a chromosomal pathology is suspected), a genetic study of the tissues of the embryo (the number and quality of chromosomes) is additionally prescribed.

A woman is recommended to refrain from pregnancy for six months, while oral contraceptives are prescribed (Yarina, Zhanin). An examination for all genital TORCH infections is also shown. The hormonal status of a woman is necessarily examined, if necessary, an adjustment is made. In addition, an ultrasound examination of the pelvic organs, the blood coagulation system and a blood test for antibodies to its own phospholipids are performed.

06.12.2017

Frozen or not developing called such a pregnancy in which the death of the embryo or fetus occurred before development, but does not develop contractile activity and there are no symptoms of external bleeding. In this case, the fetal egg can linger in the uterine cavity for many weeks and even months.

information Missed pregnancy occurs in 45-90% of all spontaneous abortions in the early stages. In the International Classification of Diseases of the X revision, this pathology is called "missed miscarriage."

Allocate 2 options this pathology:

. In this case, the embryo is not laid at all or resolves (detected before -), while the fetal sac may grow for some time before the onset of spontaneous miscarriage due to the remaining blood flow.
Doom embryo (before) or fetus (-).

Causes

The causes of fetal death are diverse and often intertwined. The main ones are the following:

Infection. But there are 2 options here:
- In acute infection in early pregnancy, direct damage to the embryo by infectious agents occurs.
- The presence of chronic inflammation leads to disruption of the process of introduction of the fetal egg into the wall of the uterus and disruption of its blood supply. All this leads to primary placental insufficiency and, ultimately, to the death of the fetus.

Hormonal disorders. It is believed that pronounced violations of the hormonal status of a woman lead to infertility, and pregnancy is possible only with erased forms of pathology, but it most often ends with an interruption at one time or another. The main forms of hormonal disorders leading to a missed pregnancy include:
- with an inferior function of the corpus luteum, production decreases (the main hormone that supports pregnancy);
- increased production of androgens (male sex hormones);
- (especially the increase in her hormone levels);
- neuroendocrine syndromes.

development reproductive organs, preventing the normal growth and development of the embryo.
Chromosomal abnormalities. Occur as a result of a violation of the process of fusion of maternal and paternal material.
Blood coagulation disorders. This includes antiphospholipid syndrome, when antibodies to platelets are produced in the mother's body and thrombosis occurs in the vessels that feed the fetal egg.
Socio-biological factors: in recent decades, there has been a significant deterioration of the ecological environment (various types of pollution, for example, radiation and chemical); poor living conditions (unbalanced nutrition, deficiency); a variety of occupational hazards that can affect both before the onset of pregnancy and at its initial stages; mother's age.

Symptoms

In the early stages (before), the main clinical manifestation will be the disappearance of subjective (morning sickness and vomiting, salivation). At a later date, these symptoms lose their relevance, since normally they should already pass and the absence or cessation of sensation comes to the fore. On the 3-6th day after the embryo development stops, the mammary glands soften and milk is released from them.

dangerously When a dead fetus is in the uterus for more than 4 weeks, some women show signs of general intoxication (weakness, malaise, fever) associated with infection of the fetal egg.

Signs such as absence, appearance from the genital tract (as a sign of what has begun) appear most often only 6 weeks after the embryo has stopped its development.

Diagnostics

sign	early term	late deadline
Reducing the blueness of the vagina and cervix	4-5 weeks after embryo death	After 6-8 weeks
Reduction or lag of the uterus in size	More typical	Less typical
Opening of the cervical canal	No	1-2 cm
from the cervical canal when viewed in the mirrors	More often absent, but very rarely there may be minor sanious	When a dead fetus is in the uterine cavity for more than 4 weeks -
-signs	There is no embryo in the fetal egg after pregnancy or is not determined	absence; fetal mismatch; abnormal position of the fetus; pronounced changes in
(chorionic gonadotropin) in the blood	Reduced by 8 times compared to normal pregnancy	Reduced by 3 times

Treatment

Treatment of a missed pregnancy includes 2 main points:

careful removal of the dead fetal egg from the uterine cavity;
anti-inflammatory therapy.

The method of evacuation of the fetal egg depends on the gestational age:

Up to 14-16 weeks produce instrumental emptying of the uterine cavity () or. The resulting material must be sent for histological examination. At the same time, in some cases it is possible to determine why the embryo has ceased to develop.
At term over 16 weeks special solutions are injected into the amniotic cavity, and intravenous drugs that stimulate uterine contractions are also administered. After the incident, scraping is performed.

additionally Recently, there have been works on the use of hormonal drugs in. These include 2 groups of drugs: (cause detachment of the fetal bladder) and (contribute to the removal of the contents of the uterine cavity).

This technique, of course, is more gentle for a woman, but it is difficult to obtain material for research and there is a risk of complications from taking these drugs.

Consequences

All the consequences of a frozen pregnancy can be divided into two groups:

arising against the background of a non-developing pregnancy and in the near future after the removal of the fetal egg;
appearing later.

If we talk about the first, then most often they are infectious in nature and depend on where the pathogens got:

With the localization of the process only in the uterus, acute endometritis can develop.. And after treatment of a non-developing pregnancy, due to the fact that the inflamed uterus is not able to adequately contract, blood clots linger in the cavity, and repeated curettage will be required.
With a long stay of a dead embryo or fetus in the uterine cavity, peritonitis may develop when infectious agents enter the abdominal cavity, or sepsis if they enter the bloodstream.
Early consequences also include severe disorders in the coagulation system. in women, which is associated with the ingress of toxic products into the blood.

As for the second group, they primarily depend on the cause of the fading and the correct approach to its treatment and rehabilitation. The possibility of subsequent pregnancy and its outcome will depend on this. According to studies, during rehabilitation in the postoperative period, pregnancy occurs in 85% of cases and ends in childbirth in 70%, without rehabilitation treatment - in 83 and 18%, respectively.

Conclusion

In conclusion, it should be noted that no matter how hard this loss was, this is not a point in history, but only a sad stage. Everything will be fine, the main thing is to take care of your health.

What every woman should know about missed pregnancy

A frozen or non-developing pregnancy is a pregnancy in which development stops, and then the death of the fetus in the early stages due to a violation of the normal course of pregnancy.

Non-developing pregnancy can occur early and up to 28 weeks of pregnancy. But the most dangerous period is the first trimester of pregnancy.

The timing of a frozen pregnancy

In most pregnant women, a missed pregnancy occurs before 12 weeks of gestation. But after 12 and up to 28 weeks it is less common.

A missed pregnancy can occur both with the first pregnancy and after the second and third successfully completed pregnancy.

What is the danger of frozen pregnancy

The danger of a frozen pregnancy lies in the fact that if the fetus after death is in the body of a woman for a long time, intoxication (poisoning) of the body of the pregnant woman develops. The body temperature begins to rise, unpleasant or painful sensations appear in the uterine cavity. A woman feels weakness throughout her body, malaise, often dizziness and the appearance of drowsiness.

If the embryo after death is in the uterine cavity for more than seven weeks, then this leads to DIC syndrome (disseminated intravascular coagulation).

The clotting properties of the circulatory system lose their ability to coagulate blood, and as a result, massive bleeding from the uterine cavity opens - a complication of non-developing pregnancies. The onset of bleeding can be fatal (unless, of course, a qualified medical care pregnant woman).

In some cases - successful cases for a woman's health, the body of a pregnant woman is able to reject the fetus itself after it stops developing - the woman begins a spontaneous miscarriage.

In some cases, a non-developing pregnancy can pass for quite a long period of time without any symptoms and signs.

Signs of a missed pregnancy in the early stages

But still, there are several signs by which it is possible to determine the onset of an undeveloped (frozen) pregnancy.

In the early stages of pregnancy, with the death of the fetus or fetal egg, decrease in basal temperature- body temperature, which is measured in the rectum. With the help of basal temperature, hormonal fluctuations are determined. As the hormone rises, the temperature rises. Therefore, the pregnancy progresses. The decline tells us otherwise.

- Indicators (human chorionic gonadotropin) stop rising. In dynamics, the growth of the hormone stops or increases slightly in comparison with the normative indicators - which indicates the pathology of the development of a normal pregnancy.

- Brown or bloody discharge from the genital tract- this is the first signal that something went wrong during a normal pregnancy. It is necessary to immediately contact your doctor to make the correct diagnosis and prescribe the appropriate treatment for a pregnant woman.

- Appearances of general malaise, drowsiness or a feeling of coldness in the body, accompanying muscle trembling. A number of such signs indicate poisoning of the body with decay products that enter directly into the mother's blood.

- An increase in body temperature. An increase in temperature suggests that an inflammatory process begins in the body of a pregnant woman and the body can no longer cope on its own. Immediate medical intervention is required.

- Stopping Breast Enlargement. The hormone progesterone decreases and, consequently, the increase (swelling) of the mammary glands decreases or disappears.

- Pain in the lower abdomen different nature (aching, cutting, pulling, stabbing or cramping). Usually, pain begins to bother a woman on the fifth - seventh day after the death of the unborn baby.

In women with early toxicosis(nausea, vomiting) - sharp, fast without any reason for it termination also speaks of a deviation in the course of the development of a progressive pregnancy.

- Delayed growth of the uterus(the size of the uterine cavity does not correspond to the set gestational age). To do this, the attending physician monitors the growth dynamics of the uterine cavity every visit to a pregnant woman.

The most reliable and accurate sign - stop or absence of fetal heartbeat which is recorded on an ultrasound machine.

- In the second trimester, a sign of a missed pregnancy is the cessation (absence) of the unborn baby moving. It is for these purposes that doctors prescribe a pregnant woman to monitor the physical activity of her baby during the day. With the help of perturbation, one can judge the condition of the fetus.

Why does an undeveloped pregnancy occur?

Doctors identify three main causes of this pathology.

1. Genetic (chromosomal damage) fetal pathology

Genetic pathology occurs in early pregnancy from six to eight weeks of pregnancy. But sometimes the fetus can live and develop until later in pregnancy. There is a pathological formation of internal organs or systems in the embryo. Chromosomal damage leads to a stop in the development and death of the embryo.

An anomaly in the development of the fetus can occur both in completely healthy parents and can be inherited from one of the parents. With the condition that one of the parents has a certain genetic change. Often, many do not even suspect about their genetics, since at first glance they are absolutely healthy. Only when they encounter problems during conception or gestation during pregnancy do they find out about it.

It would seem that healthy parents can identify a genetic pathology by donating blood for karyotyping analysis.

Analysis is given once in a lifetime. Karyotyping of spouses shows the complete set of chromosomes embedded in the genes. From the biology lessons of the school curriculum, everyone knows that women have a set of chromosomes equal to 46XX, and men - 46XY. Sometimes the set of chromosomes changes. This leads to the impossibility of procreation.

2. Infectious diseases of spouses.

The most dangerous and serious infectious diseases are rubella, herpes infection, CMV (cytomegalovirus infection), toxoplasmosis, and sexually transmitted infections: trichomoniasis, gonorrhea infection, ureaplasmosis, chlamydia and mycoplasmosis. A number of latent infections in a woman's body must be examined before the start. for when detecting sexually transmitted infections, go for a full course of treatment for both spouses. Then plan your next pregnancy.

These factors are so can affect the flow pregnancy.

A lack of progesterone or an excess of male sex hormones in the body of a pregnant woman can provoke a miscarriage. Women who produce too much or too little insulin (diabetes mellitus) or thyroid hormone are much more likely to have a miscarriage.

There are also indirect causes of non-developing pregnancy.

These include:

4. Violation of the blood coagulation system leads to uterine dysfunction. placental blood flow, to the formation of blood clots and damage to the placentaand its improper development and functioning, therefore, the embryo or already the fetus will receive an insufficient amount of nutrients, which will lead to a developmental delay and its death.

5. Drinking alcohol and smoking, which are easily enter the embryo through the blood. The influence of alcohol and smoking is especially harmful in the early stages of pregnancy, when the future organs of the baby are laid.

6. Obesity or underweight during pregnancy is another predisposing factor for miscarriage.

With increased or insufficient body weight is hormonal failure. So steroid hormones accumulate in adipose tissue, which interfere with the development and bearing of the unborn child. With a lack of weight, a woman's body, on the contrary, is not able to produce the necessary amount of hormones and necessary substances - for the development of a normal pregnancy. There is a risk of miscarriage.

7. Use before pregnancy planning or during Pregnancy drugs that can provoke a non-developing pregnancy. A certain group of drugs has a dangerous ability to accumulate in the tissues of the embryo, causing its pathological development.

Chemical substances have a detrimental effect on the embryo. For example, if a woman works in a hazardous industry and she has to come into contact with vapors of harmful substances.

8. In case of pregnancy that occurred during the IVF program, the risk of non-developing pregnancy is several times higher. Since women with problems conceiving or carrying a pregnancy are already preparing for the procedure from the very beginning.

9. Multiple pregnancies are a risk of missed pregnancy, since the body of a pregnant woman is assigned two or even three times more load. With multiple pregnancies, it is more difficult to diagnose the onset of the death of one of the fetuses in the early stages.

To reduce the likelihood of a missed pregnancy, expectant mothers and fathers need to conduct a timely examination of the body before starting pregnancy planning.

THE BELL

Symptoms of an undeveloped pregnancy

Likely Symptoms

Absolute signs

Causes

Symptoms

Treatment

Rehabilitation

Consequences

Prognosis for next pregnancy

SYNONYMS

EPIDEMIOLOGY

PREVENTION OF MISSED PREGNANCY

CLASSIFICATION

ETIOLOGY (CAUSES) OF MISSED PREGNANCY

PATHOGENESIS

CLINICAL PICTURE (SYMPTOMS) OF FAILED PREGNANCY

DIAGNOSIS OF MISTAKE PREGNANCY

ANAMNESIS

PHYSICAL EXAMINATION

INSTRUMENTAL STUDIES

LABORATORY RESEARCH

HEMOSTASIS DISORDERS IN NON-DEVELOPING PREGNANCY

DIFFERENTIAL DIAGNOSIS

INDICATIONS FOR CONSULTATION OF OTHER SPECIALISTS

EXAMPLE FORMULATION OF THE DIAGNOSIS

TREATMENT OF MISSED PREGNANCY

GOALS OF TREATMENT

INDICATIONS FOR HOSPITALIZATION

NON-DRUG TREATMENT

SURGERY

MEDICAL TREATMENT

INDICATIONS FOR CONSULTATION OF OTHER SPECIALISTS

APPROXIMATE TIMES OF INABILITY TO WORK

FURTHER MANAGEMENT

INFORMATION FOR THE PATIENT

FORECAST

Causes, signs, treatment of non-developing pregnancy

How to recognize a frozen pregnancy

Whether to terminate the pregnancy and how

What to do after a frozen pregnancy

Symptoms of non-developing pregnancy

Causes of non-developing pregnancy

Complications of non-developing pregnancy

Ways to remove an undeveloped pregnancy

Prevention of non-developing pregnancy

New pregnancy. When is it possible?

findings

Diagnosis of the disease

Signs and symptoms

Causes

Consequences of non-developing pregnancy

Pregnancy after an illness

Treatment of non-developing pregnancy

Diagnostics

Treatment

Rehabilitation

Consequences

Prognosis for next pregnancy

Clinical signs

Diagnosis of non-developing pregnancy

Removal of a dead fetal egg

How to reduce the chance of embryo death?

Frozen (non-developing) pregnancy in the early stages: symptoms, causes

The definition of "missed pregnancy"

From what the fetus can "freeze"?

Chromosomal and genetic abnormalities

infections

Hormonal disorders

Autoimmune pathology

Teratozoospermia

Wrong way of life

Other factors

Abortion clinic

Treatment of a missed miscarriage

Frozen pregnancy: what then?

Causes

Symptoms

Diagnostics

Treatment