Why does frozen pregnancy occur in the later stages? Why does the fetus freeze? Causes of frozen pregnancy in late stages

Frozen pregnancy in early and late stages: causes and prevention

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

2. Inferiority of reactions of immunocellular rejection of the dead amniotic sac. A cascade of immunocellular reactions unfolds, aimed at rejecting the “allogeneic transplant”, which has lost all immunoblocking factors due to its death. With a certain genetic identity of the spouses (consanguineous marriage), the biological compatibility of mother and fetus can be so close that it determines the state of immunological unresponsiveness of the uterus in relation to the dead embryo.

3. Reactivity of the uterus. Contractile hypofunction of the myometrium can be caused by:

o biochemical defects in the enzyme-protein metabolism system;

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

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

Most often, a gradual rejection of the dead fetal egg occurs with the help of a fibrinous-leukocyte exudative reaction in response to necrotic tissue. During this process, along with fibrin and leukocytes, trophoblastic, thromboplastic substances, and erythrocytes are released from the endometrial vessels, which leads to constant spotting and spotting from the uterus. The body of the uterus becomes soft, the myometrial tone disappears, the cervix opens slightly. All signs of pregnancy (cyanosis of the vagina, cervix) disappear.

Frozen pregnancy - the consequences of a dead embryo remaining in the uterus

With a long-term (2-4 weeks or more) presence of a dead embryo in the uterus, autolysis occurs, thromboplastic substances enter the patient’s bloodstream and DIC syndrome develops. All this is a risk of developing severe coagulopathic bleeding when attempting to terminate a pregnancy. The most unfavorable conditions of uterine hemostasis occur in patients in whom phase hemocoagulation changes are in a state of hypocoagulation and myometrial hypotension is pronounced.

Difficulties that arise when removing a dead fetus may be due to chorion previa and placenta located in the area of ​​the internal os of the uterus. Before curettage of the uterus, it is necessary to examine the state of the hemostatic system (detailed coagulogram). In case of detected disorders (hyperaggregation, hypercoagulation, disseminated intravascular coagulation syndrome), corrective therapy (fresh frozen, and other components) is necessary. The use of dicinone and ATP contributes to the relief of hemostasiological disorders at the level of the vascular-platelet unit. In the postoperative period, antiplatelet and anticoagulant therapy is indicated (, chimes,). The energy potential of the uterus is restored by administering glucose, vitamins, calcium chloride in combination with antispasmodic drugs.

Frozen pregnancy - treatment

Treatment. The retention of a dead embryo in the uterine cavity poses a threat not only to the health, but also to the life of the woman and therefore requires active tactics. Once a diagnosis of non-developing pregnancy is established, long-term conservative management of the patient is risky.

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

complications) it is necessary to terminate a non-developing pregnancy. In the first trimester of pregnancy:

1. Cervical dilatation and vacuum aspiration.

2. Preparation of the cervix using prostaglandins or hydrophilic dilators and vacuum aspiration.

3. The use of antiprogestogens in combination with prostaglandins.

In the second trimester of pregnancy:

1. Dilatation of the cervix and evacuation of products of conception with previous preparation of the cervix.

2. Therapeutic abortion using intra- and extra-amniotic administration of prostaglandins or hypertensive agents.

3. The use of antiprogestogen in combination with prostaglandin.

4. Isolated use of prostaglandins.

Immediately during the abortion or immediately after its completion, an ultrasound scan is necessary to ensure complete removal of parts of the fetus and placenta.

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

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

Frozen pregnancy - medical measures

The management tactics for patients with a history of undeveloped pregnancy are as follows.

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

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

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

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

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

o determination of autoimmune disorders (determination of lupus anticoagulant, anti-CG, anticardiolipin antibodies, etc.) and individual selection of antiplatelet agents and/or anticoagulants and glucocorticoids under the control of hemostasiograms.

3. Normalization of a woman’s mental state (sedatives, promotion of a healthy lifestyle).

Pregnancy after a frozen pregnancy

The tactics for managing patients during subsequent pregnancy are as follows.

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

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

3. Carrying out treatment and preventive measures aimed at:

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

o suppression of autoantibody production - intravenous drip administration of gammaimmunoglobulin 25 ml every other day No. 3;

o elimination of hemostasiological disorders - antiplatelet agents, direct-acting anticoagulants.

SPONTANEOUS ABORTION (MISCARRIOR)

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

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

ICD-10 CODE

O03 Spontaneous abortion.
O02.1 Failed miscarriage.
O20.0 Threatened abortion.

EPIDEMIOLOGY

Spontaneous abortion is the most common complication of pregnancy. Its frequency ranges from 10 to 20% of all clinically diagnosed pregnancies. About 80% of these losses occur before 12 weeks of pregnancy. When pregnancies are taken into account by determining hCG levels, the loss rate increases to 31%, with 70% of these abortions occurring before the pregnancy can be recognized clinically. In the structure of sporadic early miscarriages, 1/3 of pregnancies are terminated before 8 weeks due to the type of anembryony.

CLASSIFICATION

According to clinical manifestations there are:

· threatened abortion;
· started abortion;
· abortion in progress (complete and incomplete);
· NB.

The classification of spontaneous abortions adopted by WHO differs slightly from that used in the Russian Federation, combining the beginning of a miscarriage and an abortion in progress into one group - inevitable abortion (i.e., continuation of pregnancy is impossible).

ETIOLOGY

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

The most common variants of chromosomal pathology in early spontaneous miscarriages are autosomal trisomies (52%), monosomy X (19%), and polyploidies (22%). Other forms are noted in 7% of cases. In 80% of cases, death and then expulsion of the fertilized egg occurs first.

The second most important among the etiological factors is metroendometritis of various etiologies, which causes inflammatory changes in the uterine mucosa and prevents normal implantation and development of the fertilized egg. Chronic productive endometritis, more often of autoimmune origin, was noted in 25% of so-called reproductively healthy women who terminated pregnancy through induced abortion, in 63.3% of women with recurrent miscarriage and in 100% of women with NB.

Among other causes of sporadic early miscarriages, there are anatomical, endocrine, infectious, immunological factors, which to a greater extent serve as causes of habitual miscarriages.

RISK FACTORS

Age is one of the main risk factors in healthy women. According to data obtained from an analysis of the outcomes of 1 million pregnancies, in the age group of women from 20 to 30 years old the risk of spontaneous abortion is 9-17%, in 35 years old - 20%, in 40 years old - 40%, in 45 years old - 80%.

Parity. Women with a history of two or more pregnancies have a higher risk of miscarriage than nulliparous women, and this risk does not depend on age.

History of spontaneous abortion. The risk of miscarriage increases with the number of miscarriages. In women with a history of one spontaneous miscarriage, the risk is 18-20%, after two miscarriages it reaches 30%, after three miscarriages - 43%. For comparison, the risk of miscarriage for a woman whose previous pregnancy ended successfully is 5%.

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

The use of non-steroidal anti-inflammatory drugs in the period preceding conception. Data have been obtained indicating a negative effect of inhibition of PG synthesis on the success of implantation. When using non-steroidal anti-inflammatory drugs in the period preceding conception and in the early stages of pregnancy, the miscarriage rate was 25% compared to 15% in women who did not receive drugs from this group.

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

Trauma, including invasive prenatal diagnostic methods (choriocentesis, amniocentesis, cordocentesis) - the risk is 3-5%.

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

Exposure to teratogens (infectious agents, toxic substances, drugs with a teratogenic effect) is also a risk factor for spontaneous abortion.

Folic acid deficiency. When the concentration of folic acid in the blood serum is less than 2.19 ng/ml (4.9 nmol/l), the risk of spontaneous abortion significantly increases from 6 to 12 weeks of pregnancy, which is associated with a higher incidence of abnormal fetal karyotype.

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

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

CLINICAL PICTURE AND DIAGNOSTICS

Mostly, patients complain of bloody discharge from the genital tract, pain in the lower abdomen and lower back when menstruation is delayed.

Depending on the clinical symptoms, a distinction is made between threatened spontaneous abortion, which has begun, abortion in progress (incomplete or complete) and NB.

A threatened abortion is manifested by nagging pain in the lower abdomen and lower back, and there may be scanty bleeding from the genital tract. The tone of the uterus is increased, the cervix is ​​not shortened, the internal os is closed, the body of the uterus corresponds to the period of pregnancy. Ultrasound records the fetal heartbeat.

When an abortion begins, pain and bloody discharge from the vagina are more pronounced, the cervical canal is slightly open.

During an abortion, regular contractive contractions of the myometrium are detected. The size of the uterus is less than the expected gestational age; in later stages of pregnancy, OB leakage is possible. The internal and external pharynx are open, the elements of the fertilized egg are in the cervical canal or in the vagina. Bloody discharge can be of varying intensity, often abundant.

Incomplete abortion is a condition associated with retention of fertilized egg elements in the uterine cavity.

The lack of full contraction of the uterus and closure of its cavity leads to ongoing bleeding, which in some cases causes large blood loss and hypovolemic shock.

More often, incomplete abortion is observed after 12 weeks of pregnancy in the case when the miscarriage begins with the rupture of OB. With a bimanual examination, the uterus is smaller than the expected gestational age, there is abundant bloody discharge from the cervical canal, using ultrasound in the uterine cavity, the remains of the fertilized egg are determined, in the second trimester - the remains of the placental tissue.

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

The uterus contracts and bleeding stops. During bimanual examination, the uterus is well contoured, its size is smaller than the gestational age, and the cervical canal can be closed. In case of a complete miscarriage, the closed uterine cavity is determined using ultrasound. There may be slight bleeding.

Infected abortion is a condition accompanied by fever, chills, malaise, pain in the lower abdomen, and bloody, sometimes purulent, discharge from the genital tract. A physical examination reveals tachycardia, tachypnea, deflation of the muscles of the anterior abdominal wall, and a bimanual examination reveals a painful, soft uterus; The cervical canal is dilated.

In case of infected abortion (in case of mixed bacterial viral infections and autoimmune disorders in women with recurrent miscarriage, aggravated by antenatal fetal death, obstetric history, recurrent course of genital infections), immunoglobulins are prescribed intravenously (50-100 ml of 10% Gamimun solution, 50-100 ml of 5% Octagam solution and etc.). Extracorporeal therapy is also carried out (plasmapheresis, cascade plasma filtration), which consists of physicochemical blood purification (removal of pathogenic autoantibodies and circulating immune complexes). The use of cascade plasma filtration implies detoxification without plasma removal. In the absence of treatment, generalization of infection in the form of salpingitis, local or diffuse peritonitis, and septicemia is possible.

Non-developing pregnancy (antenatal fetal death) is the death of an embryo or fetus during a pregnancy of less than 22 weeks in the absence of expulsion of the elements of the fertilized egg from the uterine cavity and often without signs of a threat of miscarriage. An ultrasound is performed to make a diagnosis. The tactics of termination of pregnancy are chosen depending on the gestational age. It should be noted that antenatal fetal death is often accompanied by disturbances in the hemostatic system and infectious complications (see the chapter “Non-developing pregnancy”).

In diagnosing bleeding and developing management tactics in the first trimester of pregnancy, assessing the rate and volume of blood loss plays a decisive role.

When ultrasound shows unfavorable signs in terms of the development of the ovum during intrauterine pregnancy, the following are considered:

· lack of embryonic heartbeat with CTE of more than 5 mm;

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

Additional ultrasound signs indicating an unfavorable pregnancy outcome include:

· abnormal yolk sac, inappropriate for gestational age (more), irregular in shape, displaced to the periphery or calcified;

· Fetal heart rate less than 100 per minute at 5-7 weeks;

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

DIFFERENTIAL DIAGNOSTICS

Spontaneous abortion should be differentiated from benign and malignant diseases of the cervix or vagina. During pregnancy, bloody discharge from the ectropion is possible. To exclude cervical diseases, a careful examination in the speculum is performed, and, if necessary, colposcopy and/or biopsy.

Bloody discharge during a miscarriage is differentiated from that during an anovulatory cycle, which is often observed when menstruation is delayed. There are no symptoms of pregnancy, the hCG b-subunit test is negative. On bimanual examination, the uterus is of normal size, not softened, the cervix is ​​dense, not cyanotic. There may be a history of similar menstrual irregularities.

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

With hydatidiform mole, 50% of women may have characteristic discharge in the form of bubbles; the uterus may be longer than the expected pregnancy. Typical picture on ultrasound.

With an ectopic pregnancy, women may complain of spotting, bilateral or generalized pain; Fainting (hypovolemia), a feeling of pressure on the rectum or bladder, and a positive bhCG test are common. Bimanual examination reveals pain when moving the cervix. The uterus is smaller than it should be at the expected stage of pregnancy.

You can palpate a thickened fallopian tube, often with bulging vaults. An ultrasound can detect a fertilized egg in the fallopian tube, and if it ruptures, an accumulation of blood in the abdominal cavity can be detected. To clarify the diagnosis, puncture of the abdominal cavity through the posterior vaginal fornix or diagnostic laparoscopy is indicated.

An example of a diagnosis formulation

Pregnancy 6 weeks. Incipient miscarriage.

TREATMENT GOALS

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

In the USA and Western European countries, threatened miscarriage before 12 weeks is not treated, believing that 80% of such miscarriages are due to “natural selection” (genetic defects, chromosomal aberrations).

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

NON-DRUG TREATMENT

Oligopeptides and polyunsaturated fatty acids must be included in a pregnant woman's diet.

DRUG TREATMENT

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

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

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

Approaches to the treatment of threatened miscarriage differ fundamentally in the Russian Federation and abroad. Most foreign authors insist that it is inappropriate to continue pregnancy for less than 12 weeks.

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

Prescribing drugs that affect hemostasis (etamsylate, vikasol, tranexamic acid, aminocaproic acid and other drugs) for bleeding in pregnant women has no basis and proven clinical effects due to the fact that bleeding during miscarriages is caused by chorion detachment (early placenta), rather than coagulation disorders. On the contrary, the doctor’s task is to prevent blood loss leading to hemostasis disorders.

Upon admission to the hospital, a blood test should be performed to determine the blood type and Rh affiliation.

With an incomplete abortion, heavy bleeding is often observed, which requires emergency assistance - immediate instrumental removal of the remnants of the fertilized egg and curettage of the walls of the uterine cavity. Emptying the uterus is more gentle (vacuum aspiration is preferable).

Due to the fact that it may have an antidiuretic effect, the administration of large doses of oxytocin should be discontinued after the uterus has emptied and bleeding has stopped.

During and after the operation, it is advisable to administer intravenously an isotonic solution of sodium chloride with oxytocin (30 units per 1000 ml of solution) at a rate of 200 ml/h (in early pregnancy, the uterus is less sensitive to oxytocin). Antibacterial therapy is also carried out, and, if necessary, treatment of posthemorrhagic anemia. Women with Rh-negative blood are given anti-Rhesus immunoglobulin.

It is advisable to monitor the condition of the uterus using ultrasound.

In case of a complete abortion during a pregnancy of less than 14-16 weeks, it is advisable to perform an ultrasound and, if necessary, curettage of the uterine walls, since there is a high probability of finding parts of the fertilized egg and decidual tissue in the uterine cavity. At a later date, when the uterus has contracted well, curettage is not performed.

It is advisable to prescribe antibacterial therapy, treat anemia as indicated, and administer anti-Rhesus immunoglobulin to women with Rh-negative blood.

SURGERY

Surgical treatment of NB is presented in the chapter “Non-developing pregnancy”.

Postoperative management

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

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

PREVENTION

There are no specific methods for preventing sporadic miscarriage. To prevent neural tube defects, which partially lead to early spontaneous abortions, it is recommended to prescribe folic acid 2-3 menstrual cycles before conception and in the first 12 weeks of pregnancy in a daily dose of 0.4 mg. If a woman has a history of fetal neural tube defects during previous pregnancies, the prophylactic dose should be increased to 4 mg/day.

INFORMATION FOR THE PATIENT

Women should be informed about the need to consult a doctor during pregnancy if they experience pain in the lower abdomen, lower back, or bleeding from the genital tract.

FOLLOW-UP

After curettage of the uterine cavity or vacuum aspiration, it is recommended to avoid the use of tampons and abstain from sexual intercourse for 2 weeks.

As a rule, the prognosis is favorable. After one spontaneous miscarriage, the risk of losing a subsequent pregnancy increases slightly and reaches 18-20% compared to 15% in the absence of a history of miscarriages. If there are two consecutive spontaneous abortions, it is recommended to conduct an examination before the desired pregnancy occurs to identify the causes of miscarriage in this married couple.

Late spontaneous abortion (or miscarriage) is the termination of pregnancy between 16 and 22 weeks.

The incidence of sporadic miscarriage in the later stages is three times less common than in the earlier period.

Given the variety of causes that cause this condition, this problem should be taken extremely seriously. Self-abortion in the later stages is an integral response of the body to problems in the body, as well as environmental factors.

There are many factors that can cause miscarriage during late pregnancy:

• Violation of the blood hemostasis system.

Maintaining balance and proper regulation of physiological antagonists (coagulation and anticoagulation systems) of the blood is very important for the normal development of pregnancy. Changes with the predominance of one or another system can cause irreversible consequences for the fetus and cause its death.

The cervix should normally be closed during pregnancy.

The length of the cervical canal must exceed 25 mm.

When the cervix opens and shortens, there is a risk of miscarriage. The further development of pregnancy becomes questionable.

With pronounced changes, prolapse (gaping) of the fetal bladder through the cervix is ​​possible, with rupture of the membranes. This is the reason for termination of pregnancy.

Large size of myomatous nodes can interfere with the physiological development of the fetus. The rapid growth of nodes during pregnancy interferes with the stretching of the muscle cells of the uterus. In addition, uterine fibroids in the area of ​​placenta attachment can cause circulatory disorders in the fetoplacental blood flow, which can lead to fetal death.

• Infectious factor.

One of the leading causes of spontaneous miscarriage is infection of the fetus. The spread of infection can occur in various ways: through the placenta (transplacental route), ascending infection (the inflammatory process is transmitted from the vagina, cervix), canalicularly (through the fallopian tubes), transmuscularly (through the muscular wall of the uterus).

An infectious agent (pathogen) affects the tissue of the placenta, causing inflammation in it (placentitis). Subsequently, the inflammatory process moves to the fetal membranes with the development of amnionitis. The subsequent spread of infection in the fetus causes intrauterine infection. The resulting foci of infection can lead to fetal death.

• Endocrine factor.

Recently, more attention has been paid to the hormonal causes of abortion. Many endocrine diseases cause profound metabolic disorders in the body, which can lead to fetal death.

The most common are: diabetes mellitus, hyperandrogenism syndrome, hyperprolactinemia, decreased endocrine function of the pituitary gland, ovarian failure, thyrotoxicosis, severe hypothyroidism.

• The most common cause is a violation of hormonal interactions at the placenta level.

It is known that one of the functions of the placenta is the production of hormones. When placental insufficiency occurs, it makes a major contribution to the prolongation (development) of pregnancy.

This is why placental insufficiency can cause abortion.

• Circulatory disorders in the fetoplacental system.

With insufficient blood flow in the uterine arteries, umbilical cord vessels, as well as pathology of the vascular network of the placental bed, irreversible changes can occur, including fetal death. Adequate blood circulation is an important condition for a normally developing pregnancy.

• Genetic abnormalities.

Certain hereditary diseases can cause self-abortion.

The main part of the so-called “genetic reset” occurs in the early stages of pregnancy (the most severe malformations).

However, in the later stages, termination of pregnancy is also common due to the presence of congenital diseases in the fetus (heart defects, kidney defects, nervous system defects, and other vital organs).

• Anomalies of uterine development.

Changes in the anatomical structure of the uterus can cause miscarriage.

For example, such a pathology as a bicornuate uterus often leads to similar situations.

In this situation, the uterine cavity is divided by a septum, which reduces the volume of each cavity.

If pregnancy begins to develop in one of the horns of the uterus, then at a certain point an obstacle arises to further stretching of the muscle fibers. A bicornuate uterus does not allow the fetus to fully develop.

In addition, with the normal structure of the uterus, there are anastomoses (connections) in the arterial system between the uterine arteries, which contributes to a complete blood supply to the placental system.

With a bicornuate uterus, the arterial system of the two uterine arteries does not anastomose with each other, which significantly reduces the potential blood flow in the fetoplacental system. This can also cause fetal death.

• External factors.

These include harmful environmental influences (ionizing radiation, climatic, geographical factors). Toxic effects (poisoning with heavy metal salts, intoxication). Not only the type of influencing factor is very important, but also the duration. Mechanical factors (injuries, bruises, physical strain) can also adversely affect the course of pregnancy.

• Psycho-emotional impact.

News of an extremely bad event, severe fear, and negative emotions can cause spontaneous abortion. The mechanism is associated with the activation of stress hormones (adrenal hormones, activation of the sympatho-adrenal system), which lead to an increase in the tone of the uterine muscles, as well as vasospasm of the fetoplacental system, which causes self-abortion.

• Serious illnesses of the mother that prevent the development of pregnancy (severe heart defects, kidney defects, tuberculosis, chronic diseases in the stage of decompensation).

Main signs of miscarriage

Symptoms include:

1. . It can be pulling or cramping, regular or irregular.
2. usually scarlet in color and may bleed lightly or heavily.
3. Sometimes the temperature rises.
4. Vomiting is possible (cervical reflex: when the cervix dilates, vomiting appears).
5. The appearance of a feeling of fear, anxiety.
6. With heavy bleeding, dizziness and even loss of consciousness may occur.
7. Stages of spontaneous abortion.

Stages of spontaneous abortion

There are several stages in the development of a miscarriage:

A slight increase in temperature is possible. Upon examination, you can determine: the uterus is enlarged according to the stage of pregnancy, the cervix is ​​softened, the cervical canal is slightly open.

• A miscarriage is often accompanied by heavy bleeding and regular intense cramping pain in the lower abdomen.

The opening of the cervix is ​​also determined; a detached fertilized egg and placental tissue can be seen in the cervical canal.

• A completed miscarriage is characterized by the release of the fetus and membranes, the cessation of cramping pain, and a decrease in bleeding.

On examination: the size of the uterus does not correspond to the period of pregnancy (smaller than it should be), the uterus is contracting, dense, the cervical canal of the cervix may be closed.

Tactics of action in case of self-abortion

At this stage, in some cases the pregnancy can be saved. This is why the right tactics are important.

• When symptoms of an incipient miscarriage appear, a woman needs to call someone close to her for help. If this is not possible, then you must immediately call an ambulance.
• An important condition for maintaining pregnancy is complete rest and strict bed rest. This means that the woman needs to lie down.
• Before the ambulance arrives, you can take a No-shpa tablet (if someone close to you knows how to give intramuscular injections, then it is better to inject 2 ml of a No-shpa or Drotaverine solution intramuscularly). Can also be inserted into the rectum.

A woman is transported to a gynecological hospital on a stretcher or gurney by an ambulance team.

Upon admission to the hospital, the patient’s blood is taken to determine a general analysis, a check of the coagulation system, blood type, Rh factor, biochemical parameters, and a urine test.

The management of the patient depends on the viability of the fetus. If the data determines, then conservation therapy is carried out, which includes:

• Strict bed rest.
• Administration of hemostatic drugs.

The drug “Etamzilat” or “Ditsinon” is also used. In case of severe bleeding, it can be administered intravenously in a stream, slowly. For moderate bleeding, it can be administered intramuscularly.

• Sedative therapy. It is possible to use “Valerian”, 1 tablet. 2-3 times a day.
• Antispasmodic therapy. Intramuscular administration of "No-shpa" 2 ml 3 times a day.
• The use of "" also helps to maintain pregnancy.
• It is important to perform dynamic ultrasound to determine the fetal heartbeat. If the study does not determine pregnancy, then, unfortunately, its preservation is not advisable.

The rehabilitation period after spontaneous abortion

How to avoid miscarriage

In order for pregnancy to develop physiologically, it is necessary to undergo, which includes:

• Detection of uterine development abnormalities.

For this purpose, diagnostic methods such as ultrasound are most used. In addition, you can use metrosalpingography - the introduction of a contrast agent into the uterine cavity through the cervical canal, and recording the obtained data using an x-ray. All these methods provide information about the structure of the uterus and identify various developmental anomalies.

If during the examination a bicornuate uterus is revealed, then this developmental anomaly must be corrected surgically (removal of the septum inside the uterus can be performed using open access, laparoscopically, and even with an intrauterine manipulator during hysteroresectoscopy).

• Consultation of a woman and her husband with a geneticist to identify possible unfavorable hereditary factors.
• Examination by a hemostasiologist to determine the hemostasis system and correct its disorders.
• Examination for infections and virus carriage.

When identifying chronic infections with high antibody titers, the plasmapheresis method gave good results.

This technique allows you to cleanse the blood of infectious agents, which significantly increases the chance of bearing a healthy child.

• When terminating a pregnancy due to cervical insufficiency (with an unsuccessful attempt at surgical correction), the method of applying a cerclage to the cervix outside of pregnancy turned out to be effective.

This technique consists of introducing a mesh implant that is installed around the cervix at the level of the internal os. In the future, when pregnancy occurs, the cervix is ​​kept closed, and its premature opening does not occur.

• If there are uterine fibroids that interfere with the normal development of pregnancy, it is necessary to remove these nodes.

It is preferable to perform the operation with an open approach, which will provide the most durable scar on the uterus. However, in the presence of a subperitoneal node on a leg, laparoscopic access can be limited.

• Correction of hormonal disorders that led to termination of pregnancy.

Treatment should be carried out jointly by an obstetrician-gynecologist and an endocrinologist.

• Treatment of concomitant diseases, in case of chronic diseases, it is necessary to achieve their stable remission.

Treatment should be carried out by specialized specialists.

Experiencing a late pregnancy termination is very difficult for a woman. However, you need to know that there are many reasons for late pregnancy termination. For a successful re-pregnancy, it is important to undergo a course of rehabilitation and examination by many specialists.

In some situations, surgery may even be necessary. Competent is the key to the favorable development of subsequent pregnancy.

Frozen pregnancy is characterized by a sudden stop in fetal development in the early stages of gestation under the influence of both internal and external factors. As a rule, this condition develops in the 1st trimester of pregnancy, before the 12th obstetric week.

The fertilized egg is implanted in the uterus, and all the signs of pregnancy appear: delayed menstruation, a significant increase in the size of the uterus, toxicosis, the breasts become more sensitive, and there is an increase and darkening of the areolas.

Stopping the development of the embryo can occur at any stage, but doctors recommend paying special attention to the signs of frozen pregnancy in the early stages, i.e. up to 14 weeks. The second trimester of pregnancy is, of course, considered no less dangerous and if signs of a frozen pregnancy are detected, you should consult a doctor.

It deserves special attention. Since it is during this period that all the vital organs of the embryo are “laid,” and it is most susceptible to negative factors.

What is the danger?

A pregnant woman makes an irreparable mistake by not coming to see a doctor on time and not paying attention to the manifestations of signs of a frozen pregnancy, both in the early stages and in the second trimester. In rare cases, the pregnant woman’s body itself rejects the frozen fetus - the process ends in a miscarriage and a successful outcome for the woman’s health. After all, if a frozen fetus is in the womb for a long time, then intoxication may develop with an increase in temperature, severe pain and weakness.

With such symptoms of a frozen pregnancy, urgent hospitalization is required, where the doctor will prescribe a special drug that will provoke uterine contractions and lead to miscarriage. The sooner this procedure is carried out, the better for the woman herself.

A fertilized egg, remaining in the uterus for more than 6-7 weeks, can lead to disseminated intravascular coagulation - DIC syndrome, which is extremely life-threatening. With this diagnosis, the blood loses the ability to activate the clotting process, then possible bleeding can become fatal.

Signs

The danger is that fetal death may not be detected for a long time and may be asymptomatic for a pregnant woman. Problems with detecting a frozen pregnancy do not arise if the expectant mother regularly undergoes tests and goes to see a doctor. It is he who can ascertain the fact of discrepancy in the size of the uterus, taking into account the duration of pregnancy, and an ultrasound check will allow you to accurately find out about the heartbeat of the embryo.

How to recognize a frozen pregnancy? In general, in all trimesters, frozen pregnancy manifests itself in the same way:

• frequent discharge with blood;
• general weakness, chills and internal trembling;
• temperature increase;
• nagging and aching pain in the lower abdomen;
• causeless cessation of toxicosis;
• stopping breast enlargement;
• An ultrasound examination confirms the fact that the child’s heartbeat has stopped;
• discrepancy in the size of the uterus.

There are exceptions when the symptoms of a frozen pregnancy may have some differences.

During a frozen pregnancy, the basal temperature drops to the level characteristic of the absence of pregnancy.

If a woman does not notice a frozen pregnancy in time, and the dead fetus remains in the uterus for quite a long time, intoxication may begin, for which the following symptoms may occur:

• sharp pain in the groin and lumbar region;
• temperature increase;
• pale skin;
• weakness.

A frozen pregnancy can be complicated by the development of blood and tissue infection - sepsis, since the decay products of the dead fertilized egg enter the woman’s bloodstream.

Is it possible to feel a frozen pregnancy? It is worth noting that the manifestation of symptoms is extremely individual, and in some cases the woman does not know that the pregnancy has stopped developing until the next examination. If a woman experiences the feeling of a frozen pregnancy, she needs to see a doctor, but she should not immediately panic and do rash things. It is advisable to seek advice from several specialists, at least two.

There are real cases when in one antenatal clinic a woman was diagnosed with a “frozen pregnancy”, and in another she was told that everything was fine, and in the end this pregnancy was resolved with a successful birth.

Signs of frozen pregnancy in the first trimester

When fetal development stops, basal temperature (BT) often drops. The signs of a frozen pregnancy in the early stages are no different from the signs in the second trimester.

Signs of a frozen pregnancy in the second trimester

Stopping fetal development in this period has the only addition - the cessation of fetal movement. The signs of frozen pregnancy in late and early stages are absolutely the same.

Causes of frozen pregnancy

Doctors themselves sometimes cannot give an exact answer: “What causes a frozen pregnancy in the early stages or in the second trimester?” But there is a list of main reasons.

Genetic failure

Genetic failure is the most common reason why fetal development stops. In 70% of women, fetal freezing occurs before 8 weeks, which is due to chromosome abnormalities in the fetus. Anomalies in genetics begin to appear quite early, and almost all of them are incompatible with life. Bad genetics can be passed on from both mother and father, or an unsuccessful combination of parental genes is to blame. If a woman’s fetus fails more than three times, then a genetic disorder is to blame.

Hormonal disorders

Hormonal imbalance can affect the course of pregnancy for two reasons:

• the first reason for fetal death is a lack of progesterone, without it it cannot survive and develop in the uterus;
• The second reason for the development of frozen pregnancy in the first trimester is an excess of male hormones androgens.

It is advisable to identify hormonal disorders before pregnancy and undergo a full course of treatment. It is recommended to visit a gynecologist in advance, because only after an examination will he be able to tell what tests are needed.

Infections

Infections are also a common cause of missed abortion. With a successful conception, the expectant mother's immunity weakens. The placenta and membranes reliably protect the fetus from antibody attack, but the mother herself becomes vulnerable to various viruses and bacteria. Her infectious diseases worsen, the vaginal flora becomes more active, and then a dangerous moment comes for the baby - infection.

Cytomegalovirus and rubella have harmful effects. Moreover, they are dangerous if you become infected with them during pregnancy, and when you “recover” an infection, on the contrary, antibodies are produced that prevent the exacerbation of the disease.

No less dangerous for the formation of a frozen pregnancy is considered to be a common acute respiratory viral infection, which most often occurs very severely, since the immune system works at half strength. The danger itself comes not from the pathogen, but from the symptoms of the disease: fever and intoxication, which leads to disruption of the circulatory system. The fetus does not receive the required amount of nutrients and oxygen.

This is the reason for the development of frozen pregnancy, the signs of which may appear or may be hidden.

Bleeding disorder

Bleeding disorders, which are caused by antiphospholipid syndrome, also affect fetal development. Frozen pregnancy often occurs for several reasons:

• due to the direct effect of antiphospholipid antibodies on the egg, which interferes with the implantation of the fertilized egg;
• the formation of blood vessels in the placenta decreases and, as a result, its functions decrease;
• signs of a frozen pregnancy at 6 weeks may occur due to disruption of the full development of the fetus and the placenta itself. The reason for this is blockage and damage to the uteroplacental vessels.

Lifestyle

An incorrect lifestyle leads to a missed pregnancy, and the first signs may appear immediately.

Incorrect and inadequate nutrition, insufficient walks in the fresh air, tight clothes, spending a long time in front of a computer monitor - these are the factors that directly affect the development of the fetus.

Age

The age of the parents also plays a big role. According to statistics, at the age of 20 the risk of developing a frozen pregnancy is 10%, while after 45 it is 50%.

Diagnostics

The most accurate way to determine a frozen pregnancy, both in the early and late stages, is an ultrasound, during which a specialist will check:

1. Inconsistency between the size of the uterus and the duration of pregnancy.
2. Absence of heartbeat and breathing movements.
3. Abnormal position, deformation and contour around the fetal body in late stages, indicating tissue decomposition.
4. Lack of visualization and growth of the embryo in early pregnancy. It is very rare, but it also happens that the fertilized egg continues to grow for some time, but the embryo in it does not form or has stopped developing.

This also explains the problems that sometimes arise with determining a frozen pregnancy based on the results of an hCG analysis, the second method for diagnosing pathology. It happens that an ultrasound indicates that the development of pregnancy has stopped, but the level of hCG in the blood continues to rise, since it is produced by the membrane of the fertilized egg or it itself remains at a high level for several days after the death of the fetus.

As you can see, the test for a frozen pregnancy can show a positive result, because its action is based on the detection of hCG in the urine.

Although, as a rule, the level of hCG during a frozen pregnancy decreases sharply or is equal to zero.

Consequences and termination of frozen pregnancy

As a result of a frozen pregnancy, two scenarios are possible:

1. Spontaneous miscarriage in the early stages, when the uterus rejects the dead embryo and removes it from the body.
2. Medical intervention. If it is not carried out on time, then in the late stages of a frozen pregnancy, the decomposing fetus will poison the mother’s body with decay products, which will lead to serious consequences for her health.

So, if a frozen pregnancy is diagnosed, then its termination is currently possible in several ways:

• Medical abortion. This is a way to terminate a frozen pregnancy in the early stages. A woman is prescribed drugs that provoke uterine contractions, and, as a result, a miscarriage.
• Curettage, or curettage (cleaning) during a frozen pregnancy. Quite a popular, although not the most desirable procedure, since during it tissues are injured and the likelihood of complications is high. The operation is performed under general anesthesia and is a mechanical cleaning of the uterine cavity after a frozen pregnancy, removing its upper mucous layer, with a special instrument that is inserted into the cervical canal, having previously provided access there by installing dilators. After the operation, bleeding or inflammation may develop, so the woman should remain in the hospital for several more days, where her well-being will be monitored.
• Vacuum aspiration. The operation, performed under anesthesia or local anesthesia, involves the woman having her uterine cavity cleaned using vacuum suction. It looks like this: the tip of a vacuum apparatus is inserted into the cervical canal (without dilation). After the procedure, the woman should be under the supervision of a doctor for about two hours. Of course, this method of terminating a frozen pregnancy is more gentle than curettage. In addition, the woman will not have to stay in the hospital for a long time.
• Childbirth. In the later stages, termination of a frozen pregnancy is much more difficult, mainly from a psychological point of view. The fact is that a non-developing pregnancy is a contraindication for cesarean section (the contents of the uterus can be infected), so there is only one way out - artificially inducing labor. That is, a woman cannot simply disconnect from the process, for example, under anesthesia, she must give birth to a dead fetus herself as an emergency.

In the early stages, doctors sometimes do not make any attempts to terminate a frozen pregnancy, waiting until the uterus itself rejects the fetus. But it is impossible to maintain a pregnancy after a frozen pregnancy.

Treatment and recovery after a frozen pregnancy

After a frozen pregnancy, an examination is prescribed to determine the cause of the pathology. If one can be identified, it is recommended to undergo a course of treatment.

As a rule, tests after a frozen pregnancy include:

• blood test for hormone levels;
• smear and examination of the vaginal microflora for the presence of sexually transmitted infections;
• histology after a frozen pregnancy - study of the uterine epithelium. For analysis, a thin section of the upper layer of the uterus or tube is taken, or material obtained during curettage is used.

As for the restoration of the uterus after surgery for a frozen pregnancy, a course of antibiotics, hemostatic agents, as well as abstinence from subsequent pregnancy for a certain time are usually prescribed (depending on concomitant factors).

In case of detected genetic abnormalities of the fetus, after a missed pregnancy, a consultation with a geneticist will be required to determine the compatibility of the partners.

Pregnancy after a frozen pregnancy

Exactly how long it would be undesirable for a woman to become pregnant after the fetus has died is determined by doctors in each specific case, at least it will be six months. Until then, a woman needs to use contraception and not worry about the fact that she will no longer be able to conceive a child. These fears are completely unfounded.

A frozen pregnancy is, as a rule, a special case that in no way indicates a disorder in the woman’s reproductive system. Even if two frozen pregnancies occur in a row, according to statistics, in 75% of cases there is a chance of normal conception and gestation.

Helping a woman survive a frozen pregnancy is the task of loved ones. In severe cases, the help of a psychologist may be required, as some patients develop fear of pregnancy.

I like!

Frozen pregnancy is a diagnosis that is scary for any woman to hear. Unfortunately, no one is immune from such an outcome. This can happen both early and later.

The fruit freezes and stops developing for different reasons. The most dangerous periods of child development are considered to be 3-4 weeks; 8-11 weeks and 16-18, although at a later date the likelihood of such a scenario is significantly reduced.

Definition of pathology

In a frozen pregnancy, fetal development is interrupted long before the expected due date. Most often this happens in the first trimester, that is, before thirteen weeks. To develop like this pathological state maybe for two reasons:

• anembryony - in this case the embryo does not develop in the uterus and is not visualized;
• death of the embryo - the pregnancy developed normally for some time, and then the fetus died. An ultrasound examination also does not reveal the embryo in the uterine cavity, but the specialist can see the parts that remain after its destruction.

There are also cases in which development stops at a later stage. Then they talk about the intrauterine death of the child. For a woman, this often becomes a real tragedy, because she has already managed to recognize herself as a mother and feel the first movements of the child.

Causes of frozen pregnancy

There is no clear reason. Experts believe that pathology develops under the influence of several factors. One of the main ones is infection of the embryo at the initial stage of its development. In addition, factors that can cause abortion, include :

• genetic disorders (chromosomal pathologies);
• endocrine disorders;
• autoimmune pathologies.

Such pathological processes usually lead to the interruption of the development of a formed embryo or its absence altogether when an infection damages it at the stage of fertilization of the egg. However, in addition to this, a number of other reasons can be identified that can lead to intrauterine fetal death. These include:

Signs of anomaly

Symptoms of the development of pathology in the initial stages of pregnancy are mild, so it is not so easy to notice. Only a doctor can make a diagnosis after a thorough examination and additional research. Much easier to navigate for women in later stages, because they already feel the movements of the unborn child. But in the first trimester, fetal death can be suspected based on the following signs:

• toxicosis ends;
• the breasts no longer swell;
• basal temperature becomes lower;
• painful sensations of a cramping nature occur;
• brownish discharge that has a spotting appearance (in the early stages, when the fetus dies, just this kind of discharge may occur);
• general body temperature rises.

The presence of any such signs does not always indicate that the pregnancy is fading, however, the presence of any of these symptoms suggests an early visit to the doctor and a diagnosis.

During a frozen pregnancy, a woman can experience a variety of sensations. A state of fatigue, apathy may appear, body temperature may rise - all such symptoms should necessarily alert the expectant mother and become a reason to consult a doctor. Also, do not forget that these symptoms they don't always talk about interruption pregnancy and can simply signal a restructuring in a woman’s body. However, it is still necessary to conduct an examination by a specialist.

Only a doctor can make an accurate diagnosis. For this he carries out the following manipulations:

It should be noted that a pregnancy test when development has stopped can also show two stripes, so this is not a diagnostic method. You should definitely contact a specialist to confirm or refute the woman’s assumptions.

After the doctor makes sure and will confirm the diagnosis, he selects a suitable set of procedures for the mother, and also gives advice on how to prepare for a new pregnancy.

Doctors' actions

After diagnosis, the doctor assesses the patient’s condition, as well as the duration of pregnancy, and prescribes the necessary treatment. We are already talking about how to preserve the life and health of the mother. Therefore, the choice is made between two main methods of therapy:

• The use of medications that contribute to miscarriage. These medications are used only for up to eight weeks.
• Vacuum abortion or aspiration. During this procedure, under anesthesia, the uterine cavity is cleaned using vacuum suction.

After both procedures, it is necessary to perform another ultrasound examination to confirm that the uterine cavity is clean. Otherwise, you will also have to scrape out the remains of the fertilized egg.

In some cases, when fetal development stops, a woman may not even know that she is pregnant and a spontaneous miscarriage occurs in the very early stages. In this case, she simply notices a slight delay in her period. Sometimes doctors believe that it is better not to interfere with the patient’s body and observe her condition for some time, waiting for a spontaneous abortion.

Frozen late pregnancy

There are also many reasons for this pathology. Typically these include fetal anomalies that are incompatible with life, endocrine system problems, kidney disease, and cardiovascular diseases in a pregnant woman.

This is diagnosed much less often than in the initial stages, but for a woman this is a real tragedy. Intrauterine fetal death in later stages can be diagnosed by the cessation of the child’s motor activity, because at later stages the woman already feels t moving your baby and is able to evaluate them.

The fetus moves constantly, except during periods of sleep. Usually, it is enough for a pregnant woman to place her hand on her stomach to feel the baby’s movements. If their frequency and rhythm changes, this may indicate the development of pathology.

You can also find out about the fading of pregnancy in the later stages by listening to the heart rhythm with a stethoscope. A healthy fetus has a heartbeat of 120-160 beats per minute. During a frozen pregnancy, it is not possible to listen to the heartbeat. In addition, factors such as the lack of dynamics of uterine enlargement, the appearance of bloody discharge (with placental abruption), as well as mild nagging or cramping pain may indicate intrauterine fetal death.

If you have these types of symptoms, you should immediately consult a doctor for further diagnosis. The doctor will evaluate the patient’s complaints, conduct a full examination and prescribe the necessary additional examinations.

Once the diagnosis is confirmed, the patient is prescribed the only possible treatment - removal of the dead fetus from the uterine cavity. To do this, either an artificial birth is induced or a surgical abortion is performed. In cases where the pregnancy is slightly beyond eight weeks, the use of tablets is allowed, which are used for medical abortion. The woman is not always hospitalized.

How to prevent the development of pathology

All pregnant women are interested in the question: is it possible to prevent a frozen pregnancy? The first thing a couple planning to have children should do is get examined. It is a thorough examination that can reduce the risks and give an answer on how to avoid a frozen pregnancy.

The doctor should suggest taking a series of tests and conducting the necessary research. Usually these are hormone tests, blood tests, ultrasound examination of the pelvic organs, etc. It is also recommended that conception should not occur at a time when the threshold for acute respiratory viral infections or other viral infections is exceeded.

When a woman works in child care institutions, it is recommended to do some preventative vaccinations. The geneticist's office is also worth a visit. In addition to visiting doctors, one should not forget about the healthy lifestyle of both parents. It is necessary to give up smoking and alcoholic beverages - this will significantly increase the chances of a good pregnancy.

If one attempt to get pregnant is unsuccessful and the embryo dies, you should not give up. With proper planning and preparation, the chances of conceiving and carrying a baby to term still remain high.

For a woman who is expecting a child, such a diagnosis as a frozen pregnancy sounds like a death sentence. This is difficult to bear not only physically due to the need for surgery with anesthesia, but also morally: all hopes and dreams associated with early motherhood are destroyed. Such a diagnosis will be especially severe in the case of a desired, long-awaited or induced pregnancy after long-term treatment or.

A woman always asks herself the question - why did this happen, who is to blame for this and whether such a situation could have been prevented. It is important to understand in detail all the reasons and mechanisms for the development of frozen pregnancy, to know the signs by which both the threat of such a condition and an already accomplished fact are recognized.

Frozen pregnancy as a medical problem

Pregnancy can stop in its development at any stage and in any woman; a similar situation arises due to the influence of negative factors against the backdrop of an unfortunate combination of circumstances. Speaking from a purely medical point of view, a frozen pregnancy is understood as the death of an embryo or fetus from the moment of implantation until the period of birth. As such, the death of a child can be prevented if dangerous signs that can affect the condition of the baby in the womb are identified in time. It is for this purpose that a system of prenatal observation by a doctor has been created at certain stages of pregnancy. Many risk factors can be eliminated even earlier, during pregnancy planning, by first undergoing all examinations and curing, if possible, all existing pathologies.

Any woman worries about the health of her unborn baby. It is worth knowing that, according to statistics, such a violation of fetal development occurs infrequently. However, in the same woman, due to irremovable harmful factors, a similar condition can occur repeatedly. Obstetricians indicate the probability of a frozen pregnancy in 1 case in approximately 180 normal gestations. If we talk about the structure, then it is frozen pregnancy that leads among their causes and reaches figures of 20% of all cases of termination at different stages. Most of these babies were planned and wanted.

Frozen pregnancy: concept and conditions of formation

According to doctors, a non-developing (also known as frozen) pregnancy is a pathology in which the development of the embryo (in the first weeks) or fetus completely stops due to its death. Such a fetus has no heartbeat, all metabolic processes are stopped, and there are no processes of cell division or growth.

Sometimes a non-developing pregnancy is called, not entirely correctly from a physiological point of view, a failed miscarriage. In this case, there is death of the fetus, but there are no signs of miscarriage.

Who takes more risks and when?

It is impossible to predict such a condition in a particular patient in advance. A stop in the development of pregnancy is possible for any pregnant woman, from young to older expectant mothers.

According to obstetricians, a similar diagnosis is more common in women after 40 years of age. Most often, this condition develops up to 12-14 weeks; after this period, no more than 1% of all such pregnancies die. If such a condition is not recognized in time, it threatens the formation of purulent-inflammatory processes in the area of ​​the uterus and appendages, which can lead to complications, including loss of reproductive organs.

The exact cause of this condition is not completely clear at the moment; fetal fading can be provoked by both external negative factors and processes within the body that adversely affect gestation. The reasons may be subtle, relatively mild from the point of view of ordinary life, but often fatal for the embryo. The manifestations of undeveloped pregnancy themselves vary significantly at different times. The cessation of fetal vital activity in the second and third trimester of pregnancy is significantly different in manifestations from those symptoms that are felt at the beginning of gestation.

Frozen pregnancy: causes of pathology

When analyzing the situation, doctors often identify the combined influence of several negative factors at once, which lead to problems in the functioning of both the mother’s body and the development of the fetus itself. But it is extremely rare to accurately determine the leading pathogenic factor in each case, even based on the results of histological and cytogenetic studies after surgery. A full analysis of fetal cells is often prevented by tissue maceration (their swelling and destruction in utero) due to post-mortem decomposition and changes in the anatomical structures of the body. Today, experts identify more than three dozen leading causes of non-developing pregnancy and fetal death in certain periods of gestation.

Leading factors that sharply increase the likelihood of an unfavorable pregnancy outcome:

• Sharp hormonal fluctuations in the mother's body
• Chromosomal and gene abnormalities of the fetus;
• Acute infectious diseases of any nature;
• Chronic infections, especially aggravated during gestation;
• The presence of bad habits, intoxications and treatment incompatible with pregnancy.

And, although it is obvious to almost all pregnant women that cigarettes (including electronic ones) and drinking alcohol throughout gestation should be prohibited, many women neglect such advice, and as a result, such habits threaten the death of the fetus in the womb. You need to remove bad habits from your life before conception, while still thinking about the baby.

The most dangerous in terms of ending the life of the fetus are infections such as, or, in the presence of which preliminary examination and active treatment with complete suppression of infection are necessary. A woman with such infections needs to be monitored from the very first weeks, so that in case of the slightest deviations she can begin active therapy. Especially dangerous against the background of carriage of these infections will be such manifestations as, or absence of movements after the twentieth week of gestation.

Factors negatively affecting gestation

Although the strength of the influence of various harmful substances on the embryo and its subsequent death have not been fully and precisely clarified, researchers have identified several special conditions under which such a negative outcome is most likely. These include:

• Hormonal disorders that occurred before pregnancy. These include problems with the ovaries, thyroid gland, adrenal glands and pituitary gland, leading to sudden hormonal changes that disrupt the structure of the endometrium and the functioning of the ovaries.
• Endocrine metabolic disorders during pregnancy, especially with a pronounced deficiency or a change in its ratio relative to estrogen. This leads to changes in the tone of the muscles of the uterus and blood supply to the placental site, problems are formed with the supply of sufficient nutrition and oxygen molecules to the embryo, because of this the embryo or fetus dies. Such disorders are especially dangerous during the first weeks of pregnancy.
• Presence of immunological disorders leads to rejection of the fertilized egg as a foreign agent due to the fact that half of its genetic material is inherited from the father. As the embryo grows and develops, the mother's body begins to produce antibodies against it, which damage the cells of the embryo and lead to its death.
• Antiphospholipid syndrome, a specific autoimmune disorder in which elevated concentrations of antibodies are produced to specific phospholipid molecules in maternal plasma. With a single fading pregnancy, a similar process is detected in approximately 5% of women, while relapses of such fetal death are typical for 45% of women with a similar diagnosis. The syndrome is dangerous due to the formation of thrombosis of small vessels. Vessels of this kind are typical of the uterine arteries and vessels in the placenta, which causes chronic malnutrition in the fetus due to a lack of building substances and oxygen molecules. Pregnancy against the background of such a syndrome is carried out in a special way; the syndrome can negatively affect not only the gestation process, but also the birth act and the postpartum period.

Infections as a cause of fetal death

In a large percentage of cases, frozen pregnancy becomes a consequence of acute maternal infections or activation of chronic ones. The most aggressively affecting the fetus are the viruses of the family, as well as. Infections such as, or those that existed before conception play a significant role. Often, a woman has had these diseases for many years without manifesting themselves, but during gestation they can cause significant harm, leading to fetal deformities, gene and chromosome defects, and missed abortion. Pregnancy, even in a completely healthy and strong woman, is accompanied by a physiological decrease in immune defense (so that the fetus, which is 50% foreign to the mother, is not rejected). This, under certain circumstances, allows the infection to become more active, forming an exacerbation and harming the development of the baby. Thus, cytomegaly, when activated during pregnancy, can lead to defects incompatible with life and fetal death; in later stages, it threatens problems with the liver, spleen and the formation of jaundice. The development of sexually transmitted diseases is no less dangerous - they really threaten the life and health of the fetus.

Genetic and chromosomal pathologies as a cause

Chromosomal and genetic damage often causes pregnancy to fail. This is due to the fact that such problems will not allow the child to be born full-fledged; he will have severe developmental defects leading to disability, severe metabolic diseases, enzyme dysfunction, and others. All this will make the life of such a baby with his parents a series of sufferings. Nature is wise, and it produces, no matter how rudely it may sound, natural selection, the culling of defective embryos. With such severe pathologies in chromosomes and genes, with malformations of the baby and problems with the development of the placenta, such a pregnancy stops at some point, and the fetus dies at the beginning of its development. Chromosome and gene defects can be inherited through the mother's line or through the father's genes, but can also occur spontaneously due to the influence of mutagenic factors on the embryo. If there is a similar reason for a missed pregnancy, the couple is subsequently sent to a geneticist and for examination to prevent the story from repeating itself in the future.

note

In some cases, with a high risk of having children with gene or chromosomal mutations, parents are offered the use of assisted reproductive technologies (selection of obviously healthy cells without mutations).

Rubella virus and frozen pregnancy

If a woman has not been ill, and during early pregnancy had contact with patients, she has a high risk of miscarriage, miscarriage, or the development of embryonic defects. Up to 40% of women who became infected with rubella in the first weeks of gestation had a frozen pregnancy, and some children developed gross malformations incompatible with life. The fact is that the virus affects the formation of organs and systems, disrupting the formation of the brain, heart and eyes. For such a fetus, as in the case of genetic and chromosomal abnormalities, the mechanism of natural selection often works - the pregnancy freezes. Rubella is less dangerous after 16 weeks, but can threaten the development of intrauterine infection. If a woman had rubella as a child and her blood tests show antibodies, there is nothing to worry about. When there are no antibodies to rubella, to prevent dangerous conditions it is worth getting vaccinated in advance, three months before planning.

Do external factors have an impact?

External factors also influence the course of pregnancy and stop its development. It would seem that simple and banal reasons that a woman endures relatively easily outside of gestation, in her new position can have an extremely negative impact on the fetus during critical periods of development. Thus, sudden changes in temperature and atmospheric pressure, changes in time and climate zones, airplane flights and heavy lifting, radiation and various waves affect. Visiting or spending a long time in the open sun may have a negative impact on pregnancy.

Frequent stress and anxiety negatively affect the fetus, as does taking sedatives and some other medications without the consent of a doctor. In addition, there are a number of reasons that have not yet been clarified, but lead to the arrest of fetal development in a seemingly young and healthy woman. To protect yourself and your baby from this as much as possible, you need to be under the supervision of a doctor from the very first weeks and strictly follow all his recommendations.

Critical periods for frozen pregnancy, timing

If we talk about whether pregnancy fading, death of the embryo or an already sufficiently formed fetus is possible at all stages of pregnancy, then its sensitivity to harmful influences is not the same. The shorter the gestation period, the higher the danger to the fetus, although in the early stages there are certain critical periods. At this time, global events occur in the life of the embryo, the laying of vital organs or the formation of new functions, due to which it becomes vulnerable to harmful external or internal influences. So, this includes periods:

Causes of fetal death in late pregnancy

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The causes of fetal death, especially after the beginning of the second and third trimesters, can also be complications of pregnancy. These include:

• a sharp and pronounced increase in blood pressure during gestation,
• formation of a strong
• difficult pregnancies, especially after 20 weeks,
• malformations of the placenta, anomalies of its location, premature placenta.

The following can be dangerous to the life of the fetus:

• problems with and formation of true nodes,
• change in the volume of amniotic fluid,
• multiple births and Rhesus conflict,
• poisoning of a pregnant woman with various poisons and toxins,
• drug overdose,
• deficiency or excess of vitamins and minerals.

In addition, the life of the fetus will be significantly affected by those conditions that lead to acute fetal hypoxia or severe chronic oxygen starvation.

Alena Paretskaya, pediatrician, medical columnist