How to diagnose a missed pregnancy in the early stages. Frozen pregnancy: signs and symptoms. Causes of non-developing pregnancy

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Many pregnant women at an early stage fear that the embryo will stop developing. This condition is called missed pregnancy. It is diagnosed not only with the help of special laboratory and instrumental procedures. Knowing the first signs of a missed pregnancy, a woman herself will be able to suspect a pathology.

Signs of a missed pregnancy in the first trimester

So in medicine, a pathology is called, which is a miscarriage of the fetus, even if the previous normal course of pregnancy. As a result, the development of the embryo stops, it dies. The danger of a frozen pregnancy at an early stage is that for a long time it can hardly manifest itself. In such cases, only tests and regular visits to the doctor help to identify the pathology. Other women have the following signs of a missed pregnancy in the early stages:

chills, general weakness, internal trembling;
stop breast augmentation;
pain in the lower abdomen of a pulling, aching character;
heat;
disappearance of symptoms of toxicosis for no reason;
bloody or spotting discharge from the vagina.

Allocations

Symptoms of a missed pregnancy in the first trimester are more often associated with a change in the nature of vaginal discharge. So the body begins to gradually remove the embryo. Signs of a frozen fetus at week 12 and any other period are practically the same. So, the following highlights indirectly indicate it:

Normal consistency, whitish color. These are the usual secretions that are observed within 1-2 days after the start of the regression.
With reddish veins. Such discharge appears in the third and subsequent days. This is due to the beginning of the decomposition of the embryo and the gradual detachment of the fetal egg from the uterine wall.
Red-brown, bloody. Observed 14 days after the cessation of embryo development.

Toxicosis

Another characteristic symptom of fetal development fading, especially at an early stage, is the abrupt cessation of toxicosis. Normally, it appears in most women after implantation of a fertilized egg in the uterus. Nausea and other characteristic symptoms of toxicosis are associated with an increase in the amount of human chorionic gonadotropin (hCG), the pregnancy hormone.

If these signs were observed in the early stages, a couple of weeks after conception, then a change in the amount, frequency and intensity of vomiting may indicate problems with the child. The reason is that hCG is formed by the membranes of the fetus, which is why this hormone can only be detected during childbearing. If the development of the embryo has stopped, then the specified substance ceases to be produced. As a result, toxicosis disappears sharply. Although with a frozen pregnancy, it can change in a different way:

On the first day, toxicosis manifests itself without changes.
The next day, due to a decrease in hCG, vomiting can only develop into mild nausea.
After 4-5 days, the signs of toxicosis completely disappear.

General well-being

Deterioration of well-being is associated with a long stay in the body of a pregnant woman, a decaying fetal egg. Certain signs of a missed pregnancy in the early stages appear depending on the time that has passed since the death of the fetus:

Dizziness, a feeling of pulling pain in the lower abdomen and weakness. These signs appear 3 weeks after the start of the regression.
An increase in temperature to 37.7 degrees, sharp pains in the uterus. Occur a week after the previous symptoms.
Cramping pains in the uterus, even higher body temperature against the background of weakness and even loss of consciousness. Such signs can be observed in a woman 5 weeks after the death of the embryo.

Change in basal temperature

A characteristic sign of a missed pregnancy at an early stage is a change in basal temperature. It is the lowest and is observed during rest (sleep). It is measured immediately after waking up. During pregnancy, the increase in basal temperature is 0.3-0.5 degrees, which is associated with the action of the hormone progesterone. With normal intrauterine development of the fetus, it is 37.2-37.5 degrees when measured in the rectum immediately after waking up.

If the basal temperature decreases, this indicates violations during pregnancy. This symptom is not considered an absolute confirmation of the cessation of embryonic growth. Many women keep a diary from an early date, recording basal temperature indicators there. After the start of the regression, this body parameter changes as follows:

After two days, the indicators will begin to decline. The norm is a basal temperature of at least 37 degrees. 48 hours after the embryo development stops, it decreases to 36.9-36.8 degrees.
After 4 days, the indicators will decrease even more. The basal temperature will already be 36.7 degrees. At this level, it will be for several more days.
After the start of active decomposition of the fetal egg, the occurrence of intoxication of the body and inflammation of the pelvic organs, the basal temperature will rise sharply.

Symptoms of a missed pregnancy in the early stages on ultrasound and on the concentration of hCG

The doctor confirms the death of the fetus with the help of special laboratory and instrumental procedures. The first includes a blood test to measure the level of the hCG hormone. When the development of the fetus is stopped, the following are observed:

a decrease in the concentration of hCG below the norm for a certain gestational age;
a persistent decrease in the amount of hCG for several days;
very slight increase in hCG levels.

Ultrasound helps to accurately assess the condition of the fetus. Based on its results, the doctor can identify changes in the embryo itself and the fetal egg. With a frozen pregnancy, ultrasound shows the following:

deformation of the fetal egg with a gestational age of up to 4 weeks;
discrepancy between the size of the embryo and the gestational age;
for a period of 6-7 weeks, the fetus is not visualized;
lack of embryonic heartbeat (normally it is determined from the 5th week of gestation);
discrepancy between the diameter of the fetal egg and the norm for a certain period of pregnancy.

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A missed pregnancy is not carrying a fetus while it is still in the womb. During a frozen pregnancy, the fetus, at a certain stage, simply stops developing, and it dies.

The most common cases of missed pregnancy occur in the first trimester, and only occasionally in the second and third trimester. A woman may not even notice a stop in the development of the fetus. Therefore, today, in this article, we will dwell in detail on the first signs of such a pregnancy and how it manifests itself.

Why a missed pregnancy occurs: uterine defects, fibroids, endometriosis, various kinds of hormonal disruptions, an unhealthy lifestyle, and even age.

Causes of missed pregnancy

Fetal fading is one of the serious and unpleasant topics for conversation, but, nevertheless, requires discussion. This can happen to anyone, it is very difficult to explain why the development of a child in the womb is stopped, and few people delve into these issues. In order to determine the cause of the fading, it is necessary to conduct a series of analyzes, but since this does not change the outcome of the situation, such analyzes are rarely resorted to.

If the diagnosis is confirmed, and the child has really stopped its development, first of all, the woman needs to take care of maintaining her own psychological health. It is very difficult to transfer such a thing, especially without any reasons and explanations from doctors. Try to surround yourself with people close and dear to you, enlisting their support. Most importantly - do not give up on yourself - the fading of pregnancy will not prevent you from bearing a healthy and strong child in the future.

How do doctors motivate the fading of pregnancy? The most common and logical explanation for this phenomenon is natural selection. If a child develops with pathologies, his development simply stops.

You need to pay attention to the fact that if miscarriage occurs not for the first time, this is a serious reason for worry. After the second premature termination of pregnancy, the couple will need to consult a specialist without fail. Subsequent pregnancy will have to take place under the supervision of doctors, and possibly in a hospital. There are several factors that must be considered in order to avoid miscarriage.

How to recognize a frozen pregnancy

Each trimester is characterized by certain changes in a woman's body, which can be either obvious or not noticeable. But sometimes it happens that certain circumstances can lead to a missed pregnancy. But doctors easily know how to determine such a pregnancy, since such a pathology has characteristic signs.

The most noticeable symptom and the most obvious is that the signs of pregnancy disappear in a woman. But do not wind yourself up too much, doctors recommend, if any disturbing signs are found, consult a gynecologist. And then, according to the results of ultrasound and examination, the doctor will make a diagnosis for you.

Symptoms of an early missed pregnancy

The beginning of pregnancy occurs as usual, without any changes. When an egg is fertilized by a sperm, it slowly descends through the fallopian tubes into the uterus, where it implants against its walls and begins to divide. All the signs of a normal pregnancy are present in a woman - nausea, vomiting, lack of menstruation and hardened breasts.

The fetus stops its vital activity imperceptibly. But the sooner you detect pregnancy, possible pathologies and changes, the more chances you have to keep the pregnancy.

With a frozen pregnancy, a woman’s toxicosis abruptly disappears, abdominal pain, but milk still flows incessantly, which is why her breasts keep growing.

Although not all girls can feel these signs. Since many women do not feel any discomfort during pregnancy, and therefore, when the fetus dies, she may not notice it.

Sometimes women who have a highly developed intuition can also feel a missed pregnancy.

When the second half of pregnancy comes, the expectant mother can feel the fetus moving. And if the stirring stops, it is worth sounding the alarm.

Well, a dangerous and alarming sign is the appearance of blood discharge and abdominal cramps.

Signs of a missed pregnancy in the early stages

The gynecologist can see the primary signs of a missed pregnancy already during a general examination of the body, according to the results of an ultrasound scan and a blood test.

Women's breasts stop hurting, the pain in the mammary glands will no longer be noticeable, she no longer experiences her swelling and heaviness. Instead, the mammary glands are soft, the nipples are not sensitive. This happens on the third or sixth day, each woman differently, after the fetus has died. This sign is quite tangible, and every woman can notice it.
No toxicosis. This is another tangible sign, when after some time of everyday nausea and gag reflexes, this symptom simply stops bothering the expectant mother, toxicosis can stop abruptly, changes in appetite can end as abruptly as they began
Sudden discharge with blood. This is a characteristic sign of an impending miscarriage, and as a rule, during such discharge, the fetus is no longer alive.
Headache. Nausea, dizziness, headache, slight fever. These signs are felt by girls only three weeks after the death of the fetus. The reason for this is that the decay products of the embryo enter the woman's bloodstream, and they cause a general feeling of malaise.
Decreased basal body temperature. By measuring body temperature before and during the first trimester, the woman noticed that the temperature does not fall below thirty-seven degrees. When, in turn, during a frozen pregnancy, it begins to decline sharply.
During the examination, the gynecologist notices that the size of the uterus does not correspond to the gestational age women. Although during a frozen pregnancy, the uterus can grow as usual, due to the fact that the membranes of the fetal egg increase. And this suggests that one examination is not enough, therefore a secondary one is carried out, and special attention is paid to painful sensations and spasms.
When is an ultrasound performed?, determine a missed pregnancy if the fetus has no heartbeat, and in terms of time its size differs significantly from what it should already be by this time. It is an ultrasound without error that will show whether everything is in order with the fetus.
You can still determine such a pregnancy by donating blood to the hCG hormone, which initially decreases, and then completely stops being released.

If you turn late, then the woman usually already complains of headache, chills, muscle pain. In this case, the woman is hospitalized, because this is the advanced stage of a missed pregnancy.

But still, only a doctor can make a diagnosis of “frozen pregnancy”, so you should not wind yourself up and worry once again.

Signs of a missed pregnancy in the later stages

The mammary glands are already much smaller, there is no more tension in them, and they have become softer.
The fetus no longer moves. Already at the eighteenth week, a woman feels weak tremors of the fetus in her stomach. Gynecologists recommend observing during this period the frequency of their movements. The norm is about ten pushes a day. And if for several days you did not notice any movements, you should consult a doctor.
The fetal heartbeat is not audible. This can be determined both with the help of ultrasound and by the gynecologist himself, but only at the twentieth week, with the help of a stethoscope. at
an ultrasound examination is performed, during which the size of the uterus, the gestational age, the fetal heartbeat and the presence of the fetus in the uterus are determined;
examination by a gynecologist on a chair;
and screening for the hormone chorionic gonadotropin, which decreases in miscarriage.

How long can you get pregnant after a missed pregnancy

To eliminate the risk of a missed pregnancy, doctors recommend eating right, taking vitamins, etc. If you have already had such a pregnancy, then when asked how long it takes to get pregnant after a frozen pregnancy, the next attempt to make it is recommended no earlier than six months later.

Full examination:

testing for infections;
Ultrasound of the small pelvis;
definition of hormonal failures;
detection of autoantibodies in a woman's body;
detection of homocysteine in the blood.

What to do if a frozen pregnancy

The fading of pregnancy is regarded by doctors as a failed miscarriage. Most often, when the diagnosis is accurately established, the gynecologist prefers to wait, because the body itself can reject the frozen fetus. If this does not happen, surgical intervention is necessary.

If a miscarriage did occur, after that it is imperative to consult a doctor, undergo additional examinations, ultrasound diagnostics, because the remains of the placenta or fetus can cause serious inflammation in the future.

How to deal with depression after a missed pregnancy

If you are faced with a frozen pregnancy, in no case do not blame yourself for this. Try not to dwell on the problem, but decide how to prevent it in the future. Do not withdraw into yourself, if necessary, seek help from a psychologist.

Rid yourself of fears and fears, believe that you will succeed. The experience of previous mothers shows that such situations are far from the end of your happy life. It all depends on your attitude to the problem and the desire to change something. Do not despair!

Even if the consequences of a missed pregnancy do not pose any potential threat to a subsequent pregnancy, doctors advise to delay the subsequent conception. Miscarriage is a great stress for the body, entailing hormonal changes. Therefore, a woman needs a complete physical and psychological recovery before she is ready to conceive.

During this time, it will be good to undergo a complete diagnosis, take tests to determine the level of hormones and the state of the thyroid gland. All existing chronic and acute infectious diseases are best treated in advance. Pay attention to your lifestyle: stop smoking and drinking alcohol, spend more time outdoors, adjust your diet. And this applies not only to the future mother, but also to the future father.

And summing up, we can say that there is hardly a doctor who will tell you a 100% way to determine a missed pregnancy at home. Therefore, if you find one of the above signs, contact a gynecologist for your own peace of mind.

Spontaneous interruption of gestation, the frequency of which is on average 20% in the population, proceeds in the form of a spontaneous (complete or incomplete) miscarriage or as a non-developing (frozen) pregnancy, that is, a failed abortion. In the structure of all miscarriages, especially in the first trimester (up to 12 weeks), the latter occupies a leading position and accounts for 40 to 80% of all miscarriages, which is 10-15% of all pregnancies.

Why does pregnancy freeze?

A non-developing pregnancy is a pregnancy in which there is a long (one week or more) delay in the uterine cavity of a dead embryo or fetus in the early stages. Termination of development can be not only in the uterine cavity, but a frozen ectopic pregnancy is also possible.

Is it possible to get pregnant again?

Yes, but two consecutive spontaneous interruptions double their risk in the future, which averages 30-38%. This prognosis is even worse compared to women who have already had a normal delivery. Given this, most experts believe that the second successive missed pregnancy is a sufficient reason to regard this condition as a habitual early termination of pregnancy.

Such couples should be included in the group at high risk of "recurrent miscarriage", a thorough examination after a miscarriage should be carried out and appropriate treatment should be recommended outside of it.

Non-developing pregnancy is regarded as a pathological symptom complex, which includes:

Lack of viability of the embryo or fetus.
Lack of response to this myometrium (pathological reactivity).
The development of disorders in the hemostasis system in the body.

This pathology is distinguished from spontaneous abortion by the absence of emptying of the uterus in an independent way.

Causes in the early stages

The immediate and main causes of missed early pregnancy are disorders and conditions grouped into 5 groups:

Congenital and acquired anatomical defects of the uterus.
Genetically and chromosomally determined anomalies in the development of the embryo.
Pathological changes in the uterine mucosa, including those associated with various chronic pathologies in women. They are characterized by the inferiority of the endometrium and the lack of its ability to provide the processes that occur during gestation.
Blood coagulation disorders.
Other reasons.

The last group mainly includes:

the presence of anti-paternal cytotoxic antibodies, antibodies against antibodies (anti-idiopathic antibodies), antibodies that block the lymphocytic reaction;
abnormal activity of natural killer cells (NK cells);
tissue incompatibility of partners (according to the HLA system).

Anatomical defects

Congenital anatomical defects that can cause miscarriage include a unicornuate, saddle-shaped or completely doubled uterus, the presence of a complete or partial intrauterine septum. This anatomical pathology of the uterus causes pregnancy disorders, as a rule, in the later stages, however, a cessation of development in the early stages can occur if a fetal egg is implanted on or near the intrauterine septum.

Acquired defects are intrauterine adhesions, most often resulting from a previous non-developing pregnancy or curettage of the uterine cavity with a curette, submucosal fibroids and isthmic-cervical insufficiency.

Miscarriage with anatomical defects is due to disorders in the implantation of the fetal egg, receptor insufficiency and insufficient blood supply to the endometrium, hormonal disorders with luteal phase deficiency, and chronic endometritis.

Genetic and chromosomal abnormalities of the embryo and trophoblast

They cause the majority (up to 80%) of pregnancy losses, including missed ones, in the first trimester. These disorders occur due to a quantitative or qualitative change in the structure of chromosomes. Quantitative changes are the result of failures:

in any period of division of eukaryotic (nuclear) cells, for example, a violation of the divergence of a paired chromosome in spermatozoa or eggs, in which monosomy or trisomy is formed;
in the process of fertilization, when the egg is fertilized by two or more spermatozoa, resulting in the formation of a polyploid embryo;
at the first mitotic divisions of a fertilized egg; if these failures occur at the first division, the development of complete tetraploidy (chromosomes are duplicated without cytoplasmic separation) is possible, which is the reason for the cessation of further development already 14-21 days after conception, and failures during subsequent divisions can lead to mosaicism.

Qualitative changes in the structure of chromosomes include translocations in one of the partners. They are one of the most common causes of miscarriage and are a type of chromosome mutation in which a portion of one chromosome is transferred to another disparate (non-homologous) chromosome. Chromosomal mutations can be in the form of:

reciprocal translocations, which consist in the mutual exchange of chromosomes with their sections, they make up half of all chromosome anomalies during missed pregnancy;
fusion of chromosomes with partial or complete loss of genetic material in the zone of short arms (Robertsonian translocations);
changes in female sex chromosomes;
duplications, deletions, inversions and other disorders.

Pathology of the uterine mucosa

The main factor in the violation of the development of the embryo and fetus from the side of the endometrium is its structural and functional changes in the form of atrophic processes and reduced receptor sensitivity to progesterone and estrogen. The most typical conditions are:

Autoimmune chronic endometritis.
Syndrome of regenerative-plastic insufficiency.

Autoimmune chronic endometritis

It is provoked by an acute or chronic viral-bacterial infection, stimulating the body's reaction in the form of local and general immunity. This leads to an increase in the synthesis of cytokines, growth factors and proteolytic enzymes. They stimulate the development of the inflammatory process and promote damage to the vascular endothelium, as well as abnormal penetration and damage of the endometrium by cells of the outer layer of the embryo (trophoblast) already in early pregnancy, as well as cell proliferation and angiogenesis.

As a result, there is a new increase in the number of cytokines and growth factors. Thus, a vicious pathological circle arises. In a typical course of gestation, the immune processes of rejection of the embryo are suppressed by the body and, in the absence of inflammation, it proceeds normally.

Syndrome of regenerative plastic insufficiency

The result of the syndrome of regenerative-plastic insufficiency of the uterine mucosa is endometriopathy, or endometrial atrophy. Dysfunction of the endometrium in half of the cases is not caused by inflammatory processes, but by the progression of this syndrome, which is the realization of tissue stress in the presence of predispositions, including genetic ones.

The syndrome is manifested by auto- and alloimmune reactions, a decrease in the secretory activity of the glandular epithelium, thinning of the endometrium, a decrease in the number of progesterone receptors, and a decrease or complete loss of receptor sensitivity to progesterone and estrogen.

The syndrome is based on adaptation in response to adverse factors while maintaining the basic functions of the endometrium. The subsequent depletion of adaptive reactions leads to the development of the stage of maladaptation, in which the processes are aimed only at the preservation of cellular and tissue structures, but no longer at their adequate functioning. In the syndrome of regenerative plastic insufficiency, chronic inflammatory and autoimmune factors are a vicious circle. Implantation of a fertilized egg in these cases is not possible without active therapy.

Blood coagulation disorders

Among them, the main ones are antiphospholipid syndrome and thrombophilia of hereditary etiology. Antiphospholipid syndrome, the causes of which are not completely clear and in which the fetus freezes after 10 weeks of gestation, refers to autoimmune and thrombophilic disorders. The main signs on the basis of which we can assume the presence of antiphospholipid syndrome:

arterial and / and venous thrombosis;
a decrease in the number of platelets and a history of hemolytic anemia;
late severe in history.

Causes of missed late pregnancy

In late gestation (in the second trimester), the main causes of fetal death are primary or secondary placental insufficiency due to infection (most often the herpes virus, chlamydia and cytomegalovirus), diabetes mellitus, hypertension, cardiovascular insufficiency with heart defects, renal failure, severe preeclampsia, uncontrolled intake of certain medications.

Mechanisms of fetal retention in the uterus

The prolonged presence in the uterus of a frozen embryo or fetus in its development is assumed to occur due to the following mechanisms:

Dense attachment of the developing placenta as a result of deep germination of chorionic villi. This may be due to:

- a high degree of activity (in terms of proliferation) of chorionic villi;
- structural and functional inferiority of the uterine mucosa at the site of implantation of a fertilized egg;
- incomplete preparation of endometrial changes in the implantation zone.

Inferiority of the immune system in relation to the reaction of rejection of immunologically foreign tissue.
Decreased contractility of the myometrium due to:

- chronic course of inflammatory processes in the uterus; as a result, insufficiency of the receptor apparatus is formed, which leads to a decrease in sensitivity to substances formed during the death of the embryo and causing a decrease in the tone of the myometrium;
- violations of enzymatic biochemical processes involved in protein metabolism;
- continuation (for some time after the death of the embryo or fetus) trophoblast production of progesterone and placental lactogen, specific trophoblastic beta-globulin, and the placenta - some peptide hormones, biogenic amines and immunosuppressive peptides that suppress uterine contractility.

Risk factors

The main risk factors for miscarriage are:

Age under 18 years old.
Pregnancy in the older and late reproductive age of a woman or / and her partner - after 30 years for primiparas and over 35 years for multiparous. The risk in older and late reproductive age is associated with the gradual extinction of natural selection processes, as well as with various disorders in the partner's reproductive system. For comparison: the risk at the age of 20 - 24 is about 9%, at the age of 30 - 40 - 40%, at the age of 45 - 75%.
Repeated episodes of miscarriage in history. The greater the number of such episodes, the worse the prognosis for subsequent conception.

In addition, chronic diseases of the female genital organs or acute and, especially, chronic extragenital diseases contribute to miscarriage.

The main ones are:

erased forms of hyperandrogenism of ovarian, adrenal or mixed etiology and ovarian hypofunction;
PCOS ();
the presence in the body of a persistent bacterial-viral infection; most often (in 52%) it is a mixed viral-bacterial infection, as well as chlamydial (in 51%), ureaplasma and fungal microflora (about 42%);
chronic inflammatory processes of the female genital organs, repeated abortions and;
acute or chronic infectious diseases, they rarely cause fetal death on their own, but lead to the development of fetopathies that contribute to fetal death under the influence of other factors;
endocrine diseases - insufficiently compensated diabetes mellitus, thyroid dysfunction, mainly hypothyroidism;
chronic renal pathology;
severe form of arterial hypertension and cardiovascular insufficiency;
various systemic connective tissue pathologies in the form of systemic lupus erythematosus, systemic scleroderma, antiphospholipid syndrome, etc.

Less significant factors include:

smoking;
alcohol and drug addiction;
certain medicines;
excessive consumption of drinks containing caffeine (strongly brewed tea, coffee and other tonic drinks);
low body mass index.

The sensitivity of the embryo or fetus to damaging factors is not the same in different periods of gestation. The shorter the term, the more vulnerable they are. The most critical periods are the 7th - 12th days, when the implantation of the fetal egg occurs, the 3rd - 8th weeks (the beginning of the development of the embryo), the 12th week (the period of placental formation) and the 20th - 24th weeks (the stage of formation of the most important fetal body systems).

In most cases, a missed pregnancy is based on any one dominant cause and several risk factors and interacting mechanisms for the development of this pathological condition. How to understand that the death of the embryo or fetus has occurred?

The main symptoms of a missed pregnancy

The peculiarity of a failed pregnancy is manifested in the disappearance of the subjective and objective signs of the latter.

How to determine a frozen pregnancy?

The cessation of nausea, increased salivation, vomiting, aversion to various odors that appeared in the first 12 weeks of the gestation period are characteristic subjective sensations during a missed pregnancy.

The retention of a dead fetus in the uterus for more than 2-6 weeks in some women (about 10%) is manifested by general weakness, dizziness, fever and chills. Periodically, pains of a cramping nature in the lower abdomen, pain in the lumbar region may appear. 2-6 weeks after the death of the fetus, bloody spotting from the genital tract periodically appears, and uterine bleeding is also possible, especially at later stages of gestation.

You can also recognize the resulting pathology by changes in the mammary glands. Three days - 1 week after the death of the fetus, the mammary glands decrease in size, their soreness decreases, engorgement stops, and they soften, and milk may appear instead of colostrum. After 25 weeks of gestation, fetal death may be accompanied by engorgement and the release of large amounts of colostrum.

You can also determine a missed pregnancy at home by measuring the basal temperature, which in the early stages remains within 37.2-37.3 ° and above. The basal temperature during a frozen pregnancy quickly returns to normal.

What tests should be taken to determine an undeveloped pregnancy?

Of some importance in a frozen pregnancy is a blood test for hCG. Human chorionic gonadotropin is a specific hormone that is synthesized by the trophoblast as early as 24 hours after implantation of a fertilized egg. In a normal course, the level of hCG by 6-10 weeks of gestation becomes maximum, after which it gradually decreases.

In case of termination of the development of the embryo or fetus, its indicator decreases from 3 to 9 times. That is, it becomes below the norm corresponding to the gestational age, at 6-12 weeks by 8.6 times, at 13-26 weeks - by 3.3 times, at 28-30 weeks - by 2, 7 times. However, the diagnostic value of hCG analysis is low. It increases slightly with repeated analyzes.

Determination of an increase in the content of hCG in the urine is the basis of rapid testing at home.

With a frozen pregnancy, is the test positive or negative?

The express test does not show the concentration, but only an increase in the concentration of the hormone in the urine. With the early termination of embryonic development, the express analysis becomes negative after 2-3 days, but at later dates, chorionic gonadotropin is excreted from the blood rather slowly, and the test can remain positive for a long time (even up to 1 month).

Other tests are sometimes performed - for alpha-fetoprotein, the concentration of which increases from 1.5 to 4 times by the 3rd - 4th day after the death of the fetus, and for trophoblastic-beta 1-glycoprotein. The concentration of the latter in the blood of a woman immediately after the death of the fetal egg decreases, and if it is retained in the uterine cavity for 3 weeks, it decreases by 4-8 times.

Can there be toxicosis with a frozen pregnancy?

Preeclampsia (toxicosis) is a syndrome of multiple organ failure that develops during the gestational period. It is caused by a mismatch between the mother's body's ability to adequately meet the needs arising from the development of the fetus.

The development of early and late gestosis is possible only during pregnancy. If one already exists, then with the death of the fetus, that is, with the cessation of gestation, the cause of preeclampsia also disappears, the symptoms of which gradually decrease and disappear.

However, all these signs are not sufficiently reliable. Convincing signs of a missed pregnancy are the cessation of fetal movements or their absence at the expected time, as well as data from physical and instrumental studies.

Physical examinations that are of relative importance for diagnosis include a vaginal examination, in which they are noted with the death of the fetus for periods less than 12 and up to 20 weeks:

a decrease in the severity of cyanosis of the mucous membrane 4-5 weeks after the cessation of fetal development with a gestation period of 16 weeks and after 4-8 weeks - at later dates;
opening of the cervical canal up to 1-1.5 cm in nulliparous women and up to 3 cm or more in women who have given birth;
thick discharge from the cervical canal in the form of brownish mucus.

More convincing are the cessation of uterine enlargement or the lag of its size from the estimated gestational age. This is observed in the early stages due to the fact that the fetal egg is resorbed, and in the long term - due to the absorption of amniotic fluid into the mother's blood and a decrease in the size of the fetus as a result of its maceration.

The most informative diagnostic method that allows diagnosing pathology even before the appearance of subjective sensations of a woman is transvaginal ultrasound, which is informative from the 18th day after conception, especially in combination with a blood test for the level of hCG in the blood.

What is the danger of late diagnosis of pathology?

The consequences of a missed pregnancy can be severe, especially in cases of prolonged (from 2-4 weeks or longer) stay of the dead embryo in the uterine cavity. It is possible to develop an infection and a septic condition, coagulopathic disorders (DIC) and bleeding, etc. They are not only a negative factor in predicting the further reproductive function of a woman, the health of her offspring and the preservation of the family.

Complications pose a threat to the health of the woman herself and a serious danger to her life. The severity and frequency of complications and their consequences increase with increasing gestational age and the duration of the presence in the uterus of a dead fetal egg, embryo or fetus.

Treatment after a frozen pregnancy

Making a diagnosis requires immediate preparation of the woman and active treatment of the life-threatening condition. The point of treatment is to carefully terminate an undeveloped pregnancy by evacuating a dead ovum and to conduct anti-inflammatory therapy aimed at eliminating concomitant endometritis.

For these purposes, instrumental dilation of the cervix and vacuum aspiration, or vacuum cleaning of the uterus, are used for missed pregnancy for up to 12 weeks. It is also possible to prepare the cervix with a hydrophilic dilator or with synthetic prostaglandin analogs, followed by vacuum aspiration. The latter is also recommended in cases where the traditional instrumental surgical method of scraping the walls and fundus of the uterus (curettage) and evacuating the remains of conception is used. However, routine curettage curettage during a missed pregnancy leads to structural and functional inferiority of the endometrium in the implantation zone.

The best way to empty the uterine cavity up to 6 weeks of the gestational period (in some regions of Russia - up to 9 weeks, abroad - up to 12 weeks) is a medical abortion. For this purpose, various schemes are used for oral and vaginal administration of the synthetic steroid antiprogestogen drug Mifepristone and the synthetic analogue of prostaglandin “E 1 ” Misoprostol. This method is more than 80% effective, but it can be used in the absence of signs of infection, bleeding disorders, severe anemia, liver or kidney failure.

After applying any method, it is necessary to conduct a control or echographic study. Interruption in the later stages (in the second trimester - from 13 to 22 weeks) is carried out mainly through one of the methods that stimulate labor:

Intra-amniotic (into the cavity of the fetal bladder) or extra-amniotic administration of a hypertonic (20%) solution of sodium chloride or (if there are contraindications to its use - arterial hypertension, renal pathology) glucose through the cervix (transcervical access) or with a needle inserted through the anterior abdominal wall (transabdominal access). The intraamnial method is the most optimal and effective.
Oral oral antiprogestogen (Mifepristone) in appropriate doses or (if no effect) prostaglandin (Misoprostol) or intravaginal injection with repeated oral doses, or a combination of Mifepristone and Misoprostol.
Intra- or extramniotic administration of Dinoprost, which belongs to the F 2 -alpha prostaglandins and has a pronounced stimulating effect on the myometrium.
Imposing after the expansion of the cervical canal on the presenting department of the fetal bladder (after its opening) of the load with the help of special forceps. This method is used in case of contraindications for previous methods or in the absence of the effect of their use.

The principles of further treatment are to prescribe:

or progesterone preparations in order to restore the structure, secretory function and receptive activity of the endometrium;
broad-spectrum antibiotics and antibacterial agents (protected semi-synthetic penicillins, cephalosporins, macrolides, imidazole derivatives), but only if a causative factor of chronic endometritis or its exacerbation is identified;
anti-inflammatory therapy, including non-steroidal anti-inflammatory drugs;
drugs that contribute to the correction of the immune state of the body;
means of correcting vaginal microbiocenosis;
drugs and physiotherapy techniques that help restore microcirculation, normalize tissue regeneration, metabolic processes in them and local immunity.

When can I get pregnant after a missed pregnancy?

The term of its resolution is considered the first day of a new menstrual cycle. After it, menstruation is restored at the appropriate time, but sometimes they can occur after 1.5 months. However, the next pregnancy planning must be recommended no earlier than six months later.

This is the minimum period during which, during the appropriate treatment, there is a recovery after those changes and disorders (hormonal changes and psychological disorders, endometritis, etc.) that occurred as a result of a pathological condition.

For the purpose of protection, it is recommended to take combined oral contraceptives (“Regulon”), as well as their combination with the active form of folic acid - calcium levomefolate (“Yarina Plus” and “Jess Plus”). These drugs, in addition to the contraceptive effect, have other positive properties in terms of the rehabilitation of the endometrial layer of the uterus after the resolution of an undeveloped pregnancy:

reduce the risk of developing infectious inflammatory processes in the internal genital organs by increasing the viscosity of the mucus of the cervical canal, reducing the diameter and increasing the length of the cervix, reduce blood loss during menstruation, eliminate incoordination of contractions of the myometrium and fallopian tubes;
contribute to a more intensive production of factors (immunoglobulins "A" and "G") of local immunity, which significantly reduces the risk of developing aseptic inflammation;
the very prevention of pregnancy provides the body with time to restore plastic and energy sources.

The absence of conception within six months provides a chance for the mother's body in terms of full preparation for a more successful implementation of the next attempt at motherhood.

Prevention

The elimination of the above risk factors, the treatment of gynecological infectious diseases and inflammatory processes, the restoration of the eubiosis of the vaginal environment, hormonal correction, as well as the correction of the immune state of the body and chronic extragenital somatic pathology, allow to prevent a missed pregnancy by excluding, if possible, the above risk factors.

In order to correct the ratio of sex hormones in case of their imbalance towards progesterone deficiency, women with habitual miscarriage and when planning the latter are recommended Duphaston, which has a progestogenic effect. Its active ingredient is dydrogesterone.

With timely rehabilitation, it is possible to prevent subsequent miscarriage in 67% of women, otherwise this figure is only no more than 18%.

All women who have had at least one missed pregnancy need a comprehensive examination, preferably with the inclusion of medical genetic counseling, especially in case of repeated miscarriage, treatment and appropriate subsequent preconception preparation for a planned pregnancy.

A missed pregnancy is a condition in which the fetus inside the mother dies, and the pregnancy stops developing. Most often, this happens asymptomatically and a woman finds out about her diagnosis only with a planned ultrasound.

Why does pregnancy stop?

The life of the fetus, especially in the first 12 weeks, is very fragile and any, even minor factors can cut it off: air travel, prolonged exposure to the sun, stress, poor ecology, etc. Doctors name several of the most likely causes of pregnancy fading in the early stages:

congenital pathologies and malformations in the fetus- doctors consider this the most common reason and call it "natural selection": nature interrupts the development of a "poor-quality" fetal egg and thus prevents the birth of a child with genetic abnormalities;
the woman has an infectious disease(influenza, herpes, rubella, chlamydia, toxoplasmosis, etc.) is the second most common cause;
consequences of rhesus conflict between mother and child or hormonal disorders.

In addition, the risk of fetal death in the early stages significantly increases the bad habits of the expectant mother: smoking, alcohol, and, especially, drugs.

The fetus died, the pregnancy no longer develops, and the woman may not suspect anything. In the early stages, the signs of a missed pregnancy at home are difficult to recognize. But women, especially those who have already experienced a terrible diagnosis, carefully control the course of their new pregnancy. There are only indirect symptoms by which a pregnant woman may suspect something is amiss.

Causeless decrease or complete disappearance of toxicosis can be seen, but not always. If the pregnant woman suffered from severe toxicosis, then his disappearance, of course, will not go unnoticed. And if the signs of toxicosis were weak, then little attention is paid to this factor.

Breast softening may indicate intrauterine fading of the fetus. In almost all pregnant women, immediately after conception, the mammary glands swell and become painful. When the fetus dies, the chest relaxes. But you should not immediately panic when this symptom occurs. For 9 months of pregnancy, according to many women, the chest can relax and tighten several times. This is most likely due to hormonal changes during pregnancy.

Decrease in basal temperature may cause a missed pregnancy. This happens due to a decrease in the level of progesterone, a hormone that supports pregnancy. Basal temperature should be measured in the morning in the rectum, as soon as you wake up. Prepare the thermometer in the evening, as it is important to be motionless for at least 6 hours before and during measurements. But this method is also an unreliable indicator of pregnancy fading, as other factors can also affect the value of basal temperature: taking hormonal drugs, sex, illness with fever, etc.

Bloody discharge and pulling pains in the lower abdomen do not always happen with a frozen pregnancy. This is its difference from a miscarriage. But in any case, this is a very alarming sign during pregnancy, requiring immediate medical attention.

Mismatch between the size of the uterus and the gestational age a gynecologist may notice during a vaginal examination, but this fact does not always indicate precisely the fading of pregnancy. In this case, the dynamics of the development of pregnancy is monitored. And if in 2-3 weeks the uterus has not grown, but, on the contrary, has become smaller and softer, then the doctor can make a preliminary diagnosis of “missed pregnancy” and send the patient for an analysis of the hCG hormone and ultrasound to confirm it.

Decreased hCG hormone H - a regular pregnancy test can respond to this indicator (will show a negative result). But it is better to hand over the special analysis.

Ultrasound indications- this is the most reliable and reliable indicator confirming the presence of a missed pregnancy. Mistakes occur only in the early stages of pregnancy, when the doctor may mistake for an empty fetal egg that develops normally. In this case, if the patient's condition does not inspire concern, you can wait up to 6-7 weeks and repeat the ultrasound. At this time, an experienced doctor with the help of modern equipment already sees the embryo well and hears its heartbeat.

What's next?

If the terrible diagnosis is nevertheless confirmed, then two scenarios are possible.

First. Doctors are waiting for a spontaneous miscarriage, while monitoring the woman's health. They can help stimulate a miscarriage with the introduction of special drugs. Such expectant tactics are most often followed by foreign doctors.

Second. After confirming the diagnosis, the woman is immediately sent to clean the uterus, without waiting for a miscarriage and possible negative consequences from it. A long stay in the uterus of a dead fetus can cause an inflammatory process. This option for terminating a missed pregnancy is used by Russian doctors.

Doctors recommend planning the next pregnancy after a frozen pregnancy no earlier than six months later, and preferably a year later. During this time, it is advisable for both parents to take tests and undergo an examination to identify the cause of the fetal fading.

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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 an ultrasound scan 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 enlargement 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 the 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.