• Frozen or undeveloped pregnancy - Causes, symptoms and treatment. MF.

    A dead or undeveloped pregnancy is the cessation of fetal development and death. Most often, a pregnant woman faces a similar problem in the first trimester of pregnancy( up to 14 weeks).Much less often the frozen pregnancy occurs in later terms.

    A non-developing pregnancy is a type of miscarriage, just like a miscarriage.

    How does pregnancy stop?

    Initially, as with normal pregnancy, implantation of the embryo into the uterus takes place. But for some reason the development of the fetus stops and the fetus dies. But, despite this, interruption of pregnancy does not occur, as with a normal miscarriage, that is, the fetal egg does not exfoliate and does not leave the uterus. Therefore, the uterus continues to grow, the woman still feels "pregnant" and the level of hCG( human chorionic gonadropin) - the pregnancy hormone - while not growing, but slowly declining. But sooner or later there is an abruption of the placenta and the fetal egg and only then symptoms of a frozen pregnancy appear.

    What can lead to an undeveloped pregnancy?

    First, because of hormonal imbalance, or rather, due to a lack of progesterone or because of an excess of androgens, in particular, testosterone.

    The second possible cause of frozen pregnancy is the genetic abnormality of the fetus that is incompatible with life. According to most researchers, nature thus conducts natural selection, timely eliminating an unviable fetus.

    The third most common cause is infections. During pregnancy, immunity weakens, which serves as a favorable background for exacerbation of infectious diseases. The most dangerous are sexual infections( gonorrhea, chlamydia, ureaplasmosis and mycoplasmosis) and TORCH infections( toxoplasmosis, rubella, herpes, cytomegalovirus infection).

    Increasingly, the cause of undeveloped pregnancy and miscarriages is the presence of a pregnant APS.

    Other provoking factors include pregnancy after in vitro fertilization;
    stresses and a sharp change of climate - long distance flights;
    smoking and drinking alcohol,
    age of the pregnant over 35 years.

    Symptoms of a dead pregnancy

    The symptoms of a stiff pregnancy are almost identical to those of a miscarriage. With detachment of the fetal egg appear cramping pains in the lower abdomen, bloody discharge from the genital tract.

    A woman can pay attention to the disappearance of pregnancy symptoms: toxemia( if, of course, he was), tenderness of the mammary glands and so on.

    If a frozen pregnancy occurred at a later date, then one of the terrible signals about the occurrence of pathology will be the absence of fetal movement.

    However, even in the presence of these symptoms, it is quite difficult to say whether there is a frozen pregnancy or not, so for any described symptoms, a gynecologist's consultation is necessary. In the presence of blood secretions and lack of fetal movement, a doctor's consultation is necessary in an emergency.

    Diagnosis of a dead pregnancy

    Examination includes examination of a gynecologist, ultrasound of the pelvic organs and a blood test for hCG in dynamics. Based on these studies can be reliably diagnosed frozen pregnancy.

    When examined on an armchair in all pregnant women with an undeveloped pregnancy, there is a discrepancy between the size of the uterus and the term of pregnancy, that is, the uterus is smaller than it should be.

    According to ultrasound, the size of the embryo is less than the due gestation period. He does not have a heartbeat. When ultrasound is also possible to identify anembrion - a kind of undeveloped pregnancy, when the fetal egg is empty, without the embryo.

    The level of hCG, as has already been said, does not grow with a stagnant pregnancy and lags far behind the hCG in normal pregnancy. To better assess the dynamics of hCG in the blood, it is advisable to take the test two times at intervals of 48 hours.

    Interruption of the frozen pregnancy

    Unfortunately, it is impossible to keep a frozen pregnancy and the pregnancy is interrupted in any case. The tactics of the doctor will depend on the specific case.

    In most cases, they begin with expectant tactics. That is, after the fetus dies, the hCG level falls, the uterus contracts and spontaneous abortion occurs, ie the fetal egg leaves the uterus itself.

    The second method is the interruption of pregnancy with medications. This method is used if the gestation period is less than 8 weeks. For medication interruption, progesterone antagonists( Mifepristone or Mifegin) with prostaglandin E2 analogues( misoprostol, Saitotec) are used. After a few hours, medications develop and a spontaneous miscarriage occurs.

    Also used surgical treatment, which is a scraping of the uterine cavity with the removal of the fetal egg. The resulting scraping is sent to a histological and cytogenetic study of the tissues of the fetal egg. After scraping, intravenously, a hormone is applied that reduces the uterus( Oxytocin) and prescribes antibiotics to prevent infectious complications.

    After a week or two after scraping, a small pelvic ultrasound check is done to see if there are any remains of the fetal egg in the uterus.

    All women who have been diagnosed with an undeveloped pregnancy, after treatment, that is, after miscarriage or curettage, are recommended for examination by a gynecologist to find out the cause of the frozen pregnancy, otherwise the subsequent pregnancy may also be undeveloped.

    The complex of examination after a dead pregnancy includes:

    - cytogenetic and histological examination of the fetal tissues, which is performed after scraping and with this result a woman should consult her gynecologist;
    - PCR diagnosis for urogenital infections;
    - smear on the flora;
    - blood test for TORCH infection;
    - blood test for hormones that affect conception and gestation( LH, FSH, prolactin, estradiol, progesterone, testosterone androgens and DHEA, 17-hydroxyprogesterone, cortisol. If necessary, examine thyroid hormones( TTG, T4, T3);
    - ultrasound of the pelvic organs,
    - blood coagulogram,
    - blood test for antibodies to phospholipids and chorionic gonadotropin

    Based on the results, the doctor prescribes treatment. After undeveloped pregnancy, it is recommended to be protected from pregnancy within 3- 6 months for examination, treatment and recovery of the body. As a rule, oral contraceptives are prescribed for protection( Janine, Jess, Jarina etc.)

    In most cases, an undeveloped pregnancy is not a sentence and after that a woman can safely become pregnant and give birth

    Complications of a suspended pregnancy

    Possible complications of an undeveloped pregnancy are associated with a prolonged finding of the deceased fetus in the uterine cavity. This can lead to chorionamnionitis, that is, to infection of the membranes and to endometritis-inflammation of the uterine mucosa. If the frozen pregnancy occurred later, there is a risk of maceration of the fetus, that is, the decomposition of the deceased fetus, which can lead to serious complications, such as peritonitis or sepsis.

    Preventing a stiff pregnancy:

    - a healthy lifestyle, rejection of bad habits, regular exercise;
    - examination by a gynecologist before planning pregnancy and timely treatment of all infections and hormonal disorders;
    - taking folic acid and vitamin E during pregnancy planning and in the first trimester until 12-14 weeks of pregnancy.

    Questions and Answers.

    1. When will the menstrual period begin after scraping for a frozen pregnancy?
    After 25-60 days after curettage should come monthly.

    2. I was scraped a month ago. The gynecologist has appointed or nominated for 6 months oral contraceptives, but I do not wish them to drink. What will advise?
    Oral contraceptives have a curative effect, so they are often prescribed. It is temporary possible to use barrier contraception, but in any case it is your doctor who decides on the basis of tests.

    3. How many days after curettage can there be bloody discharge?
    Up to 10-14 days.

    4. What are my chances of a normal pregnancy if there was a frozen pregnancy before?
    Same as in healthy women, if the frozen pregnancy was only once.

    5. I drink oral contraceptives. Can I take tests for hormones?
    You can not. It does not make any sense.

    6. At what time of pregnancy does the fetal heartbeat on ultrasound clearly show?
    At the 6th week of pregnancy.

    7. Can an undeveloped pregnancy develop if it is often done by ultrasound?
    No, it can not.

    8. What kind of ultrasound should be done on a short term if there is a suspicion of a frozen pregnancy?
    In the early stages of more informative ultrasound with a vaginal sensor.

    9. I have an HCG that matches the deadline, and ultrasound is said to indicate that the pregnancy is undeveloped. Whom to believe?
    Watching what period of pregnancy. Up to 6 weeks of pregnancy, heartbeat is not always visible on ultrasound. But it happens that pregnancy "pauses", which is clearly visible on ultrasound after 6 weeks, and hCG still does not have time to decrease.

    Obstetrician-gynecologist, Ph. D.Christina Frambos