Pregnancy after a stiff pregnancy - Causes, symptoms and treatment. MF.

You have come and developed a desired pregnancy, and suddenly something strange happened and she "froze."So they said in the women's consultation, and the doctor confirmed the ultrasound. What to do with it and what will happen next? Do not despair, every woman has a chance to endure and give birth to a baby. And you are no exception. We will tell you how to recover and competently prepare for the next pregnancy.

Fetal pregnancy is the spontaneous death of a fetus, more often in the first trimester( in the second trimester it occurs much less often).

Fetal pregnancy ends with spontaneous miscarriage, medical or surgical abortion. And spontaneous complete rejection of the fetal egg is the most favorable outcome, since there is minimal damage to the endometrium( internal mucous membrane of the uterus).

In medical abortion, to withdraw from the uterus of the fetus dead, taking drugs that enhance the muscular contraction of the uterus, the endometrium is not directly affected, but there is a risk of delaying parts of the fetus in the uterine cavity.

Surgical abortion scraping the uterine cavity and damaging the endometrium, but at the same time, it is the only way that almost completely guarantees the removal of the fetus from the uterus.

Rehabilitation after a stiff pregnancy:

- Antibacterial treatment

Antibacterial drug after scraping is prescribed in 100% of cases, it helps to avoid the development of infection and prevents many complications. Antibiotics of cephalosporins( ceftriaxone), aminoglycosides( gentamycin, netromycin), antimicrobials( metronidazole) are used. The method of administration( in injections, infusions or in tablets), the form of the drug and the duration of administration are determined by the doctor. In some cases, a combination of drugs is necessary.

- Uterine-reducing preparations

Allocations after the curettage procedure should resemble normal menstruation, unaffiliated, with no pronounced smell, gradually decreasing to 4-7 days. If the discharge stops abruptly, then this is a sign of blood stagnation in the uterus( hematomas).In the hospital for the treatment of this condition is used uterotonics( drugs that reduce the uterus): oxytocin, methylergobrevin( intramuscular or intravenously).Treatment with uterotonics is performed under ultrasound control.

Next( after discharge), you will be recommended to take a decoction of nettles dioecious( 2 teaspoons of dry herbs pour 1 cup of boiling water, let it brew and drink during the day in 4-5 receptions) or tincture of water pepper( 30 drops 3 times a day for a glasswater) for 7-14 days to prevent bleeding.

- Combined oral contraceptives( COC)

COCs are needed to restore the normal hormonal rhythm of the female reproductive system. Any pregnancy that does not end with childbirth is a great stress for the body. The drugs are used from the 2nd day after scraping, miscarriage, medical abortion in the first trimester. If the frozen pregnancy and miscarriage occurred in the second trimeter, then the medication is started on days 21-28.But before this, it is necessary to maintain sexual rest or use barrier contraception( condoms).At the moment, there is a huge number of hormonal contraceptives in pharmacies, the doctor will help you find the best option. Reception of the COC must be at least 3 cycles.
After a detailed examination, the drug can be replaced with a more specific one( for example, having an antiandrogenic effect).
If you are alarmed by hormonal contraception, then we hasten to dispel doubts, at the moment in the pharmaceutical market there are only those drugs that have been thoroughly researched.

- Psychological rehabilitation

This is an important aspect in the rehabilitation of women. It is desirable to participate in the partner, his support and care.

It is possible to take sedative phytopreparations: valerian extract 1 dragee 3 times a day, motherwort tincture 30 drops 3 times a day( or Leonor-forte 1 tablet 2 times a day).Duration of reception is determined individually.

Contrary to popular belief, do not go on a long journey and dramatically change the climatic conditions. Instead of recovery, you will spend the strength of the body on acclimatization. It is not forbidden to rest in places with a similar climate and humidity.

It will not hurt to communicate with women who survived the same problem safely overcoming this test.

Preparing for pregnancy after a dead

Preparation is carried out in three stages:

1) a complete clinical and laboratory and instrumental examination,
2) treatment of the revealed pathology,
3) evaluation of treatment effectiveness and pregnancy planning.

Survey of

1. Preparation for the next pregnancy begins with of histological( microscopic) and cytogenetic examination of tissues of the dead fetus .If you want to be given this test, be sure to tell the doctor in consultation with the doctor who is making the scraping. Histological examination can reveal some of the causes of this pathology: sexually transmitted infections, diabetes mellitus, viral infections( rubella, hepatitis), anembrion( only the fetal membranes are found in the uterus, the fetus has not developed).In any case, a histological examination will help your doctor diagnose the causes of a frozen pregnancy.

2. Gynecological examination of with smear on flora( + gonococci, Trichomonas) and cytological examination.

3. Test for infection( including sexually transmitted infections) by the ELISA and PCR method
- ureaplasma, mycoplasma, human papillomavirus
- TORCH complex
T - toxoplasmosis
O( other - other) - syphilis, HIV,chlamydia, chicken pox, hepatitis B and C
R - rubella
C - cytomegalovirus
H - herpes

4. Hormonal examination. If by the time of the hormonal examination you came up while on hormonal contraception, then further tactics are developed by your obstetrician-gynecologist. In some cases, it is possible to study with COC, sometimes it is necessary to cancel the drug and start taking it from the next cycle.

FSH( follicle-stimulating hormone) - 3-8 and 19-21 days of the menstrual cycle( strictly on an empty stomach).
LH( luteinizing hormone) - the same.
Prolactin - twice a cycle, strictly on an empty stomach, before analyzing 30 minutes of complete rest, you can not run to the laboratory and immediately pass the analysis for prolactin - there will be a false-positive result( you can take it on the same days as FSH, LH).
Estradiol - is given throughout the cycle, on an empty stomach, its peak is determined before ovulation.
Progesterone - on the 19-21 days of the cycle, on an empty stomach.
Testosterone - any day, on an empty stomach.
DEA-sulfate - any day, on an empty stomach.
Thyroid gland hormones( T4, T3, TTG, antibodies to TPO) - any day, on an empty stomach.

5. ultrasound of pelvic organs, monitoring of folliculogenesis .The ultrasound of the pelvic organs is usually performed 2 times per cycle, the thickness of the endometrium, the changes in the ovaries are estimated. Monitoring folliculogenesis is tracking the maturation of the follicle, the first ultrasound should be 4-5 days before the expected ovulation( if the cycle is regular), then you will be assigned the following visits, often enough 2-3 occurrences per cycle.

6. General blood and urine tests.

7. Biochemical blood test.

8. Coagulogram ( blood clotting assay): MNO, APTT, PTI, PTV, D-dimer, RFMC

9. Blood test for homocysteine, antibodies in phospholipids and chorionic gonadotropin .

10. Examinations of other specialists on indications( therapist, hematologist, endocrinologist, infectious disease specialist, hepatologist, rheumatologist, immunologist, etc.)

11. Specialized examination for thrombophilia according to indications( there are a lot of indicators, the cost of analyzes is high, therefore the minimum informative listanalysis should appoint a doctor-hematologist)

12. Colposcopy( examination of the cervix by a special microscope) according to the indications

13. Survey of the partner

- examination for the same infections as in the wife
-osNeg urologist
- TRUS, semen analysis, hormone research on the testimony

14. karyotyping spouses, genetics consultation .Karyotyping is a special genetic study showing the possibility of these spouses to have children( compatibility), hereditary genetic abnormalities. This study is quite expensive and it is recommended to conduct couples with habitual miscarriages, couples where the age of spouses exceeds 35 years, there are known hereditary diseases, the birth of children with genetic abnormalities.

Treatment of the revealed pathology is performed by a specialist doctor.

If there is an STI, the treating doctor will be an obstetrician-gynecologist, in case of hormonal disorders treatment is performed together with an endocrinologist, bleeding disorders require consultation of the hematologist and so on.

Planning pregnancy after a dead

When can I get pregnant after a stiff pregnancy? Planning for the next pregnancy is recommended after 6-12 months, not earlier. If you are examined as your doctor recommends, then it will not take less than 6 months. Also, the break period depends on the presence of detected infections, coagulation disorders and other conditions requiring treatment.

Preparedness for conception is determined by the sum of the factors:

- the optimal state of the endometrium by ultrasound
- the presence of ovulation
- the regular menstrual cycle
- the cure of both partners from infections, including STI
- absence of inflammation in the vagina( smear 1, 2 degreescleanliness)

Your lifestyle should include the rejection of bad habits, rational nutrition, optimal drinking regime, metered physical activity. Most such recommendations seem trivial, but how difficult it is to observe them in our business hours. Accustomed to a new way of life, you are much easier to transfer the inevitable restrictions in pregnancy( prohibition of alcohol, tobacco and energy drinks, excessive consumption of coffee, fast food and other).

Also recommended:

- if you do not have antibodies that indicate rubella, should be vaccinated with at least three months before the expected conception. Rubella, borne during pregnancy, provokes anomalies and death of the fetus and is an indication for the termination of pregnancy.

- The reception of multivitamin complexes , designed specifically for pregnant women( elevitnatal, vitrum prenatal, trimestrum, femibion ​​natalkea 1 and 2, multi-tabs perinatal).

- Preparations of folic acid .Folic acid preparations and their benefits for pregnant women have been known for a long time, but recently they are given special attention in pre-gravity training, especially if there is a loss of pregnancy, the birth of children with developmental anomalies. Folic acid prevents the development of neural tube defects in the fetus. There are a lot of drugs that include folic acid, and your doctor can help.

Folic acid preparations: folic acid, folic acid 9 months, folacin, mammapol.
Combined preparations: angiovitis, folio, folic.
Now recommends the intake of folic acid for both partners. Duration of admission is usually three months before the expected conception and up to 12 weeks of pregnancy.

Forecast of the next pregnancy

After going through all the examinations, you will know what your chances of becoming parents are. Frozen pregnancy is not a verdict at all. At the moment, the level of medicine makes it possible to know the joy of motherhood even in case of detection of hereditary diseases( thrombophilia), systemic, chronic infectious diseases and others.

The examination for the next pregnancy is carried out in accordance with the order of the Ministry of Health of Russia of November 12, 2012, No. 572n. In addition:

- medical genetic counseling,
- blood test for alpha-fetoprotein, chorionic gonadotropin after 6 weeks of pregnancy.

With competent examination, preparation and observation during pregnancy, you have every chance to safely endure and give birth to a healthy child.

Doctor Petrova A.V.