That it is necessary to know about the stood pregnancy how to reduce probability of not incubation of a fruit - the doctor of medical sciences, professor Igor Makarov tells.
At not developing pregnancy which is called still “the stood pregnancy“ the death of an embryo / fruit occurs, but there are no clinical signs of a spontaneous abortion at the same time.
of the Reason for not developing pregnancy are very various
of the Reason for not developing pregnancy. So, the stop of development of an embryo / fruit can be caused by inflammatory process as a result of action of various microorganisms. Most often activators of an inflammation are: streptococci, staphylococcus, colibacillus, klebsiyella, rubella virus, cytomegalovirus, virus of a simple gerepes, Koksaki`s virus, mycoplasmas, hlamidiya, treponema, mikobakteriya, toxoplasma, plasmodiums, mushrooms (milkwoman). Chronic infectious diseases at the woman most often directly do not lead of
to pre-natal death of a fruit, but cause the certain violations promoting it. For example, as a result of direct influence of an infectious factor at a fruit heart disease which interferes with its further normal development is formed. However not always and not any infection leads to death of an embryo. Influence of an infection at the same time depends on a way of its penetration, involvement in infection of a fruit and amniotic covers, a look and activity of the activator, quantity of the getting microorganisms, duration of a disease of mother, activity of protective opportunities of an organism and other factors.
Microorganisms can get into a uterus from underlying departments of reproductive system, infecting amniotic waters which are swallowed then by a fruit. The infection can extend also on amniotic covers, and further to a fruit, causing damages of his internals that, in turn, and is the reason of his death. The infection can get to a fruit and from the chronic centers of an inflammation in uterine tubes and in ovaries.
the Death of an embryo / fruit can be caused by violation of immune relationship, in view of that fetal egg is half alien for a maternal organism. At the same time the rejection reactions directed to defeat of fetal egg and removal it from a uterus are activated. Not developing pregnancy can be caused by various chromosomal violations : in first 6 - 7 weeks of pregnancy chromosomal changes are available in of 60 - 75% cases of spontaneous interruption of pregnancy, in of 12 - 17 weeks - in of 20 - 25%, in of 17 - 28 weeks - for of 2 - 7%. With age the probability of emergence of chromosomal violations increases. Are the reasons of development of chromosomal violations as well adverse external factors. A stop of growth and development of an embryo / fruit the trombotichesky complications caused by genetic defects of system of fibrillation at the pregnant woman can cause . Among them are the most widespread: factor mutation the V Leiden, G202110A prothrombin mutation, metiltetragidrofolatreduktaza mutation, polymorphism of a gene of the activator of a plazminogen, polymorphism of trombotsitarny receptors.
of Violation of the curtailing system of blood , caused by an anti-phospholipidic syndrome, also determine adverse development of an embryo / fruit. In early terms of pregnancy the role of the direct damaging impact of anti-phospholipidic antibodies on structures of fetal egg with the subsequent spontaneous interruption of pregnancy is not excluded. At this pathology process of implantation of fetal egg is broken. Besides, at an anti-phospholipidic syndrome reduction of formation of vessels of a placenta and decrease in its function is observed that can become the reason for not developing pregnancy. Other cause of infringement of development of an embryo and a placenta at an anti-phospholipidic syndrome - a trombirovaniye and damage matochno - placentary vessels.
hormonal changes distinguish to
From the reasons of not incubation of pregnancy as well . Violation of education and decrease in function of a yellow body in an ovary leads to reduction of progesterone and defective preparation of a uterus for implantation of fetal egg. In this regard formation matochno - placentary blood circulation is broken that involves reduction of blood supply of an embryo / fruit, and his death. Quite often similar violations take place at excess accumulation in an organism of the woman of male sex hormones (the Matte syndrome - Leventalya, an adrenogenital syndrome), at the lowered or increased function of a thyroid gland.
The pregnancy term is less than
, the sensitivity of an embryo / fruit to action of the damaging factors is higher. However it decreases unevenly throughout pre-natal development. Allocate the critical periods during pregnancy in which fetal egg, the embryo, a fruit are especially vulnerable for adverse effects: the period of implantation (7 - 12 day), the period an embryogenesis (3 - 8 week), the period of formation of a placenta (till 12 weeks), the period of formation of the major functional systems of a fruit (20 - 24 weeks).
a number of consecutive violations, characteristic of not developing pregnancy : decrease and the termination matochno - placentary blood circulation against defeat of structures of a placenta; the termination matochno - placentary blood circulation; the violation of structure of an inside layer of a uterus (endometriya) caused by presence of the dead of elements of fetal egg at a uterus cavity.
Clinical signs of not developing pregnancy can be extremely poor against the termination of increase in the sizes of a uterus and their discrepancy to pregnancy term. However the uterus can be and the normal sizes, can be reduced, and can even be increased in case of filling by its blood at an otsloyka of fetal egg.
Some time after death of an embryo / fruit the patient can feel
as the pregnant woman. However eventually subjective signs of pregnancy gradually disappear. The smearing bloody allocations from a genital tract and spastic belly-aches are periodically noted. The Horionichesky gonadotrophin, as a rule, is in the woman`s blood at extremely low level or even completely is absent.
Diagnostics of not developing pregnancy
Most authentically can reveal not developing pregnancy by results of ultrasonic research in the absence of heartbeat of a fruit. One of the most widespread options of not developing pregnancy is the anembrioniya, i.e. lack of an embryo in a cavity of fetal egg after 5 - 6 weeks of pregnancy. At the same time fetal egg has the smaller sizes, than it is necessary, and the embryo is not visualized.
fetal egg by the sizes corresponds to
At other options of not developing pregnancy according to ultrasonic research or lags behind in the development, the embryo can be visualized, but without heartbeat. Quite often the retrokhorialny hematoma which represents a blood congestion in the place of an otsloyka of fetal egg from a uterus wall can come to light.
visualization of an embryo is impossible
At longer stay of the dead of an embryo in a uterus, signs of its activity are absent. The sizes of a uterus lag behind pregnancy term, deformation of fetal egg with indistinct contours is noted.
Removal of the died fetal egg
the Death of an embryo / fruit is not always followed by its spontaneous exile from a uterus. Cases when the died fetal egg is late in a uterus for vaguely long time are often observed. Can be the cause of such delay: primary dense attachment of fetal egg to a uterus wall during implantation, inferiority of reactions of immune rejection of the died fetal egg, decrease in sokratitelny activity of a uterus.
When finding of the died embryo in a uterus more than 4 weeks elements of disintegration of fetal egg get to a maternal blood-groove that can become the reason of massive bleeding in pregnancy interruption attempt. Therefore before a scraping of a uterus it is necessary to execute researches of a condition of the curtailing system of blood and, if necessary, to carry out the corresponding treatment.
(carrying out lechebno - the preventive actions directed to decrease in risk of development of possible complications) needs to interrupt with
After careful inspection and the corresponding training of the woman the stood pregnancy. For this purpose carry out tool or medicamentous expansion of a neck of a uterus and tool removal of contents of a uterus. Perhaps also application of special medicamentous means for not expeditious removal of fetal egg from a uterus. Directly during abortion or right after its end carrying out ultrasonic scanning is necessary to be convinced of full removal of parts of a fruit and placenta. After removal of fetal egg at not developing pregnancy, irrespective of the chosen interruption method, carrying out anti-inflammatory treatment is expedient.
In each case at not developing pregnancy needs profound inspection for identification of the possible reasons of interruption of pregnancy with the subsequent their elimination or weakening of action.
How to reduce probability of death of an embryo?
For reduction of probability of action of the possible damaging factors by the course of pregnancy needs to conduct screening examination the patients planning pregnancy and also women in early terms of pregnancy on an urogenital infection. Important also carrying out the physician - genetic consultation for the purpose of identification of groups of high risk on congenital and hereditary pathology. In the presence of the endocrine reasons of not incubation it is necessary to pick up the corresponding corrective hormonal therapy.
Important is also identification of various autoimmune violations and their correction. Repeated pregnancy is possible at elimination of the established embryo / fruit causes of death, and after carrying out necessary treatment. At the pregnancy which came again conduct ultrasonic research, definition in blood of markers of possible violations of development of a fruit, including: α - fetoprotein, a horionichesky gonadotrophin, RARR - And the test in the most informative terms. According to indications carry out also invasive prenatal diagnostitka, including a biopsy of a horion, amniotsentez or kordotsentez for definition chromosomal and a number of monogenic diseases of a fruit. Besides, carry out lechebno - preventive actions, directed to elimination of infectious process, carry out specific anti-inflammatory therapy in combination with immunoproofreaders, correction of violations of the curtailing system of blood and prevention of placentary insufficiency of c 14 - 16 weeks of pregnancy.