Not developing pregnancy of
Unfortunately, situations when the come pregnancy at some stage stops the development are frequent and is interrupted. The pre-natal death of an embryo at early stages of development (till 28 weeks) is called not developing pregnancy. Most often it occurs in the first trimester - till 12 weeks. Of course, it is difficult for the woman who is adjusted on motherhood to endure loss of the child - even if on very early term of pregnancy. However, realizing all dramatic nature of this situation, we will not concern its psychological aspects yet and we will concentrate on aspects medical - first of all in order that those who were comprehended by such trouble had an opportunity objectively to estimate the condition, to learn about its reasons and to take care whenever possible beforehand of that it did not repeat.
of the Reason for not developing pregnancy are various
of the Reason for not developing pregnancy, but in the first trimester genetic, infectious, endocrine and autoimmune factors have the greatest value. the Genetic factor
in half of cases pregnancy is interrupted by
from - for chromosomal violations at formation of an embryo. It is known that future kid begins the development after merge of two gametes - female (ovum) and man`s (spermatozoon). Each of these cages has to contain a half set of chromosomes (that is 23), and as a result of association of genetic material the zygote (germ) with a totality of chromosomes turns out (46). In case fertilization of an ovum for any reason happened two or three spermatozoa, the zygote with the set of chromosomes by quantity exceeding norm is formed: 69 or 92 instead of 46. There are more often situations when as a result of violation of an ovogenesis (maturing of an ovum) or a spermatogenesis (formation of mature spermatozoa) there are cages with the lost or excess chromosome. The chronic stress, smoking, the use of drugs, alcohol, ecologically adverse situations, and also internal factors can be the reasons of it: existence in an organism of mother or the father of genes - small sites of chromosomes, - the chromosomes contributing to not divergence in the course of formation of gametes. And when genetically defective germ is formed, under laws of natural selection the organism of mother tries to get rid of it. the Infectious factor
Second on frequency is the reason of not incubation of pregnancy of early terms
an infection which can be both sharp, and chronic. Matters also virus 1 (a cytomegalovirus, a virus of simple herpes, Koksaki`s viruses And yes In, enterovirusa), and bacterial 2 (hlamidiya, mycoplasmas, ureaplasmas, streptococci, staphylococcus, gonokokk) infections. A certain part in infection is assigned to a fungal infection and a bacterial vaginosis. Three ways of infection of fetal egg are possible:
- in the presence at the woman of chronic inflammatory process of a mucous cavity of a uterus (endometritis) microbes get in the contact way on fetal egg. Besides, at a chronic endometritis also uterus receptors - the structures perceiving influence of biologically active agents, including hormones, and itself mucous since there is no due preparation it to implantation process (introduction of fetal egg) suffer, fetal egg “is badly attached“ to a uterus and easily torn away.
- At a bacterial vaginosis, fungal damage of a vagina and other inflammations of a vagina microorganisms are capable to get through a neck of a uterus into a uterus cavity, to reach the lower pole of fetal egg and to infect him. Further the infection passes to amniotic waters and an embryo. In such situation pregnancy interruption most often begins with a rupture of a fetal bubble and an otkhozhdeniye of waters.
- At a sharp viral infection, even at banal ORZ, microbes with current of blood can get through a placentary barrier to the kid. Here first of all suffers horion (placenta) which functioning is broken, delivery of oxygen and nutrients to a fruit worsens.
If infection happens on early terms of pregnancy, the embryo ceases to develop and perishes. On later terms the fruit birth with a pre-natal infection is possible.
the Endocrine factor
Among pathological conditions of endocrine system which can become the pregnancy not incubation reason - a giperandrogeniye (the increased amount of male sex hormones), a giperprolaktinemiya (increase of amount of the hormone stimulating production of milk), a syndrome of polycystous ovaries (a state at which the structure of ovaries is broken: they are presented by a set of small cysts, at the same time production of sex hormones, menstrual function), dysfunction of a thyroid gland, obesity or deficiency of body weight is broken. Dysfunction of ovaries is observed at a chronic salpingooforit (an inflammation of appendages of a uterus), an endometritis (an inflammation of an internal cover of a uterus), genital endometriosis (formation of the centers an endometriya in places uncharacteristic for this purpose), infantility (an underdevelopment of an organism and genitals in particular). Anyway, at endocrine pathology there is an insufficiency of a yellow body. This education in an ovary produces hormone progesterone which prepares endometry and all organism of the woman for pregnancy approach. At its deficiency implantation of fetal egg is broken, the embryo does not receive enough nutrients from blood of mother and perishes.the Autoimmune factor
Earlier various immunological reasons of spontaneous interruption of pregnancy carried
to inexplicable. With development of science in this category of patients began to find antibodies 3 to own tissues and tissues of the kid. To this group of the reasons it is possible to refer existence of an anti-phospholipidic syndrome, antibodies to HG (to a horionichesky gonadotrophin - the hormone produced by fetal egg), immunological not compatibility of mother and child`s father. The raised tromboobrazovaniye in vessels can become a cause of death of fetal egg at this pathology; it is observed at an anti-phospholipidic syndrome when antibodies against own phospholipids which make a basis of cellular walls are developed. It leads to violation of food of a fruit and its death owing to formation of blood clots in placenta vessels. By a sad outcome can also give education in an organism of mother of protective antibodies to fruit fabrics.
| of 1 Viruses - the noncellular life forms possessing a genome (DNA and RNA), but deprived of own synthesizing device and capable to reproduction only in cages of more high-organized beings. |
2 the Bacterium is a unicell which parasitizes in live organisms, using them as the environment for reproduction.
3 Antibodies - substances which are normal produced by lymphocytes at introduction in an organism of alien substances. Contacting these alien substances, antibodies promote their destruction.
make the Diagnosis of not developing pregnancy to
at the dynamic supervision over growth of a uterus defined at vaginal research, and specify during ultrasonography. can be established to
At ultrasonic research absolutely precisely lack of heartbeat of an embryo on terms when it has to be defined. Visible manifestations (pains in the bottom of a stomach, in a waist, allocations from a genital tract) in this case can not be. After establishment of the diagnosis the patient has to be hospitalized for pregnancy interruption. Delay is life-threatening women from - for possible infectious complications and bleeding as the embryo which stopped in development is a favorable nutrient medium for development of infectious complications. The fruit which stopped in development provokes the beginning of inflammatory process in a uterus; such uterus is badly reduced, it is difficult to stop the bleeding which began at an otsloyka of fetal egg. It is good if at a scraping (removal of fetal egg or its remains) took fabric of a horion on histologic (at this research of fabric of an embryo study under a microscope) and cytogenetic (definition of a set of chromosomes) researches. It allows to specify the reason for not developing pregnancy. After a scraping of a cavity of a uterus and removal of not developing fetal egg the patient needs carrying out anti-inflammatory therapy.to
needs further complex inspection to establish the reason of pathology and to have training for the subsequent pregnancies. By the way, after a scraping it is allowed to plan pregnancy only in 6 months.we Will list to
inspections which recommend to take place for identification of the reasons for not developing pregnancy.
- First of all needs to receive results of histologic and cytogenetic researches. At histologic research of fabrics of fetal egg the changes characteristic of this or that reason of his death come to light. According to cytogenetic research it will be possible to judge a set of chromosomes of not developing embryo.
- needs to pass inspection on diseases, sexually transmitted, and other infections. In usual dab on flora from the channel of a neck of a uterus and a vagina it is possible to see mushrooms, trichomonads, to diagnose a bacterial vaginosis, and also to find indirect signs of an inflammation. In the analysis of contents of a vagina the streptococci and other microbes capable to cause an inflammation of female genitals and by that the pregnancies provoking loss come to light staphylococcus. For diagnosis of clamidiosis, ureaplasmosis, mycoplasmosis it is necessary to hand over dab from the channel of a neck of a uterus. It is better if the received material undergoes a cultural method of research (material is placed on special nutrient mediums and watch what microorganisms grow on this Wednesday; sometimes influence the grown activator different antibiotics to look what antibiotic is suitable for treatment more in this case). At suspicion on a viral infection it is necessary to take a blood test for determination of level of protective antibodies from each of infections. For a defeat exception Koksaki`s viruses And yes In, and also enterovirusam it is necessary to make the test of urine on these infections. Similar researches there has to pass also the child`s father.
- Conduct hormonal research for specification of level of the hormones influencing conception and development of pregnancy. On 5 - 7 - y the level of lyuteiniziruyushchy (LG) and follikulostimuliruyushchy (FSG) of hormones, Prolactinum, an estradiol define day of a menstrual cycle, in the second phase of a menstrual cycle determine progesterone level. Regardless of a phase of a menstrual cycle it is possible to look at levels of androgens: testosterone, a degidroepiandrosteron (DGEA), 17 - a gidrok - a siprogesterona; tireotropny hormone (TTG) and hormones of a thyroid gland (T4 and TZ), and also cortisol level. Usually doctors ask to take
- rectal temperature (temperature in a rectum). Normal rectal temperature increases in day of an ovulation - in the middle of a menstrual cycle - and remains raised to the next periods. It is necessary to know rectal temperature to specify day of an ovulation and to estimate, the yellow body of an ovary - the education supporting activity of a germ at early stages of its development how fully functions.
- Ultrasonic research (ultrasonography) several times during a menstrual cycle allows to monitor growth of a prepotent follicle which in this cycle leaves an ovum, and an endometriya (an internal cover of a uterus), to define full value of preparation an endometriya to acceptance of fetal egg. to
- In some situations needs specification of reaction of receptors an endometriya to sex hormones. For this purpose undertakes soskob from a uterus cavity, and the received material is exposed to research on existence of these receptors.
- For an exception of immunological factors of not incubation of pregnancy needs to take a blood test for definition of antibodies to phospholipids and a horionichesky gonadotrophin. And at habitual not incubation (when 2 and more pregnancies ended unsuccessfully) determine compatibility by HLA - system. These are anti-genes of the main complex of a gistosovmestimost which are responsible for functioning in an organism of alien proteins, for example at change of internals; these anti-genes matter also at pregnancy approach, a germ - half an alien organism for mother. >
- also it makes sense to Hand over li to a koagulogramm - blood test for definition of a condition of the curtailing system of blood.
- At pregnancy not incubation, especially if the karyotype (set of chromosomes) of an embryo in the previous pregnancy was pathological, it is necessary to define a karyotype of spouses, and also to make blood test for definition of the genes contributing to not divergence of chromosomes during formation of gametes. For this purpose it is necessary to take place the physician - genetic consultation in the specialized centers. Considering
- that quality of spermatozoa plays a huge role in formation of a full-fledged germ, future father needs to hand over a spermogram. Experts will define total of spermatozoa, existence of normal and pathological forms, mobility.
- Pregnancy assumes considerable loads of all organism of the woman therefore it is necessary to pass inspection at the therapist and doctors of other specialties for diagnostics and the subsequent treatment of chronic diseases of internals. Surely make the general blood test for determination of level of hemoglobin, leukocytes and platelets, biochemical blood test for evaluation of the work of kidneys and a liver, the general analysis of urine to look in what state there is an urinary system. It is also necessary to remove the electrocardiogram (electrocardiogram) because functioning is warm - vascular system during pregnancy is exposed to serious reorganization. If the doctor advises, make fluorography and pass other necessary researches.