Frozen pregnancy after 12 weeks symptoms. Frozen pregnancy in early and late stages: causes and prevention

No toxicosis

The cessation of morning sickness and vomiting is a sign of frozen pregnancy in the first trimester. However, women do not always pay attention to this phenomenon, because they believe that the unpleasant symptoms have simply gone away and the body has adapted to the birth of a child. As a rule, toxicosis during a frozen pregnancy ends very abruptly. Typically, this symptom does not appear immediately after the death of the fetus, but after several days or even weeks.

Returning breasts to their pre-conception condition

The absence of swelling of the mammary glands and hyperpigmentation of the nipples is another sign of a frozen pregnancy. These changes in the chest are also drastic. In addition, signs of a frozen pregnancy include a one-time cessation of colostrum secretion, if it was secreted previously.

Decrease in basal temperature

If a pregnant woman monitors her pregnancy, then if it decreases, a frozen pregnancy can be suspected. If the fetus dies, the thermometer displays a temperature of less than 37 degrees Celsius (usually 36.4-36.9). However, based on this sign of a frozen pregnancy in the first trimester, it is impossible to accurately diagnose, since there may be an incorrect measurement or thermometer error.

Appearance of pain

The appearance of menstrual pain in the lower abdomen may indicate a missed pregnancy. However, this symptom appears after a long period of time, sometimes up to several weeks after the death of the embryo. On the contrary, nagging pain in the lower abdomen, accompanied by bloody discharge, more often speaks of.

Pathological vaginal discharge

The appearance of spotting vaginal discharge streaked with blood or red in color may be a symptom of a frozen pregnancy. But much more often, this sign indicates the onset of a spontaneous miscarriage.

Increased body temperature

If there is an infectious process in the uterus due to the disintegration of a dead fetus, a woman experiences an increase in body temperature to subfebrile values ​​(up to 38 degrees). However, if this process begins to be systemic in nature, hyperthermia to very high values ​​(40-41 degrees) and a general serious condition of the woman’s body are possible.

Frozen pregnancy is not a rare complication and can occur in a completely healthy woman, so when making this diagnosis you should not despair too much, since the probability of the next successful pregnancy and subsequent birth is 80-90%.

Lack of drowsiness, fatigue

When progesterone decreases due to fetal death, its effect on the woman’s body decreases. She loses her feeling of fatigue and drowsiness. This sign of a frozen pregnancy is extremely unreliable, however, if there are other symptoms, the woman should be examined.

No increase in hCG

During a frozen pregnancy, human chorionic gonadotropin stops increasing after the death of the fetus, and then it begins to decrease altogether. Therefore, if you suspect this pathology, you should monitor the dynamics of hCG by taking a repeat test after 2-3 days.

Gynecological examination

During the examination, the obstetrician-gynecologist measures the volume of the uterus. During a frozen pregnancy, there is a lag in size, which can serve as a diagnostic criterion for pathology. However, this sign cannot be used in the first weeks of gestation, since at this time the volume of the uterus is practically no different from its dimensions before conception.

Ultrasound

During an ultrasound examination, the doctor may detect a frozen pregnancy. This method is considered the “gold” standard for diagnosing this pathology. The absence of heartbeats and a lag in fetal size are the main symptoms of a frozen pregnancy during ultrasound.

Behavior during frozen pregnancy

If subjective symptoms of a frozen pregnancy appear, you should immediately consult a doctor for a thorough diagnosis. If this diagnosis is confirmed using a blood test for hCG and ultrasound, measures are taken to remove the embryo from the uterine cavity.

Sometimes doctors take a wait-and-see approach, the goal of which is the spontaneous onset of miscarriage. When this does not happen, or the fetus died long ago and there is a possibility of infection of the uterus, an abortion is performed. If the pregnancy is less than 8 weeks, artificial miscarriage can be used using.

At short stages of gestation, it is possible to use vacuum aspiration, the safest method of surgical abortion. In later weeks of pregnancy, cleaning the uterine cavity is used. This procedure is performed under general anesthesia, and the resulting materials are sent for histological examination.

Risk group

A frozen pregnancy can occur in any woman, even a completely healthy woman. It is usually associated with congenital abnormalities of the embryo that are incompatible with life, or due to increased emotional and physical stress. The risk group for this pathology includes those with an untreated sexually transmitted infection, as well as those who have a history of abortion or recurrent miscarriage. In addition, the chances of developing a frozen pregnancy are increased in persons with somatic diseases such as diabetes mellitus, thyroid dysfunction and thyrotoxicosis.

One of the pathologies of pregnancy development is the so-called frozen pregnancy. Doctors prefer to call this disorder a non-developing pregnancy or a failed miscarriage. But this does not change the essence: behind any of these names is hidden a condition when the fetus in the uterine cavity suddenly stops developing and dies, but remains in the woman’s womb.

There are 3 types of frozen pregnancy:

• anembryony - in this case, an embryo is not visible on ultrasound, only an empty fertilized egg;
• death of the embryo - ultrasound can establish that there was a living embryo, but it died;
• multiple pregnancy in the early stages followed by the death of one of the embryos.

This pathology is a variant of miscarriage and occurs relatively often: in 12-20% of all pregnancies.

Important: Pregnancy can freeze in almost any woman, but with age this pathology occurs more often.

In early pregnancy, almost 80% of miscarriage cases are associated with this pathology. This is not surprising, because pregnancy most often ends in the 1st trimester. Judging by the statistics, the most “dangerous” periods can be considered periods of 3-4 weeks and 8 weeks.

Causes of fading

A non-developing pregnancy does not appear out of nowhere. The following main reasons have been identified:

Additional factors that provoke miscarriage are:

• in vitro fertilization;
• woman's age over 35 years;
• bad habits of the expectant mother;
• unfavorable environment: environmental, social, or psychological;
• tumor diseases;
• chronic diseases of the cardiovascular system;
• previous abortions or cases of miscarriage.

Important: The presence in the medical history of just one of the reasons why a pregnancy may freeze is not a reason for a tragic outcome of events. As a rule, a whole causal complex leads to a non-developing pregnancy.

Symptoms of undeveloped pregnancy in the early stages

In the early stages of pregnancy, a woman cannot independently diagnose a frozen pregnancy. But there are several signs, the appearance of which should alert the expectant mother and serve as a reason for an unscheduled visit to the doctor:

• the previously existing signs of pregnancy suddenly disappear: toxicosis, drowsiness, breast swelling;
• nagging pain appears in the lower abdomen;
• discharge from the genital tract may be mixed with blood or dark mucus;
• the state of health deteriorates significantly: first the temperature rises, and dizziness and signs of poisoning appear much later, several weeks after the death of the embryo.

With a high degree of probability, the following self-diagnosis results can indicate the fading of pregnancy:

• decrease in basal temperature to 37 degrees or less;
• fading or complete disappearance of the second line on a pregnancy test.

Important: Changes in basal temperature are more reliable if a woman measured it before pregnancy and in the early stages. If the expectant mother measures her basal temperature for the first time only to exclude pregnancy fading, then the data she receives has little diagnostic value.

To confirm a non-developing pregnancy, an obstetrician-gynecologist performs a number of diagnostic procedures:

1. Analyzes the patient's medical history to identify the degree of risk of pathology.
2. Performs manual examination on a chair. Signs of fading pregnancy include: discrepancy between the size of the uterus and the expected duration of pregnancy, changes in the cervix, and the release of brown mucus.
3. An ultrasound examination with which the doctor determines the fetal heartbeat and the presence or absence of a living embryo. If the heartbeat is not heard before 8 weeks, this is an unreliable indicator of embryonic death. It is recommended to perform a repeat ultrasound in a week.
4. Laboratory blood test to determine the level of hCG (human chorionic gonadotropin). With a significant decrease in hCG, it can be said with a high degree of probability that pregnancy does not develop.

The table shows normal and abnormal levels of this hormone:

If the diagnosis of “frozen pregnancy” is confirmed

Patients diagnosed with “non-developing pregnancy” are hospitalized in the hospital. To prevent possible complications due to intoxication with decomposition products of biological materials, the entire contents of the uterus must be removed. Doctors may use one of the following options:

1. Take a wait-and-see approach in the hope that a miscarriage will occur and the uterine cavity will clear spontaneously. This development of events occurs rarely and only if the patient is not in danger and does not have the slightest signs of intoxication. In any case, doctors must constantly monitor the woman’s condition.
2. Medical abortion. It is carried out with the help of powerful hormonal drugs that provoke uterine contractions and miscarriage.
3. Vacuum aspiration or mini-abortion using vacuum suction.
4. Curettage or cleaning is the most common method that doctors resort to in case of a non-developing pregnancy. This is a surgical operation that is performed under anesthesia. As a result, the contents of the uterus are removed and the top layer of its mucous membrane is scraped out.

Important: There is no reliable non-drug way to cope with a frozen pregnancy. Seeing a doctor is a must!

Cleaning is a reliable way to avoid a large number of complications associated with the presence of decomposing biomaterials in the uterine cavity. But recovery after this operation is quite difficult:

• postoperative pain lasts several days;
• spotting bothers you for about 2 weeks;
• hospital treatment will be required for 7-10 days;
• It takes several months to restore hormonal balance in the body.

Possible complications of a frozen pregnancy

Important: With competent and timely medical care, 9 out of 10 women do not have any serious complications after a frozen pregnancy.

Consequences and prognosis after a frozen pregnancy

Sometimes a woman is not even aware of her failed pregnancy. In this case, the freezing remains unnoticed by her until serious consequences arise in the form of bleeding or the development of an extensive infectious process.

It is extremely rare that a dead embryo remains in the uterine cavity, mummifying or petrifying. And a failed mother, without even knowing it, can carry the so-called lithopedion (fossilized remains of an embryo) within herself for years.

Much more common consequences of miscarriage are the woman’s extreme stress and fear of trying to conceive again. After all, there is a mythical “horror story” that if a pregnancy freezes once, it will happen again and again. This is actually not true. For most women, a single miscarriage of pregnancy does not at all affect further successful childbearing. Even doctors diagnose “recurrent miscarriage” only if the same woman’s pregnancy has miscarried more than 2 times.

The prognosis for a frozen pregnancy, which occurred for the first time and was promptly diagnosed and treated, is positive. A huge number of women then give birth to absolutely healthy and normal children.

Important: Without appropriate treatment and rehabilitation therapy, the likelihood of successfully bearing a child in the future is reduced by approximately 4 times.

Algorithm of actions for a woman whose pregnancy has frozen early

1. It is imperative to cooperate with your doctor in searching for the probable causes of pregnancy failure. Having established the cause, you can try to avoid its destructive effect on the body during your next attempts to get pregnant.
2. It is necessary to undergo a full examination to identify hidden infections, endocrine diseases, and pathologies of the development of the pelvic organs. To do this, you need to undergo an ultrasound examination and blood tests.
3. All existing and identified diseases must be cured.
4. It is necessary to normalize the psycho-emotional state of a woman, to set her up in an optimistic mood. Indeed, in matters of successful conception and bearing a child, much depends on the internal mood of the expectant mother.

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Spontaneous termination of gestation, the frequency of which is on average 20% in the population, occurs 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 takes a leading place and accounts for 40 to 80% of all cases of miscarriages, which in relation to all pregnancies is 10-15%.

Why does pregnancy stop?

A pregnancy is called non-developing, 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. Cessation of development can occur 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 normally completed labor. Taking this into account, most experts believe that a second miscarriage in a row is a sufficient reason to regard this condition as a habitual early termination of pregnancy.

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

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

1. Lack of embryo or fetal viability.
2. Lack of reaction to this by the myometrium (pathological reactivity).
3. 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 frozen pregnancy in the early stages are disorders and conditions grouped into 5 groups:

1. Congenital and acquired anatomical defects of the uterus.
2. Genetically and chromosomally determined abnormalities of embryo development.
3. 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 support the processes occurring during gestation.
4. Disorders of the blood coagulation system.
5. Other reasons.

The last group mainly includes:

• the presence of anti-paternal cytotoxic antibodies, antibodies against antibodies (anti-idiopathic antibodies), antibodies that block the lymphocyte 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 a missed abortion include a unicornuate, saddle-shaped or completely double uterus, the presence of a complete or partial intrauterine septum. This anatomical pathology of the uterus causes pregnancy disorders, usually in the later stages, but cessation of development in the early stages can occur if the fertilized 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, submucous fibroids and isthmic-cervical insufficiency.

Miscarriage due to anatomical defects is caused by disturbances during implantation of the fertilized egg, receptor deficiency 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 are responsible for the majority (up to 80%) of pregnancy losses, including frozen ones, in the first trimester. These disorders arise due to quantitative or qualitative changes 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 sperm or eggs, in which monosomy or trisomy is formed;
• during the process of fertilization, when an egg is fertilized by two or more sperm, resulting in the formation of a polyploid embryo;
• during the first mitotic divisions of a fertilized egg; if these failures occur during the first division, complete tetraploidy may develop (chromosomes double without cytoplasmic separation), which causes the cessation of further development within 14-21 days after conception, and failures during subsequent divisions can lead to mosaicism.

Qualitative changes in chromosome structure include translocations in one of the partners. They are one of the most common causes of missed abortion and are a type of chromosome mutation in which a section 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 by their sections, they make up half of all chromosome abnormalities during frozen pregnancy;
• chromosome fusions with partial or complete loss of genetic material in the area 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 disrupting the development of the embryo and fetus on the part of the endometrium is its structural and functional changes in the form of atrophic processes and reduced receptor sensitivity to progesterone and estrogens. The most typical conditions are:

1. Autoimmune chronic endometritis.
2. Regenerative-plastic failure syndrome.

Autoimmune chronic endrometritis

Triggered by an acute or chronic viral-bacterial infection, stimulating the body's reaction in the form of local and general immunity. This leads to increased synthesis of cytokines, growth factors and proteolytic enzymes. They stimulate the development of the inflammatory process and contribute to damage to the vascular endothelium, as well as abnormal penetration and damage to 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, a new increase in the amount of cytokines and growth factors occurs. Thus, a vicious pathological circle arises. During the typical course of gestation, the immune processes of embryo rejection are suppressed by the body and, in the absence of inflammation, it proceeds normally.

Regenerative-plastic failure syndrome

The result of the syndrome of regenerative-plastic failure of the uterine mucosa is endometriopathy, or endometrial atrophy. Impaired endometrial function in half of the cases is caused not by inflammatory processes, but by the progression of this syndrome, which is the implementation 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 estrogens.

The syndrome is based on an adaptation in response to the influence of unfavorable factors while maintaining the basic functions of the endometrium. Subsequent exhaustion of adaptive reactions leads to the development of the maladaptation stage, in which processes are aimed only at preserving cellular and tissue structures, but no longer at their adequate functioning. In regenerative-plastic failure syndrome, chronic inflammatory and autoimmune factors represent a vicious circle. Implantation of a fertilized egg in these cases is impossible 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 fetal death occurs after 10 weeks of gestation, is an autoimmune and thrombophilic disorder. The main signs on the basis of which one can assume the presence of antiphospholipid syndrome:

• arterial and/or venous thrombosis;
• decreased platelet count and history of hemolytic anemia;
• late severe history.

Causes of frozen pregnancy in late stages

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

Mechanisms of fetal retention in the uterus



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

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

- 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 the 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 myometrial contractility due to:

— chronic course of inflammatory processes in the uterus; as a result of this, 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 myometrial tone;
— disturbances of enzymatic biochemical processes involved in protein metabolism;
- continuation (for some time after the death of the embryo or fetus) of trophoblast production of progesterone and placental lactogen, specific trophoblastic beta globulin, and by the placenta - some peptide hormones, biogenic amines and immunosuppressive peptides that suppress uterine contractility.

Risk factors

The main risk factors for frozen pregnancy are:

1. Age under 18 years.
2. Pregnancy at an older and late reproductive age of a woman and/or her partner - after 30 years for primiparous women and over 35 years for multiparous women. The risk in older and late reproductive ages is associated with the gradual extinction of natural selection processes, as well as with various disorders in the reproductive system of the partner. For comparison: the risk at 20-24 years of age is about 9%, at 30-40 years of age - 40%, at 45 years of age - 75%.
3. History of repeated episodes of miscarriage. 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:

• erased forms of hyperandrogenism of ovarian, adrenal or mixed etiology and ovarian hypofunction;
• PCOS();
• the presence of a persistent bacterial-viral infection in the body; most often (52%) it is a mixed viral-bacterial infection, as well as chlamydial (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 independently cause intrauterine fetal death, 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, predominantly hypothyroidism;
• chronic renal pathology;
• severe form of arterial hypertension and cardiovascular failure;
• various systemic pathologies of connective tissue in the form of systemic lupus erythematosus, systemic scleroderma, antiphospholipid syndrome, etc.

Less significant factors include:

• smoking;
• alcohol and drug addiction;
• certain medications;
• 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 varies at different periods of gestation. The shorter the term, the more vulnerable they are. The most critical periods are days 7–12, when implantation of the fertilized egg occurs, weeks 3–8 (beginning of embryo development), week 12 (placental formation period) and weeks 20–24 (formation stage of the most important fetal body systems).

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

The main symptoms of a frozen pregnancy

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

How to determine a frozen pregnancy?

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

The retention of a dead fetus in the uterus for more than 2 to 6 weeks in some women (about 10%) is manifested by general weakness, dizziness, fever and chills. Periodically, cramping pain in the lower abdomen and soreness 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 in later stages of gestation.

The resulting pathology can also be recognized by changes in the mammary glands. Three days to 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 the gestational period, fetal death may be accompanied by engorgement and the release of large amounts of colostrum.

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

What tests need to be taken to determine whether a pregnancy is not developing?

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

If the development of the embryo or fetus stops, its indicator decreases from 3 to 9 times. That is, it becomes 8.6 times lower than the norm corresponding to the gestational age at 6–12 weeks, 3.3 times at 13–26 weeks, 2 times at 28–30 weeks, 7 times. However, the diagnostic value of the hCG test is low. It increases slightly with repeated tests.

Determining the increase in hCG levels in urine is the basis of rapid testing at home.

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

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

Sometimes other tests are carried out - 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 a woman’s blood immediately after the death of the fertilized egg decreases, and when it is retained in the uterine cavity for 3 weeks, it decreases by 4-8 times.

Can there be toxicosis during a frozen pregnancy?

Preeclampsia (toxicosis) is a syndrome of multiple organ failure that develops during the gestational period. It is caused by a discrepancy between the mother’s body’s ability to adequately provide for the needs arising as a result of fetal development.

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 gestosis also disappears, the symptoms of which gradually decrease and disappear.

However, all these signs are not reliable enough. Convincing signs of a frozen 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 vaginal examination, which is noted in case of fetal death at less than 12 and up to 20 weeks:

• reduction in the severity of cyanosis of the mucous membrane 4-5 weeks after the cessation of fetal development at a gestation period of 16 weeks and after 4-8 weeks at later stages;
• 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 a lag in its size from the expected gestational age. This is observed in the early stages due to the resorption of the fetal egg, 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, which makes it possible to diagnose pathology even before the appearance of a woman’s subjective sensations, is transvaginal ultrasound, which is informative from the 18th day after conception, especially in combination with a blood test to determine the level of hCG in the blood.

What is the danger of late diagnosis of pathology?



The consequences of a frozen pregnancy can be severe, especially in cases of prolonged (2-4 weeks or longer) stay of the dead embryo in the uterine cavity. The development of infection and septic condition, coagulopathic disorders (DIC syndrome) and bleeding, etc. are possible. They are not only a negative factor in the prognosis of a woman’s further reproductive function, 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 as the gestation period increases and the duration of stay of the dead fertilized egg, embryo or fetus in the uterus.

Treatment after a frozen pregnancy

Diagnosis requires immediate preparation of the woman and active treatment of the life-threatening condition. The meaning of treatment is to carefully terminate a non-developing pregnancy by evacuating the dead ovum and carrying out anti-inflammatory therapy aimed at eliminating concomitant endometritis.

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

The optimal 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 medical abortion. For these purposes, various schemes of oral and vaginal administration of the synthetic steroidal antigestagenic drug Mifepristone and the synthetic analogue of prostaglandin “E 1” Misoprostol are used. 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 using any method, a control or ultrasound examination is necessary. Late termination (in the second trimester - from 13 to 22 weeks) is carried out mainly through one of the methods that stimulate labor:

1. Intra-amniotic (into the amniotic sac cavity) or extra-amniotic administration of a hypertonic (20%) sodium chloride solution or (if there are contraindications to its use - arterial hypertension, renal pathology) glucose through the cervix (transcervical access) or using a needle inserted through the anterior abdominal wall (transabdominal access). The intraamnial method is the most optimal and effective.
2. Isolated administration in appropriate doses of an antiprogestagen (Mifepristone) orally or (if there is no effect) a prostaglandin (Misoprostol) or the introduction of the latter into the vagina with repeated doses of the drug orally, or a combination of Mifepristone with Misoprostol.
3. Intra- or extra-amniotic administration of Dinoprost, which belongs to the “F 2 alpha” prostaglandins and has a pronounced stimulating effect on the myometrium.
4. After dilation of the cervical canal, placing a load on the presenting section of the amniotic sac (after its opening) using special forceps. This method is used if there are contraindications for previous methods or if there is no effect from 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;
• antibiotics and broad-spectrum antibacterial agents (protected semi-synthetic penicillins, cephalosporins, macrolides, imidazole derivatives), but only if the causative factor of chronic endometritis or its exacerbation is identified;
• anti-inflammatory therapy, including non-steroidal anti-inflammatory drugs;
• drugs that help correct the immune state of the body;
• means for correcting vaginal microbiocenosis;
• drugs and physiotherapeutic techniques that help restore microcirculation, normalize tissue regeneration, metabolic processes in them and local immunity.

When can you get pregnant after a frozen pregnancy?

The period of its resolution is considered the first day of the new menstrual cycle. After it, periods are restored within the appropriate period, but sometimes they can occur after 1.5 months. However, the next pregnancy planning should definitely be recommended no earlier than six months later.



This is the minimum period during which, with appropriate treatment, recovery occurs from those changes and disorders (hormonal changes and psychological disorders, endometritis, etc.) that occurred as a result of the 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, also have other positive properties in terms of rehabilitation of the endometrial layer of the uterus after resolution of a non-developing 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, reducing blood loss during menstruation, eliminating coordination disorders of contractions of the myometrium and fallopian tubes;
• promote more intensive production of factors (immunoglobulins “A” and “G”) of local immunity, which significantly reduces the risks of developing aseptic inflammation;
• Pregnancy prevention itself provides the body with time to restore plastic and energy sources.

The absence of conception for six months provides the mother’s body with a chance to fully prepare for a more successful attempt at motherhood.

Prevention

Frozen pregnancy can be prevented by eliminating, if possible, the above risk factors, treating gynecological infectious diseases and inflammatory processes, restoring eubiosis of the vaginal environment, hormonal correction, as well as correction of the body’s immune state and chronic extragenital somatic pathology.

In order to correct the ratio of sex hormones when they are imbalanced towards progesterone deficiency, Duphaston, which has a gestagenic effect, is recommended for women with recurrent miscarriage and when planning the latter. Its active component 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 frozen pregnancy require a comprehensive examination, preferably including medical and genetic counseling, especially in case of repeated miscarriage, treatment and appropriate subsequent pregravid preparation for a planned pregnancy.

Frozen pregnancy is manifested by the cessation of fetal development as a result of disorders that arose already during the period of waiting for the child. This condition is typical for the early stages. The outcome of a frozen pregnancy is fetal death and premature termination of pregnancy.

Causes of frozen pregnancy

The fetus is most vulnerable until the twelfth week, when the formation of important organs and systems of the unborn baby occurs. During this period, the greatest likelihood of miscarriage or miscarriage remains.

Frozen pregnancy can be caused by many reasons. Among them are:

• a genetic failure that is accompanied by chromosomal abnormalities of the fetus. These developmental disorders appear very early and carry the threat of miscarriage;
• disturbances in the hormonal system of a pregnant woman, occurring against the background of a lack of progesterone or, conversely, too high a level of androgens. This complication can be detected before pregnancy if you take hormonal status tests and receive treatment in advance;
• suppression of the pregnant woman's immunity. When pregnancy occurs, a woman’s immunity sharply weakens: all reserves of strength go to protect the child. Weakened immunity causes problems with the vaginal microflora, which provoke infection of the fetus;
• rubella. The disease causes multiple developmental defects;
• flu. For the expectant mother, it is very difficult and has multiple complications. Influenza contributes to the appearance of intoxication in a pregnant woman, disrupts blood flow and oxygen supply to the fetus;
• diabetes;
• drinking alcohol and smoking;
• treatment with certain medications;
• irrational and unbalanced nutrition;
• constant stress, overexertion;
• lack of oxygen in the room;
• work in hazardous production;
• lifting weights;
• living in an environmentally unfavorable area.

The risk group includes the following categories of women:

1. Over 35 years of age.
2. Those who have had an abortion in the past.
3. With abnormal development of the uterus;
4. Who had an ectopic pregnancy.

Why does frozen pregnancy happen?

Frozen pregnancy is caused by bleeding disorders, which are based on antiphospholipid syndrome. It manifests itself in a decrease in the formation of blood vessels in the placenta, as a result of which its basic functions are reduced. Another sign of antiphospholipid syndrome is blockage and damage to the uteroplacental vessels, which contributes to impaired development of the placenta (most often occurs in the sixth week).

Frozen pregnancy sometimes also occurs due to a woman’s poor lifestyle. The first signs can immediately make themselves felt. Direct factors affecting the condition of the fetus include:

• poor nutrition;
• little exposure to fresh air;
• wearing clothes that strongly compress and tighten the stomach;
• prolonged exposure to a computer monitor.

Signs of a frozen pregnancy

The peculiarity of miscarriage is that the fetus has already died, but the symptoms of pregnancy still continue. If a woman experiences a sudden cessation of pregnancy symptoms, she should immediately go to the hospital.

The main symptom of fetal freezing is a discrepancy in the size of the uterus: it either becomes sharply enlarged or significantly decreases in size. The woman does not feel these changes. This symptom can only be determined by a gynecologist at the next examination.

A frozen pregnancy is manifested by the following symptoms:

1. No movement of the child for several days. During an ultrasound, the baby's heartbeat cannot be heard.
2. Copious bloody discharge.
3. Feeling of weakness, chills and internal trembling.
4. Fever.
5. Drawing and aching pain in the lower abdomen, cessation of its growth. There is also no enlargement of the uterus.
6. Disappearance of signs of toxicosis.
7. A decrease in basal temperature and a sharp increase in body temperature, especially if the fetus died a long time ago and the woman does not know anything.
8. Stopping breast growth.
9. No baby's heartbeat.

To avoid a frozen pregnancy, you must regularly visit your doctor and take the necessary tests. The doctor may be the first to see the discrepancy between the size of the uterus and the current stage of pregnancy. Carrying out an ultrasound examination will help to accurately listen to the presence or absence of an embryo’s heartbeat.

Frozen pregnancy in the early stages

The life of the fetus in the earliest stages of its development is very fragile. Even minor deviations can lead to a missed pregnancy: psycho-emotional stress, stress, severe fatigue and overwork, long exposure to direct sunlight and long-distance air travel. For the normal development of a baby in the womb, it is necessary to completely eliminate all physical and psychological stress.

Frozen pregnancy in the early stages usually occurs before 13 weeks for the following main reasons:

• certain chromosomal disorders, hereditary diseases. If a child is not viable, then nature does not give him the opportunity to be born;
• malfunction of the hypothalamus;
• Rh conflict between the expectant mother and her baby, especially if the mother is Rh negative and has had abortions before.
• drinking alcohol or drugs, smoking.

Frozen pregnancy in late stages

The main reasons for miscarriage in the later stages include: previous infectious diseases of the child's mother, abdominal trauma, the situation if the child himself suffocated with his own umbilical cord.

Almost one hundred percent symptom of a frozen pregnancy is the absence of fetal movements for more than five hours. Among other signs, it is worth noting: the disappearance of nausea, vomiting, cessation of abdominal growth and a decrease in the tone of the uterus. Over time, bloody discharge may occur.

If a frozen pregnancy occurs in the later stages, it is necessary to pay special attention to the issue of rehabilitation of the woman, both therapeutic and psychological.

For three months, a woman must take hormonal contraceptives to normalize hormonal levels and restore the organs of the reproductive system. Taking multivitamins (to increase immunity) and sedatives (to tidy up the nervous system) is also indicated. A week after pregnancy fading, it is worth conducting a control ultrasound examination.

For a woman who has experienced fetal death, the support of family and friends is very important. In some especially severe cases, it is better to seek qualified help from a good psychologist.

It is necessary to plan your next pregnancy at least six months after the incident. This time should be used with maximum benefit: for the treatment of chronic diseases, examination of the endocrine system.

Complete physical and psychological rehabilitation after a sudden termination of pregnancy is the key to successful pregnancy and the birth of a healthy baby in the future.

Diagnosis of frozen pregnancy

A frozen pregnancy is diagnosed only by a doctor and with the help of a comprehensive examination, which includes:

1. Gynecological examination: will help determine whether the size of the uterus corresponds to the stage of pregnancy.
2. Ultrasound, which can be used to diagnose the absence of a heartbeat in the fetus and the arrest of its growth.
3. Blood test: will show a stop in the production of human chorionic gonadotropin.

Examination after miscarriage

After a frozen pregnancy, it is necessary to undergo a long examination to determine the causes of fetal death. Not only the woman, but also her partner should be examined.

A histological and cytogenetic study of embryonic tissue is also carried out, which will help determine the presence or absence of genetic failures.

If a frozen pregnancy occurs due to an infectious disease, it is determined which infection caused the death of the fetus.

Treatment after a frozen pregnancy

After a frozen pregnancy, a woman needs to carefully take care of her health. Possible intoxication by decay products of the tissues of the fetus and placenta, inflammatory processes in the uterus, so doctors are taking measures to completely remove the fetus from the uterine cavity.

Treatment of frozen pregnancy is carried out in two main ways:

• Medication method. It consists in the fact that a woman takes medications that cause spontaneous miscarriage.
• Vacuum aspiration method is a surgical intervention under anesthesia. Using vacuum suction, the uterine cavity is cleaned.

The procedure for cleaning the uterus during a frozen pregnancy:



Often after a missed pregnancy, hormonal contraceptives are used for treatment. They help normalize the menstrual cycle and prevent inflammatory processes in the female organs.

The issue of further pregnancy planning is decided by the doctor individually. It all depends on the period at which the frozen pregnancy occurred, the woman’s age, and the presence of concomitant diseases. During treatment, you should carefully protect yourself from possible pregnancy.

The preventive measures taken will help avoid miscarriage in the future. Before planning her next pregnancy, a woman should be vaccinated against rubella and chickenpox, especially if she works in a children's educational institution, treat sexually transmitted diseases, take a course of multivitamins and strengthen the immune system. The treatment regimen is agreed with the attending physician individually. In most cases, the prognosis after treatment is favorable.

Frozen pregnancy is characterized by a sudden stop in fetal development in the early stages of gestation under the influence of both internal and external factors. As a rule, this condition develops in the 1st trimester of pregnancy, before the 12th obstetric week.

The fertilized egg is implanted in the uterus, and all the signs of pregnancy appear: delayed menstruation, a significant increase in the size of the uterus, toxicosis, the breasts become more sensitive, and there is an increase and darkening of the areolas.

Stopping the development of the embryo can occur at any stage, but doctors recommend paying special attention to the signs of frozen pregnancy in the early stages, i.e. up to 12 weeks.

The second trimester of pregnancy is, of course, considered no less dangerous and if signs of a frozen pregnancy are detected, you should consult a doctor.

Frozen early pregnancy

It deserves special attention. Since it is during this period that all the vital organs of the embryo are “laid,” and it is most susceptible to negative factors.

In addition, at 6-8 weeks the embryo can be rejected by the mother’s body if it has serious genetic mutations. This cannot be influenced and there is no need for this - a fetus with genetic “damages” is not viable. This is a natural mechanism.

In general, the expectant mother should be more attentive to her well-being and lifestyle in the period from 6 to 12 weeks.

What is the danger?

A pregnant woman makes an irreparable mistake by not coming to see a doctor on time and not paying attention to the manifestations of signs of a frozen pregnancy, both in the early stages and in the second trimester.

In rare cases, the pregnant woman’s body itself rejects the frozen fetus - the process ends in a miscarriage and a successful outcome for the woman’s health. After all, if a frozen fetus is in the womb for a long time, then intoxication may develop with an increase in temperature, severe pain and weakness.

With such symptoms of a frozen pregnancy, urgent hospitalization is required, where the doctor will prescribe a special drug that will provoke uterine contractions and lead to miscarriage. The sooner this procedure is carried out, the better for the woman herself.

A fertilized egg, remaining in the uterus for more than 6-7 weeks, can lead to disseminated intravascular coagulation - DIC syndrome, which is extremely life-threatening. With this diagnosis, the blood loses the ability to activate the clotting process, then possible bleeding can become fatal.

Signs of a frozen pregnancy

The danger is that fetal death may not be detected for a long time and may be asymptomatic for a pregnant woman. Problems with detecting a frozen pregnancy do not arise if the expectant mother regularly undergoes tests and goes to see a doctor.

It is he who can ascertain the fact of discrepancy in the size of the uterus, taking into account the duration of pregnancy, and an ultrasound check will allow you to accurately find out about the heartbeat of the embryo.

In general, the symptoms of a frozen pregnancy are the same in all trimesters:

• frequent discharge with blood;
• general weakness, chills and internal trembling;
• temperature increase;
• nagging and aching pain in the lower abdomen;
• causeless termination;
• stopping breast enlargement;
• An ultrasound examination confirms the fact that the child’s heartbeat has stopped;
• discrepancy in the size of the uterus.

There are exceptions when the symptoms of a frozen pregnancy may have some differences.

Curettage

Or scraping (cleaning) during a frozen pregnancy. Quite a popular, although not the most desirable procedure, since during it tissues are injured and the likelihood of complications is high.

The operation is performed under general anesthesia and is a mechanical cleaning of the uterine cavity after a frozen pregnancy, removing its upper mucous layer, with a special instrument that is inserted into the cervical canal, having previously provided access there by installing dilators.

After the operation, bleeding or inflammation may develop, so the woman should remain in the hospital for several more days, where her well-being will be monitored.

Vacuum aspiration

The operation, performed under anesthesia or local anesthesia, involves the woman having her uterine cavity cleaned using vacuum suction. It looks like this: the tip of a vacuum apparatus is inserted into the cervical canal (without dilation).

After the procedure, the woman should be under the supervision of a doctor for about two hours. Of course, this method of terminating a frozen pregnancy is more gentle than curettage. In addition, the woman will not have to stay in the hospital for a long time.

Childbirth

In the later stages, termination of a frozen pregnancy is much more difficult, mainly from a psychological point of view. The fact is that a non-developing pregnancy is a contraindication for cesarean section (the contents of the uterus can be infected), so there is only one way out - artificially inducing labor.

That is, a woman cannot simply disconnect from the process, for example, under anesthesia, she must give birth to a dead fetus herself as an emergency.

In the early stages, doctors sometimes make no attempts to terminate a frozen pregnancy, waiting until the uterus itself rejects the fetus. But it is impossible to maintain a pregnancy after the fetus has died.

Treatment and recovery after a frozen pregnancy

After a frozen pregnancy, an examination is prescribed to determine the cause of the pathology. If one can be identified, it is recommended to undergo a course of treatment.

As a rule, tests after a frozen pregnancy include:

• blood test for hormone levels;
• smear and examination of the vaginal microflora for the presence of sexually transmitted infections;
• histology after a frozen pregnancy - study of the uterine epithelium. For analysis, a thin section of the upper layer of the uterus or tube is taken, or material obtained during curettage is used.

As for the restoration of the uterus after surgery for a frozen pregnancy, a course of antibiotics, hemostatic agents, as well as abstinence from subsequent pregnancy for a certain time are usually prescribed (depending on concomitant factors).

In case of detected genetic abnormalities of the fetus, after a missed pregnancy, consultation with a geneticist will be required to determine the compatibility of partners.

Pregnancy after a frozen pregnancy

Exactly how long it would be undesirable for a woman to become pregnant after the fetus has died is determined by doctors in each specific case, at least it will be six months. Until then, a woman needs to use contraception and not worry about the fact that she will no longer be able to conceive a child. These fears are completely unfounded.

A frozen pregnancy is, as a rule, a special case that in no way indicates a disorder in the woman’s reproductive system. Even if two frozen pregnancies occur in a row, according to statistics, in 75% of cases there is a chance of normal conception and gestation.

Helping a woman survive a frozen pregnancy is the task of loved ones. In severe cases, the help of a psychologist may be required, as some patients develop fear of pregnancy.

In order not to experience this blow again, a woman should undergo a thorough examination, adhere to a healthy lifestyle and competently approach planning the next pregnancy. It is very important that the future father supports her in this. And this is not only a matter of moral support: it has been established that miscarriage in some cases is due to factors emanating from the man.

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