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

The phenomenon of frozen pregnancy can occur in women of any age. The emergence of this pathology is facilitated by a combination of many factors and circumstances. To prevent fetal freezing, you must strictly follow the recommendations and advice of your gynecologist, and also carefully take care of your own health even at the stage of planning the birth of a child.

Fortunately, this pathology is quite rare in women: out of 176 normally developing pregnancies, one is a frozen pregnancy. A frozen pregnancy is understood as a pathology of pregnancy development, in which the development and growth of the fetus ceases, as a result of which it dies. This phenomenon occurs at all stages of pregnancy, but most often in the first three months of pregnancy (up to 13 weeks). A frozen pregnancy can trigger the occurrence of inflammatory processes in the female body, as well as lead to other undesirable consequences. In particular, it poses some threat to future offspring. Symptoms of frozen pregnancy can be observed in the early and late stages of gestation, while the symptoms in the second trimester will differ from those in the early stages.

How to detect a frozen pregnancy in time?
As a rule, the symptoms of fetal freezing are very accurate, and medical diagnosis is not difficult at all. The most important sign of cessation of embryo growth and development is the disappearance of signs of a developing pregnancy. When the first suspicions arise, you should consult a doctor, who, based on the results of an ultrasound examination, will identify the presence or absence of symptoms of a frozen embryo.

To date, doctors have calculated the periods of fetal development at which the risk of fetal death is very high: the first 3-4 weeks, from 8 to 11 weeks and from 16 to 18 weeks of pregnancy. The likelihood of developing a frozen pregnancy is especially high in the eighth week, when changes are observed in the mother’s body and the formation of the most important organs of the unborn child occurs.

Causes of frozen pregnancy.
This phenomenon can be provoked by anything, from a hormonal imbalance in the mother and genetic disorders in the fetus, to acute infectious diseases and bad habits. The most common causes of frozen pregnancy are the woman’s consumption of alcohol in large quantities, drugs and cigarettes, as well as diseases such as herpes, chlamydia, toxoplasmosis, etc. Of course, if a woman really wants to have a healthy baby, then she should eliminate all these dangerous factors in the early stages of pregnancy.

Genetic abnormalities of embryonic development are the most common factor causing fetal death (70% of cases) for up to eight weeks. In this case, nature itself does not give life to the initially “sick” fetus. In the future, if both parents are absolutely healthy, there is a very high probability that this situation will not happen again. If the second, third and subsequent pregnancies in a row end in the death of the embryo, this indicates the fault of genetic factors.

Hormonal imbalances in a woman’s body also often provoke the development of frozen pregnancy. This is mainly due to a lack of progesterone or pregnancy hormone in the female body, without which successful attachment of the embryo to the uterus cannot occur.

Hyperandrogenism is also one of the causes of fetal death. In approximately twenty percent of women, while carrying a child, the level of male sex hormones (androgens) increases, as a result of which the woman begins to develop masculine characteristics (excessive hair, changes in the properties of the skin, voice, physique, etc.). Therefore, if you have previously had a frozen pregnancy, miscarriage, frequent delays in menstruation and male-type hair growth, it is important before planning a pregnancy to take tests to determine your hormonal status and, if necessary, undergo a course of treatment, thereby you will prevent or significantly reduce the likelihood of fetal fading in the future .

Various infections can cause fetal death not only in the early, but also in later stages of gestation (about 30% of cases). While carrying a child, a woman’s immunity is completely suppressed, because then the body would simply begin to fight the foreign body that appears, which is the embryo. As a result, the mother's body becomes very vulnerable to various infections. In pregnant women, all infectious diseases begin to worsen. Non-hazardous flora begins to multiply rapidly, the vaginal microflora is activated, creating a threat of intrauterine infection of the fetus. But infection of the expectant mother during pregnancy, and not the exacerbation of existing infectious diseases, poses a particular danger. In particular, infection with chickenpox or rubella, in addition to frozen pregnancy, can cause an abnormality in the development of the fetus. In this situation, the question of artificial termination of pregnancy already arises. Irreversible changes can result from infection with cytomegalovirus (CMV), which causes multiple malformations of the embryo.

A serious danger to the fetus is the common flu, which a pregnant woman can “catch.” Due to weakened immunity, even ordinary ARVI is very difficult to tolerate. It is worth noting that the danger is not the virus itself, but rather its manifestations: intoxication, fever, which, in turn, disrupts the blood flow from mother to fetus. As a result of lack of oxygen and essential nutrients, the fetus may die.

An unhealthy lifestyle, including an unbalanced diet and bad habits, frequent stress and overexertion can also cause fetal death. In addition, insufficient walks in the fresh air, drinking coffee and other harmful drinks can cause complications in the form of early placental abruption and increased uterine tone. All this leads to disruption of blood flow, as a result of which the fetus does not receive oxygen and necessary substances.

It should be noted that very often pregnancy as a result of in vitro fertilization ends in embryonic death or spontaneous miscarriage.

The cause of a frozen pregnancy can also be the use of medications by a woman (who is not aware of her pregnancy), the use of which is contraindicated during pregnancy. You should know that several months before a planned pregnancy, as well as during it, it is not recommended to use any medications without a doctor’s prescription. However, taking medications in the early stages (7-10 days) cannot cause a frozen pregnancy, since at this time there is no close connection between the embryo and its mother. After 8-10 weeks of pregnancy, the placenta protects from the effects of drugs, so the likelihood of frozen pregnancies in later stages is slightly reduced. If the expectant mother works in hazardous work, then the risk of developing a frozen pregnancy is very high.

After fetal death, the body needs six months to restore the endometrium and hormonal status to prepare for the next pregnancy. During this period, you can carry out all the necessary medical procedures that will allow you to conceive and normally carry a full-fledged and healthy baby.

Symptoms of frozen pregnancy and its diagnosis.
Unfortunately, in the early stages, a frozen pregnancy may not manifest itself in any way. The first signal indicating the presence of a problem is the sudden cessation of attacks of toxicosis, if any existed previously. At the same time, other obvious symptoms indicating the presence of pregnancy disappear: a decrease in basal temperature, pain in the mammary glands. In the early stages, a woman may not pay attention to such signs. At a later stage of gestation, a frozen pregnancy may manifest itself in the form of pain in the lower abdomen or bloody discharge from the vagina. These symptoms may indicate detachment of the fertilized egg during an incipient miscarriage. Another main symptom in the later stages is the cessation of fetal movement. Unfortunately, it is very difficult to determine a frozen pregnancy at home. The belly may still grow, and blood tests may indicate pregnancy. However, in this case, it is not the fetus that may develop, but the empty membrane inside.

A frozen pregnancy is diagnosed by a gynecological examination, an ultrasound examination of the pelvis and a blood test for hCG. When examined by a gynecologist, pathology is determined by the size of the uterus, which should correspond to the norm for the current stage of pregnancy. An ultrasound shows the absence of a fetal heartbeat, as well as anembryony (a disorder in which the fertilized egg is completely empty). On a hormonal blood test (hCG), a similar problem is characterized by a deviation in the level of the pregnancy hormone from the indicators characteristic of a normal pregnancy.

As a rule, a frozen pregnancy ends with curettage (cleaning) of the uterine cavity in a hospital setting using vacuum aspiration (in the early stages) or under the supervision of a doctor, a miscarriage is induced using special medications. Sometimes it happens that a woman’s frozen pregnancy without medical intervention ends in spontaneous miscarriage. If this does not happen within a certain time, and according to ultrasound, there are remains of the fertilized egg in the uterus, then they resort to the measures described above, after which antibacterial therapy is carried out. Two weeks later, an ultrasound is performed to assess the recovery of the body.

Consequences of a frozen pregnancy.
If there was a frozen pregnancy, this does not mean that the woman will not be able to have children in the future. Very often, doctors cannot fully identify the cause of this phenomenon, but in the vast majority of cases, women become pregnant and carry the child normally. If cases of frozen pregnancy occur repeatedly, it is necessary to undergo a full medical examination of both partners, since repeated cases may indicate the woman’s inability to bear a child.

It is a fact that a frozen pregnancy has a serious impact on a woman’s physical health. But the psychological problems associated with it are more serious. A woman experiences fear in planning her next pregnancy due to unsuccessful past experiences. Over time, all fears go away, especially if a woman hears the stories of women who have been in the same situation, who then conceived, carried and gave birth to a baby normally.

Recovery and treatment after a frozen pregnancy.
Before prescribing treatment, both partners undergo a full course of examination: tests for sex hormones and thyroid hormones, smears for various sexually transmitted infections using the PCR method (to identify hidden sexually transmitted infections), undergo an ultrasound examination, determine group compatibility and etc., which will make it possible to identify and eliminate the causes that caused the development of pathology.

After doctors have identified the causes of a missed abortion and carried out appropriate treatment, if necessary, the woman must regain her strength before planning her next pregnancy. This will take her about six months. During this period, it is important to take all possible preventive measures to prevent the situation from recurring (lead a healthy lifestyle, take vitamins, use contraception). The woman herself needs to see a psychologist who will help overcome her fears and worries about planning her next pregnancy.

A woman who has experienced a similar situation, with normal tests, may not require treatment, because, as I have already said, most often a frozen pregnancy develops due to a genetic malfunction, the repetition of which is unlikely to be observed in the future. However, in case of repeated cases of fetal freezing, treatment is mandatory.

Prevention of frozen pregnancy.
To prevent a recurrence of such a situation, it is necessary to follow preventive measures even before planning a pregnancy. Prevention will help reduce the risk of a recurrence of the tragedy.

So, if you have a sexually transmitted infection, you need to get rid of them at least three months before the planned conception. If you did not have diseases such as rubella or chickenpox as a child, you should get vaccinated, especially if you have frequent contact with children (for example, you work in a kindergarten).

To prevent frozen pregnancy and other complications, all women need to eat a rational and balanced diet, including more fresh vegetables and fruits in their diet. In addition, it is necessary to give up all bad habits, as they sharply increase the risk of frozen pregnancy. Spend more time outdoors.

Who is at risk for a repeat pregnancy that does not develop?

Women who have had abortions, and the more abortions, the higher the likelihood of encountering such a complication.
Women who have had an ectopic pregnancy, as well as those whose fetal heart has stopped beating in the last weeks of pregnancy.
Women with infectious and viral diseases of the genital organs.
Women over thirty years of age. It is desirable for every woman to give birth to her first child before the age of thirty.
Women who have some anatomical features of the reproductive system (bicornuate and saddle uterus).
Women with uterine fibroids. It leads to deformation of the uterine cavity and prevents the fertilized egg from attaching.
Suffering from endocrine disorders (diabetes mellitus, decreased thyroid function, cycle disorders, impaired progesterone production).

In conclusion, I would like to note that the best prevention of any pregnancy complications is to maintain a healthy lifestyle, regularly visit the gynecologist and strictly follow his instructions.

It consists in the fact that nothing bothers the woman for some time after the intrauterine death of the fetus. She enjoys her position, sometimes not suspecting that the child does not develop and dies, especially in the first and early second trimester, when the expectant mother does not yet feel the fetus moving. Unfortunately, this can happen to any woman.

information The symptoms of a non-developing pregnancy are slightly different (before 12 weeks) and (after 12 weeks) terms, but they are all divided into probable and reliable. The first category includes those symptoms that may prompt the doctor or the woman herself to undergo a more detailed examination, but are not the main ones for determining a frozen pregnancy. Reliable signs are those on the basis of which a diagnosis is made.

Symptoms of frozen pregnancy in the early stages

Possible symptoms in the early stages

The very first signs of a frozen pregnancy in the early stages are a decrease in the woman’s subjective sensations that appear with the onset of conception: manifestations (nausea, vomiting), engorgement of the mammary glands, sensitivity to smells, changes in taste preferences.
Decline. Basal temperature (resting body temperature, which is measured in the rectum at the same time in the morning, without getting out of bed) increases in the second phase of the menstrual cycle by 0.3-0.5 degrees and remains elevated during conception and pregnancy. This is facilitated by high levels of the hormone progesterone, which maintains pregnancy. If fetal freezing occurs, the basal temperature drops to normal (36.4-36.8 degrees Celsius). However, this can also occur with a lack of the hormone progesterone, and with a threatening miscarriage.
Gynecological examination. During a gynecological examination, the doctor assesses the size, consistency of the uterus, the length and density of the cervix, and the patency of the cervical canal (cervical canal). A sign of a frozen pregnancy is the smaller size of the uterus compared to what it should be at a given expected period. If the doctor discovers such a discrepancy, it is necessary to do an ultrasound of the uterus to confirm or refute suspicions.
Bloody discharge from the genital tract. Usually, the appearance of bloody discharge indicates that a spontaneous miscarriage has begun. Most often, this symptom occurs some time (2-4 weeks) after the intrauterine death of the baby.
Nagging pain in the lower abdomen, increased pain, also occurs after some time has passed after the fetus has died.

Reliable signs of a non-developing pregnancy

You can detect a frozen pregnancy in the early stages using human chorionic gonadotropin (hCG). HCG is produced by the cells surrounding the embryo, starting from the 7th day after fertilization. Every day the level of this hormone almost doubles and reaches a maximum by the 10th week of pregnancy, then gradually decreases and remains at the same level until childbirth. At the earliest stages, when the fetal heartbeat is not yet detected on ultrasound, fetal fading can be suspected based on the level of hCG, since each stage of pregnancy is characterized by a certain level of hCG, as well as its daily increase up to 10 weeks. If human chorionic gonadotropin is below the levels typical for a given week of pregnancy, and when the analysis is repeated the next day, its level drops, this gives the right to diagnose fetal fading.
One of the reliable signs of a frozen pregnancy is the absence of a fetal heartbeat on ultrasound. The baby's heartbeat begins to be detected from the 5-6th week of pregnancy. Therefore, if the fetus is visualized well, but there is no cardiac activity, this means that the fetus is frozen. But if the heartbeat is not detected at the earliest stages, and only the fertilized egg is visible, you need to wait and do a second ultrasound after 5-7 days. During this period, the size of the fertilized egg during normal pregnancy increases.

The violation criteria are:

Absence of heartbeat when the coccygeal-parietal size of the fetus is more than 5 mm;
Absence of an embryo when the size of the fertilized egg is more than 25 mm;
Abnormal yolk sac.

Signs of frozen pregnancy in late stages

additionally In addition to those listed, from the middle of the second trimester another sign of a frozen pregnancy appears - the woman stops feeling the baby move. Usually she begins to feel it from 18-20 weeks (it matters whether it is a repeat pregnancy or not, and the build of the woman herself).

At first, the movements are not so obvious and active, more like bowel movements. Sometimes the baby’s movements during the day are not so active. A woman is busy with her daily activities, especially if she is still working and is constantly on the move, so the slightest movements of the child may go unnoticed. And when, in the evening, the expectant mother can finally relax, lie down on the sofa or bed, the child’s activity increases (at least it feels that way) and the mother can concentrate and enjoy the kicks of her baby. Pay attention to your baby's activity throughout the day. If he hasn't pushed you for a long time, sit down, rest, talk to him to feel his presence. If you haven't felt any movement for 6 hours, it's a cause for concern!

If, after all, you have been diagnosed with a non-developing pregnancy, do not despair. Take this as an opportunity to prepare more thoroughly for your next pregnancy.

Reliable signs in later stages

A reliable sign of intrauterine fetal death is the absence of a heartbeat during ultrasound examination.

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, a consultation with a geneticist will be required to determine the compatibility of the 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.

Replies

The fetus froze - these are perhaps one of the most terrible words from a doctor for a couple dreaming of children. You can hear them for various reasons at the very beginning of the development of a new life (the most dangerous are considered to be from 3 to 4, from 8 to 11 and from 16 to 18 weeks from conception). Sometimes the diagnosis is made at a later date, but the likelihood of hearing it is significantly lower. An analogue is the development of an empty fertilized egg: in this case, fertilization has occurred, but the embryo does not develop. The pathology occurs spontaneously, maybe several times in a row throughout a woman’s life. Unfortunately, no one is safe from it. However, it is better to know the causes and signs of frozen pregnancy in the early stages in order to take timely measures and consult a doctor, as well as prevent the development of pathology before conception. Anything can influence the development of a little life. And the worst thing about this is that it is not so easy to notice changes.

Why does frozen pregnancy occur in the early stages? This question worries and frightens young mothers. There are actually quite a lot of reasons:

Genetic deviations occupy a leading place. They are detected in 70% of cases for up to 8 weeks. They are associated with many factors, including hereditary diseases, as well as the result of drug use by one of the partners. That is why it is important not to refuse screenings and other examinations suggested by a geneticist and gynecologist.

Excessive consumption can also cause developmental arrest. It is especially dangerous if the mother cannot give up bad habits after conception.
Medicines can also provoke the development of abnormalities. That is why doctors themselves strongly recommend that you stop taking any medications. The only exceptions can be severe diseases, the treatment of which with folk remedies is simply impossible. It is worth noting that for up to 10 days and after 8-10 weeks, when the fetus becomes partially protected by the placenta, the effect of the drugs is not so significant. As for herbs, they also need to be taken only under the supervision of a doctor, because some of them can provoke a breakdown or arrest in the development of the embryo.
The reasons for frozen pregnancy in the early stages may lie in both the mother and the child. If a woman has had abortions before, then the chances of a happy development are not so great. Antibodies produced by the mother's body towards the baby accumulate over time. And after several abortions, it is very difficult for a conceived baby to resist such an attack.
Infections, both genital organs and viral (flu), are a serious threat at the very beginning of life. The mother's body is already weakened by the new position, so it is not at all difficult to get sick. But the consequences of a high temperature or a viral attack can be very serious. Rubella is a formidable enemy, in the event of which the pregnancy not only stops, but the fetus may develop severe anomalies. And in this case, the mother will have to decide whether she can raise a special child or whether it is better to terminate the pregnancy.

Consequences of congenital rubella for a child

Hormonal disorders. Moreover, a non-developing pregnancy in the early stages, the reasons for which lie precisely in this factor, can freeze due to both a lack of prolactin and an excess of testosterone. If a woman has regular irregularities in her menstrual cycle, then it is imperative to undergo examinations during planning, as well as regularly check the status of the hormones after conception.
Harmful factors at work, diabetes, heavy lifting, stress - all these factors can also cause the development of pathology.

Women who are at higher risk of developing pathology

But this is not the only answer to the question of why pregnancy fails in the early stages. Doctors identify a certain risk group, which includes:

old-time mothers or expectant mothers over 35 years of age;
if you have had multiple abortions in the past;
if your previous pregnancy was ectopic;
in the presence of a congenital anomaly of the uterus.

If one or all factors are present, the woman will be under constant medical supervision.

Expectant mothers who do not want to visit a gynecologist in the early stages are also at risk. There may be many reasons for such a decision, but the result will be a serious threat to the health of not only the woman, but also the child.

What signs indicate a frozen pregnancy?

The saddest thing is that the symptoms of a frozen pregnancy in the early stages are not clearly expressed. Therefore, the expectant mother may not even be aware of the change in the condition of the fetus. Only a qualified doctor, after examining and ordering additional examinations, can determine the absence of embryo development.

You shouldn’t look for symptoms of an undeveloped pregnancy in the early stages, and even less so, ask for advice from friends or on forums. In each case, everything is purely individual and depends on many factors.

Symptoms of an approaching disaster

At later stages, it is easier for a woman to navigate, because she can already feel the baby moving. This is very difficult to do in the early stages. A frozen pregnancy, the symptoms of which in the first trimester may be similar to less serious abnormalities, manifests itself as follows:

passes ;
no more ;
reduced;
cramping pain began to appear;
spotting appeared (discharge during a frozen pregnancy in the early stages has exactly the same consistency and red-brown color);
general body temperature increased.

If any of the listed symptoms are detected, a woman should urgently consult a doctor! If the signs of pregnancy disappear, this should also alert the mother and become a reason to visit a specialist!

How does a pregnant woman feel when pathology develops?

Women experience very different sensations during a frozen pregnancy. They are even influenced by the fact whether this is the first time this has happened or whether a similar situation has happened before. Fatigue, apathy, fever - all this in any case should alert the expectant mother.

It is worth noting that all symptoms that indicate the development of pathology may turn out to be false! There is no need to immediately prepare yourself for the approaching disaster. Quite often they turn out to be similar to less serious ones, or the body is simply undergoing a reconfiguration.

Diagnosis of the fact of fetal freezing

Only a doctor knows exactly how to recognize a frozen pregnancy in the early stages. To do this he will do the following:

, will assess the condition of the mucus secreted, and will ask you to measure your basal temperature.
If there is any suspicion of a deviation from the norm, the doctor will send the pregnant woman for a test. However, it is worth noting that hCG during a frozen pregnancy in the early stages can be completely within normal limits for several weeks after the death of the fetus. And yet, more often than not, a urine test will show a low level of the hormone, which is not typical for the first trimester.
The last stage of examination will be an ultrasound. With the help of an ultrasound examination, it will become clear whether the embryo’s heart is beating or not.

Typically, a test for a frozen pregnancy in the early stages may show the same two lines. This is again related to the level of hCG in the urine.

After the specialist confirms the diagnosis, he will select the necessary set of procedures for the mother, and will also further help her prepare for a new pregnancy.

What do doctors do if the fetus is frozen?

Depending on how a frozen pregnancy manifests itself in the early stages, as well as directly on the number of days from the moment of conception, the doctor will choose the most alternative method of treatment. After all, when establishing such a diagnosis, we are talking about preserving the life and health of the mother. There are two main treatment methods:

With the help of medications that provoke. Can be used for up to 8 weeks.
(vacuum aspiration). Under anesthesia, the woman's uterine cavity is cleaned using vacuum suction.

In any case, professional help will definitely be required, since in order to avoid adverse consequences, it is necessary to clean the uterine cavity (remnants of the amniotic sac, which will be indicated by ultrasound).

There is a third option, in which even the woman herself does not have time to realize that she was pregnant. This is a spontaneous abortion. If the fetus froze almost from the first days of life, then the body can reject it as a foreign body. In this case, the woman will simply notice a delay in her periods. Sometimes doctors prefer to observe the patient’s condition, waiting for a spontaneous abortion, so as not to interfere with the body again.

Why is it so scary not to see a doctor on time?

Sometimes a woman does not fully realize how severe the consequences of a missed early pregnancy can be for her. But the body does not always reject the fetus itself. If an embryo that has stopped developing remains in the womb for a long time, then intoxication is likely to develop. In this case, not only does the temperature rise, the woman begins to suffer from acute pain and weakness, and it is quite possible to delay the time until the blood becomes infected with elements of fetal decay.

If the pregnancy is more than 6 weeks, then in this case the woman has every chance of developing disseminated intravascular coagulation (DIC syndrome). The danger is that the blood loses its ability to clot. As a result, the woman may die from bleeding.

How to prevent fetal death during pregnancy

The couple, regardless of whether they are preparing to become parents for the first time or have children, must undergo an examination. It is he who will be able to reduce the risks and give an answer on how to avoid a frozen pregnancy in the early stages in their case. The doctor will suggest taking several tests: hormones, genetic examinations, ultrasound of the pelvic organs, blood for infections and other additional ones, which will be prescribed taking into account the parents’ medical history. It is also recommended to refrain from conceiving for up to six months after diseases such as acute respiratory viral infections, influenza, and chicken pox.

If a woman works in a children's team, she will be offered preventive vaccinations. Additional hormonal levels will need to be adjusted. Don't ignore visiting a geneticist. A healthy lifestyle will only increase your chances of becoming parents. In the first months, it is recommended to refrain from flying, sudden climate changes and prolonged exposure to the sun.

If your previous pregnancy ended in stopping the development of the embryo, don’t give up! With proper planning, the chance of a normal pregnancy and birth is 80%-90%. A gynecologist who cares for a couple will tell you how to prevent a frozen pregnancy in the early stages.

Pregnancy after fetal growth arrest

Doctors predict good chances of conceiving only if the couple does not ignore visiting specialized specialists, undergoes a course of treatment, and also gives up the thought of having a child for the next six months after an unsuccessful experience. On average, this period is necessary not only for a detailed examination and finding out the reason for the fading of pregnancy, but also for the physical restoration of the mother’s body.

As sad as it may be, it is quite rare to say with 100% certainty about the reasons for pregnancy termination. However, parents do not need to despair! Try to avoid stress, harmful factors, and don’t forget to get examined - and may everything work out for you and the baby will be born healthy and happy!

Frozen pregnancy in early and late stages: causes and prevention

o implantation of the fertilized egg in places of incomplete gravid transformation of the uterine mucosa.

2. Inferiority of reactions of immunocellular rejection of the dead amniotic sac. A cascade of immunocellular reactions unfolds, aimed at rejecting the “allogeneic transplant”, which has lost all immunoblocking factors due to its death. With a certain genetic identity of the spouses (consanguineous marriage), the biological compatibility of mother and fetus can be so close that it determines the state of immunological unresponsiveness of the uterus in relation to the dead embryo.

3. Reactivity of the uterus. Contractile hypofunction of the myometrium can be caused by:

o biochemical defects in the enzyme-protein metabolism system;

o chronic inflammatory processes in the uterus, when receptors for contractile substances are not formed;

o lack of hormonal support from the dead fetus and non-developing placenta.

Most often, a gradual rejection of the dead fetal egg occurs with the help of a fibrinous-leukocyte exudative reaction in response to necrotic tissue. During this process, along with fibrin and leukocytes, trophoblastic, thromboplastic substances, and erythrocytes are released from the endometrial vessels, which leads to constant spotting and spotting from the uterus. The body of the uterus becomes soft, the myometrial tone disappears, the cervix opens slightly. All signs of pregnancy (cyanosis of the vagina, cervix) disappear.

Frozen pregnancy - the consequences of a dead embryo remaining in the uterus

With a long-term (2-4 weeks or more) presence of a dead embryo in the uterus, autolysis occurs, thromboplastic substances enter the patient’s bloodstream and DIC syndrome develops. All this is a risk of developing severe coagulopathic bleeding when attempting to terminate a pregnancy. The most unfavorable conditions of uterine hemostasis occur in patients in whom phase hemocoagulation changes are in a state of hypocoagulation and myometrial hypotension is pronounced.

Difficulties that arise when removing a dead fetus may be due to chorion previa and placenta located in the area of the internal os of the uterus. Before curettage of the uterus, it is necessary to examine the state of the hemostatic system (detailed coagulogram). In case of detected disorders (hyperaggregation, hypercoagulation, disseminated intravascular coagulation syndrome), corrective therapy is required (fresh frozen plasma, HAES-steril and other components). The use of dicinone and ATP contributes to the relief of hemostasiological disorders at the level of the vascular-platelet unit. In the postoperative period, antiplatelet and anticoagulant therapy (trental, chimes, fraxiparin) is indicated. The energy potential of the uterus is restored by administering glucose, vitamins, calcium chloride in combination with antispasmodic drugs.

Frozen pregnancy - treatment

Treatment. The retention of a dead embryo in the uterine cavity poses a threat not only to the health, but also to the life of the woman and therefore requires active tactics. Once a diagnosis of non-developing pregnancy is established, long-term conservative management of the patient is risky.

After a thorough examination and appropriate preparation of the woman (carrying out treatment and preventive measures aimed at reducing the risk of developing possible

complications) it is necessary to terminate a non-developing pregnancy. In the first trimester of pregnancy:

1. Cervical dilatation and vacuum aspiration.

2. Preparation of the cervix using prostaglandins or hydrophilic dilators and vacuum aspiration.

3. The use of antiprogestogens in combination with prostaglandins.

In the second trimester of pregnancy:

1. Dilatation of the cervix and evacuation of products of conception with previous preparation of the cervix.

2. Therapeutic abortion using intra- and extra-amniotic administration of prostaglandins or hypertensive agents.

3. The use of antiprogestogen in combination with prostaglandin.

4. Isolated use of prostaglandins.

Immediately during the abortion or immediately after its completion, an ultrasound scan is necessary to ensure complete removal of parts of the fetus and placenta.

After removal of the fertilized egg during a non-developing pregnancy, regardless of the chosen method of termination, it is advisable to carry out complex anti-inflammatory treatment, including specific antibacterial, immunocorrective and restorative therapy.

Each case of non-developing pregnancy requires in-depth examination in relation to genetic, endocrine, immune and infectious pathologies.

Frozen pregnancy - medical measures

The management tactics for patients with a history of undeveloped pregnancy are as follows.

1. Identification of pathogenetic factors in the death of the embryo (fetus).

2. Elimination or weakening of the effects of identified factors outside and during pregnancy:

o screening of patients planning pregnancy, as well as women in the early stages of gestation for urogenital infection;

o medical and genetic counseling to identify high-risk groups for congenital and hereditary pathologies;

o differentiated individually selected hormonal therapy for endocrine genesis of non-developing pregnancy;

o determination of autoimmune disorders (determination of lupus anticoagulant, anti-CG, anticardiolipin antibodies, etc.) and individual selection of antiplatelet agents and/or anticoagulants and glucocorticoids under the control of hemostasiograms.

3. Normalization of a woman’s mental state (sedatives, promotion of a healthy lifestyle).

Pregnancy after a frozen pregnancy

The tactics for managing patients during subsequent pregnancy are as follows.

1. Screening using non-invasive methods: ultrasound, analysis of serum marker proteins alpha-fetoprotein, human chorionic gonadotropin in the blood at the most informative time.

2. According to indications - invasive prenatal diagnostics to determine chromosomal and a number of monogenic diseases of the fetus.

3. Carrying out treatment and preventive measures aimed at:

o elimination of the infectious process, carrying out specific anti-inflammatory therapy in combination with immunocorrectors;

o suppression of autoantibody production - intravenous drip administration of gammaimmunoglobulin 25 ml every other day No. 3;

o elimination of hemostasiological disorders - antiplatelet agents, direct-acting anticoagulants.

SPONTANEOUS ABORTION (MISCARRIOR)

Spontaneous abortion (miscarriage) is the spontaneous termination of pregnancy before the fetus reaches a viable gestational age.

According to the WHO definition, abortion is the spontaneous expulsion or extraction of an embryo or fetus weighing up to 500 g, which corresponds to a gestation period of less than 22 weeks.

ICD-10 CODE

O03 Spontaneous abortion.
O02.1 Failed miscarriage.
O20.0 Threatened abortion.

EPIDEMIOLOGY

Spontaneous abortion is the most common complication of pregnancy. Its frequency ranges from 10 to 20% of all clinically diagnosed pregnancies. About 80% of these losses occur before 12 weeks of pregnancy. When pregnancies are taken into account by determining hCG levels, the loss rate increases to 31%, with 70% of these abortions occurring before the pregnancy can be recognized clinically. In the structure of sporadic early miscarriages, 1/3 of pregnancies are terminated before 8 weeks due to the type of anembryony.

CLASSIFICATION

According to clinical manifestations there are:

· threatened abortion;
· started abortion;
· abortion in progress (complete and incomplete);
· NB.

The classification of spontaneous abortions adopted by WHO is slightly different from that used in the Russian Federation, combining the beginning of a miscarriage and an abortion in progress into one group - inevitable abortion (i.e., continuation of pregnancy is impossible).

ETIOLOGY

The leading factor in the etiology of spontaneous abortion is chromosomal pathology, the frequency of which reaches 82–88%.

The most common variants of chromosomal pathology in early spontaneous miscarriages are autosomal trisomies (52%), monosomy X (19%), and polyploidies (22%). Other forms are noted in 7% of cases. In 80% of cases, death and then expulsion of the fertilized egg occurs first.

The second most important among the etiological factors is metroendometritis of various etiologies, which causes inflammatory changes in the uterine mucosa and prevents normal implantation and development of the fertilized egg. Chronic productive endometritis, more often of autoimmune origin, was noted in 25% of so-called reproductively healthy women who terminated pregnancy through induced abortion, in 63.3% of women with recurrent miscarriage and in 100% of women with NB.

Among other causes of sporadic early miscarriages, there are anatomical, endocrine, infectious, immunological factors, which are more likely to cause habitual miscarriages.

RISK FACTORS

Age is one of the main risk factors in healthy women. According to data obtained from an analysis of the outcomes of 1 million pregnancies, in the age group of women from 20 to 30 years, the risk of spontaneous abortion is 9–17%, in 35 years - 20%, in 40 years - 40%, in 45 years - 80%.

Parity. Women with a history of two or more pregnancies have a higher risk of miscarriage than nulliparous women, and this risk does not depend on age.

History of spontaneous abortion. The risk of miscarriage increases with the number of miscarriages. In women with a history of one spontaneous miscarriage, the risk is 18–20%, after two miscarriages it reaches 30%, after three miscarriages it reaches 43%. For comparison, the risk of miscarriage for a woman whose previous pregnancy ended successfully is 5%.

Smoking. Consumption of more than 10 cigarettes per day increases the risk of spontaneous abortion in the first trimester of pregnancy. These data are most revealing when analyzing spontaneous abortions in women with a normal chromosomal complement.

The use of non-steroidal anti-inflammatory drugs in the period preceding conception. Data have been obtained indicating a negative effect of inhibition of PG synthesis on the success of implantation. When using non-steroidal anti-inflammatory drugs in the period preceding conception and in the early stages of pregnancy, the miscarriage rate was 25% compared to 15% in women who did not receive drugs from this group.

Fever (hyperthermia). An increase in body temperature above 37.7 °C leads to an increase in the frequency of early spontaneous abortions.

Trauma, including invasive prenatal diagnostic methods (choriocentesis, amniocentesis, cordocentesis) - the risk is 3–5%.

Caffeine consumption. With daily consumption of more than 100 mg of caffeine (4-5 cups of coffee), the risk of early miscarriages significantly increases, and this trend is valid for a fetus with a normal karyotype.

Exposure to teratogens (infectious agents, toxic substances, drugs with a teratogenic effect) is also a risk factor for spontaneous abortion.

Folic acid deficiency. When the concentration of folic acid in the blood serum is less than 2.19 ng/ml (4.9 nmol/l), the risk of spontaneous abortion significantly increases from 6 to 12 weeks of pregnancy, which is associated with a higher incidence of abnormal fetal karyotype.

Hormonal disorders and thrombophilic conditions are to a greater extent the causes not of sporadic, but of habitual miscarriages, the main cause of which is an inadequate luteal phase.

According to numerous publications, from 12 to 25% of pregnancies after IVF end in spontaneous abortion.

CLINICAL PICTURE AND DIAGNOSTICS

Mostly, patients complain of bloody discharge from the genital tract, pain in the lower abdomen and lower back when menstruation is delayed.

Depending on the clinical symptoms, they distinguish between abortion, which has begun, abortion in progress (incomplete or complete) and NB.

A threatened abortion is manifested by nagging pain in the lower abdomen and lower back, and there may be scanty bleeding from the genital tract. The tone of the uterus is increased, the cervix is not shortened, the internal os is closed, the body of the uterus corresponds to the period of pregnancy. Ultrasound records the fetal heartbeat.

When an abortion begins, pain and bloody discharge from the vagina are more pronounced, the cervical canal is slightly open.

During an abortion, regular contractive contractions of the myometrium are detected. The size of the uterus is less than the expected gestational age; in later stages of pregnancy, OB leakage is possible. The internal and external pharynx are open, the elements of the fertilized egg are in the cervical canal or in the vagina. Bloody discharge can be of varying intensity, often abundant.

Incomplete abortion is a condition associated with retention of elements of the fertilized egg in the uterine cavity.

The lack of full contraction of the uterus and closure of its cavity leads to ongoing bleeding, which in some cases causes large blood loss and hypovolemic shock.

More often, incomplete abortion is observed after 12 weeks of pregnancy in the case when the miscarriage begins with the rupture of OB. With a bimanual examination, the uterus is smaller than the expected gestational age, there is abundant bloody discharge from the cervical canal, with the help of ultrasound, the remains of the fertilized egg are determined in the uterine cavity, and in the second trimester - the remains of placental tissue.

Complete abortion is more common in late pregnancy. The fertilized egg comes out completely from the uterine cavity.

The uterus contracts and bleeding stops. During bimanual examination, the uterus is well contoured, its size is smaller than the gestational age, and the cervical canal can be closed. In case of a complete miscarriage, the closed uterine cavity is determined using ultrasound. There may be slight bleeding.

Infected abortion is a condition accompanied by fever, chills, malaise, pain in the lower abdomen, and bloody, sometimes purulent, discharge from the genital tract. A physical examination reveals tachycardia, tachypnea, deflation of the muscles of the anterior abdominal wall, and a bimanual examination reveals a painful, soft uterus; The cervical canal is dilated.

In case of infected abortion (in case of mixed bacterial viral infections and autoimmune disorders in women with recurrent miscarriage, aggravated by antenatal fetal death, obstetric history, recurrent course of genital infections), immunoglobulins are prescribed intravenously (50–100 ml of 10% solution of Gamimune©, 50–100 ml of 5% solution octagama©, etc.). Extracorporeal therapy is also carried out (plasmapheresis, cascade plasma filtration), which consists of physicochemical blood purification (removal of pathogenic autoantibodies and circulating immune complexes). The use of cascade plasma filtration implies detoxification without plasma removal. In the absence of treatment, generalization of infection in the form of salpingitis, local or diffuse peritonitis, and septicemia is possible.

Non-developing pregnancy (antenatal fetal death) is the death of an embryo or fetus during a pregnancy of less than 22 weeks in the absence of expulsion of the elements of the fertilized egg from the uterine cavity and often without signs of a threat of miscarriage. An ultrasound is performed to make a diagnosis. The tactics of termination of pregnancy are chosen depending on the gestational age. It should be noted that antenatal fetal death is often accompanied by disturbances in the hemostatic system and infectious complications (see the chapter “Non-developing pregnancy”).

In diagnosing bleeding and developing management tactics in the first trimester of pregnancy, assessing the rate and volume of blood loss plays a decisive role.

When ultrasound shows unfavorable signs in terms of the development of the ovum during intrauterine pregnancy, the following are considered:

· lack of embryonic heartbeat with CTE of more than 5 mm;

· absence of an embryo when the size of the fetal egg, measured in three orthogonal planes, is more than 25 mm with transabdominal scanning and more than 18 mm with transvaginal scanning.

Additional ultrasound signs indicating an unfavorable pregnancy outcome include:

· abnormal yolk sac, inappropriate for gestational age (more), irregular in shape, displaced to the periphery or calcified;

· Fetal heart rate less than 100 per minute at 5–7 weeks;

· large sizes of retrochorial hematoma (more than 25% of the surface of the fetal egg).

DIFFERENTIAL DIAGNOSTICS

Spontaneous abortion should be differentiated from benign and malignant diseases of the cervix or vagina. During pregnancy, bloody discharge from the ectropion is possible. To exclude cervical diseases, a careful examination in the speculum is performed, and, if necessary, colposcopy and/or biopsy.

Bloody discharge during a miscarriage is differentiated from that during an anovulatory cycle, which is often observed when menstruation is delayed. There are no symptoms of pregnancy, the hCG b-subunit test is negative. On bimanual examination, the uterus is of normal size, not softened, the cervix is dense, not cyanotic. There may be a history of similar menstrual irregularities.

Differential diagnosis is also carried out with hydatidiform mole and ectopic pregnancy.

With hydatidiform mole, 50% of women may have characteristic discharge in the form of bubbles; the uterus may be longer than the expected pregnancy. Typical picture on ultrasound.

With an ectopic pregnancy, women may complain of spotting, bilateral or generalized pain; Fainting (hypovolemia), a feeling of pressure on the rectum or bladder, and a positive bhCG test are common. Bimanual examination reveals pain when moving the cervix. The uterus is smaller than it should be at the expected stage of pregnancy.

You can palpate a thickened fallopian tube, often with bulging vaults. An ultrasound can detect a fertilized egg in the fallopian tube, and if it ruptures, an accumulation of blood in the abdominal cavity can be detected. To clarify the diagnosis, puncture of the abdominal cavity through the posterior vaginal fornix or diagnostic laparoscopy is indicated.

An example of a diagnosis formulation

Pregnancy 6 weeks. Incipient miscarriage.

TREATMENT GOALS

The goal of treating threatened miscarriage is to relax the uterus, stop bleeding and prolong pregnancy if there is a viable embryo or fetus in the uterus.

In the USA and Western European countries, threatened miscarriage before 12 weeks is not treated, believing that 80% of such miscarriages are due to “natural selection” (genetic defects, chromosomal aberrations).

In the Russian Federation, a different tactic for managing pregnant women with a threat of miscarriage is generally accepted. For this pathology, bed rest (physical and sexual rest), a nutritious diet, gestagens, vitamin E, methylxanthines are prescribed, and as symptomatic treatment - antispasmodics (drotaverine, suppositories with papaverine), herbal sedatives (motherwort decoction, valerian).

NON-DRUG TREATMENT

Oligopeptides and polyunsaturated fatty acids must be included in a pregnant woman's diet.

DRUG TREATMENT

Hormonal therapy includes natural micronized progesterone 200-300 mg/day (preferred) or dydrogesterone 10 mg twice a day, vitamin E 400 IU/day.

Drotaverine is prescribed for severe pain intramuscularly at 40 mg (2 ml) 2-3 times a day, followed by switching to oral administration from 3 to 6 tablets per day (40 mg in 1 tablet).

Methylxanthines - pentoxifylline (7 mg/kg body weight per day). Papaverine suppositories 20–40 mg twice a day are administered rectally.

Approaches to the treatment of threatened miscarriage differ fundamentally in the Russian Federation and abroad. Most foreign authors insist that it is inappropriate to continue pregnancy for less than 12 weeks.

It should be noted that the effect of any therapy - medicinal (antispasmodics, progesterone, magnesium preparations, etc.) and non-medicinal (protective regimen) - has not been proven in randomized multicenter studies.

Prescribing drugs that affect hemostasis (etamsylate, vikasol©, tranexamic acid, aminocaproic acid and other drugs) for bleeding in pregnant women has no basis and proven clinical effects due to the fact that bleeding during miscarriages is caused by detachment of the chorion (early placenta) rather than coagulation disorders. On the contrary, the doctor’s task is to prevent blood loss leading to hemostasis disorders.

Upon admission to the hospital, a blood test should be performed to determine the blood type and Rh affiliation.

With an incomplete abortion, heavy bleeding is often observed, which requires emergency assistance - immediate instrumental removal of the remnants of the fertilized egg and curettage of the walls of the uterine cavity. Emptying the uterus is more gentle (vacuum aspiration is preferable).

Due to the fact that oxytocin may have an antidiuretic effect, large doses of oxytocin should be discontinued after the uterus has emptied and bleeding has stopped.

During and after the operation, it is advisable to administer intravenously an isotonic solution of sodium chloride with oxytocin (30 units per 1000 ml of solution) at a rate of 200 ml/h (in early pregnancy, the uterus is less sensitive to oxytocin). Antibacterial therapy is also carried out, and, if necessary, treatment of posthemorrhagic anemia. Women with Rh-negative blood are given anti-Rhesus immunoglobulin.

It is advisable to monitor the condition of the uterus using ultrasound.

In case of a complete abortion during a pregnancy of less than 14–16 weeks, it is advisable to perform an ultrasound and, if necessary, curettage of the uterine walls, since there is a high probability of finding parts of the fertilized egg and decidual tissue in the uterine cavity. At a later date, when the uterus has contracted well, curettage is not performed.

It is advisable to prescribe antibacterial therapy, treat anemia as indicated, and administer anti-Rhesus immunoglobulin to women with Rh-negative blood.

SURGERY

Surgical treatment of NB is presented in the chapter “Non-developing pregnancy”.

Postoperative management

In women with a history of PID (endometritis, salpingitis, oophoritis, tubo-ovarian abscess, pelvioperitonitis), antibacterial therapy should be continued for 5–7 days.

In Rh-negative women (during pregnancy from a Rh-positive partner), in the first 72 hours after vacuum aspiration or curettage during pregnancy for more than 7 weeks and in the absence of RhA, rhesus immunization is prevented by administering anti-Rhesus immunoglobulin at a dose of 300 mcg (intramuscular).

PREVENTION

There are no specific methods for preventing sporadic miscarriage. To prevent neural tube defects, which partially lead to early spontaneous abortions, it is recommended to prescribe folic acid 2-3 menstrual cycles before conception and in the first 12 weeks of pregnancy in a daily dose of 0.4 mg. If a woman has a history of fetal neural tube defects during previous pregnancies, the prophylactic dose should be increased to 4 mg/day.

INFORMATION FOR THE PATIENT

Women should be informed about the need to consult a doctor during pregnancy if they experience pain in the lower abdomen, lower back, or bleeding from the genital tract.

FOLLOW-UP

After curettage of the uterine cavity or vacuum aspiration, it is recommended to avoid the use of tampons and abstain from sexual intercourse for 2 weeks.

As a rule, the prognosis is favorable. After one spontaneous miscarriage, the risk of losing a subsequent pregnancy increases slightly and reaches 18–20% compared to 15% in the absence of a history of miscarriages. If there are two consecutive spontaneous abortions, it is recommended to conduct an examination before the desired pregnancy occurs to identify the causes of miscarriage in this married couple.