Why does the fetus die in the early and late stages of pregnancy: the reasons for what to do

Frozen fruit is the cessation of all vital functions of the child in utero before birth. This is a very serious pathology, which is dangerous not only for the baby's life, but also for the life of the mother. Therefore, it is very important to diagnose this condition in time and take preventive measures to prevent complications.

Epidemiology

Statistics of the spread of fetal fetal pathology are such that about 6% of women are faced with this problem, and about 87% - at the first pregnancy. In 99% of cases there is a clear cause or a number of factors that cause this condition. About 80% of cases of monoamnotic twins with feto-fetal transfusion syndrome die one fetus and die in the early stages of pregnancy.

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11]

Causes of the dead fetus

Undoubtedly, the birth of a child for every woman is happiness. But in certain cases a child may die still in utero, which is called fetal fading. To prevent other cases of this pregnancy, the mother needs to find out the reason that could lead to this.

The causes of fetal fading can be divided into several groups.

1. Anomalies in laying eggs and breaking their chromosomal structure. This is more often when the woman's age is more than 35 years. Then the probability of mutation in the egg or already directly in the cells of the embryo increases, since during this time many different factors acted on the organism of the mother. This can lead to normal implantation of the egg, but at a certain stage of development of pregnancy a mutation occurs that does not allow the child to be born. The protective mechanism works and pregnancy can stop.
2. Hormonal disorders in the mother before and during pregnancy. Insufficiency of certain hormones that control not only implantation but also support the function of the placenta is one of the most frequent causes of fetal trophic disorders. Up to a certain point, such violations can be compensated, but then there may be an acute shortage of the placenta function, which will lead to fetal death in utero.
3. Infectious process in the mother of an acute or chronic nature. Any microorganism, be it a virus or a bacterium, can penetrate the placenta and disrupt the differentiation of cells and the functioning of the fetal organs. Certain bacteria and viruses have a certain effect, but any of these pathogens can cause an acute reaction from the fetus. The most dangerous for the child are microorganisms from the group TORCH. Viruses are considered to be more powerful inducers of mutations, so they can often cause fetal fading. Often, women are infected with the herpes virus. Can the fetus be frozen because of herpes? In herpetic infection, the membranes of the fetus, in particular the chorion, are affected. There is necrosis of the villus of the chorion, leukocyte infiltrates appear, large histiocytes with decaying nuclei, intranuclear inclusions. Dystrophic changes of syncytium, stromal fibrosis and changes in vascular network of villi with thickening of the walls are observed. These changes are clinically expressed in chronic placental insufficiency, which eventually leads to a decrease in fetal trophic and death due to insufficiency of oxygen and nutrients.
4. The pathology of the structure or function of the female genital organs often allows one to conceive, but does not allow the child to be born normally. Defects of the development of the uterus (saddle, double), violations of the histological structure of the uterus, insufficiency of the ovaries - all this leads to the fact that pregnancy can occur, but can not develop normally. Also to such group of the reasons it is possible to carry inflammatory processes of ovaries. Such a process can be asymptomatic, but when pregnancy occurs, the process is activated. Then directly the microorganism can become a mutagen in relation to the fetus, or there is a deficiency of the inflamed ovary, which does not allow to produce hormones necessary for pregnancy.
5. Immunological causes of the development of fetal fading occupy the first place in prevalence. During pregnancy, the immunological activity of the maternal organism decreases, so that the fetus is not perceived as an alien organism and there were no immune reactions. In women who have autoimmune diseases, or lack of an immune response system, this reaction is different. The pathogenesis of fading pregnancy is as follows: any factor that leads to fetal death in utero should cause a reaction of rejection of the dead fetus. But with the breakdown of immune reactivity, such a reaction does not occur, which leads to the fact that the fetus is still in the womb for a while.
6. Gestational endotheliopathy is a lesion of the endothelium, as a result of which there are violations of physiological processes that provide adequate utero-placental-fruity haematopoiesis. Conditions for the development of gestational endotheliopathy are formed when infringement of trophoblast invasion into spiral vessels of the uterus, as a result of which they partially or completely retain the muscle layer and are capable of reacting with constriction or expansion to the action of vascular-active substances. Endothelial dysfunction is manifested in excessive synthesis of vasoconstrictors, activation of blood clotting, as a result of which the nutrition of the embryo or fetus is disrupted and its death occurs in utero.
7. Antiphospholipid syndrome is a newly diagnosed pathology, which is accompanied by disturbances in the system of coagulation in vessels with frequent thrombosis. Pathology arises from the formation of specific antibodies against cell phospholipids. Changes affect the fetus very often. There is a pathology of the placenta, which is accompanied by infarcts and necrosis of the placenta, the accumulation of fibrinoid masses in the intervillous space, atherosis and thrombosis of the spiral arteries. Add to this the developmental disorders of the placenta - dystrophic changes of syncytium, fibrosis of the stroma and changes in the vasculature of villi with thickening of the walls. This causes a double risk of placental insufficiency and fetal fading early in life.
8. Many drugs can cause pregnancy fading, and not so important is their direct admission, as in general the fact of reception ever. Which pills freeze from the pills? This group includes contraceptives, as well as funds that are classified as early means of abortion.
9. Fetal fading, unfortunately, is more common in multiple pregnancies. Often there are cases when monochorion monoamniosic double one fetus is frozen. Why is this happening? When two fetuses have one placenta, anastomoses can form between their circulatory systems. According to these anastomoses, a blood pressure gradient results in the discharge of blood from one circulatory system to another. One child becomes a donor and gives his blood to these vessels on the placenta to the second child - the recipient. Such "stealing" eventually leads to acute deficiency of oxygen and nutrients and fetuses die in utero, while the other continues to live. An immune reaction does not occur, because there is a living fetus, so the dead child dies.

Given the many reasons for pregnancy fading, it is necessary to identify the risk factors for this pathology, which can not directly cause fetal fading, but can affect it if there is a cause. These factors include the adverse effects of radiation, medications, large growth and maternal body weight, eating habits with malnutrition and very strict diets.

[12], [13], [14], [15], [16], [17]

Symptoms of the dead fetus

Fading of the fetus is dangerous precisely because the course of this pathology up to a certain point can be absolutely asymptomatic. The symptoms of a dead fetus are more pronounced when it is already formed in later terms.

Fetal fetus in early pregnancy is rarely diagnosed, as it proceeds with the symptoms of miscarriage. If the fetal fading occurs in the first few hours, the body may not react, as with a miscarriage. Only after a few hours can there be a reaction of rejection of the fetus, which will already have symptoms. Then there is pain in the lower abdomen, excretion.

Frozen fetus in the second trimester has a richer clinical picture, since during this period all the organs and systems in the child have already formed. Mom begins for the first time to feel the movements of the fetus, its activity, sometimes palpitations. This begins with the 19-20th week of pregnancy. Therefore, the first signs of fading of the fetus in the second trimester is a sharp cessation of movements and any activity of the fetus. Mom immediately feels the change, because earlier all the movements were active. This symptom may be preceded by a history of injury or the effect of a pathogenic factor. Together with this, body temperature can rise, which is not always the case.

When the fetus died at a late date, the symptoms of this are most pronounced. All movements are drastically slowed down, a woman can feel a sharp deterioration in the state, which is progressing in dynamics. When fetal fading occurs without miscarriage, all the products of fission and vital activity of the dead fetus enter the body of the mother. Therefore, there may be nausea, the body temperature will rise, intoxication will increase. There may be spotting from the uterus or with time pulling the pain in the abdomen. But severe clinical signs are rare, and apart from stopping fetal movements and disappearing subjective sensations of a pregnant woman, there are rarely any symptoms.

When a pregnant woman develops twins, and one fetus freezes, the diagnosis in most cases is possible only with the help of additional methods.

[18], [19], [20], [21], [22], [23]

Complications and consequences

The consequences of fetal fading for a woman's life, as a rule, are not dangerous with timely diagnosis. Several days the frozen fetus may be in the uterus without symptoms, but then the process of rejection begins, and symptoms appear. If this process lasts a very long time, then there may be a secondary infection and the development of sepsis in the mother, since there is a supporting source of infection. The long-term consequences of fetal fading can develop already in the following pregnancies. Since there is a delay in the fetus and its tissues in the uterus for a long time, this can lead to a violation of the histological structure of the endometrium. In the future, such changes threaten to violate the process of implantation of the egg or miscarriages. In addition, the longer the frozen fetus is in the uterus, the greater the likelihood of the formation of antibodies and the occurrence of an antigenic conflict in the future.

Complications can occur in women after fetal fading with the onset of the next pregnancy. As the hormonal background is sharply broken, it can influence the further function of the ovaries. Therefore, after such a result of pregnancy, women should be carefully screened and treated, observing the interval before the next pregnancy is at least a year.

[24], [25], [26], [27]

Diagnostics of the dead fetus

Diagnosis can be difficult because of the poor clinical picture of this disease. Therefore, it is important to take into account anamnestic data, and in the presence of trauma or any other pathological factor - carefully examine the woman.

If any pathology is suspected, the pregnant women are examined in mirrors and manually examined. When viewed in mirrors in the case of a frozen fetus, there is no pathology - the external yawn is closed, the cervix is formed, of normal height, the tone is not changed. In a manual study, it can be established that the size of the uterus can be slightly less than expected for a given period of pregnancy. In the second trimester, it is impossible to determine the fetal heart rate and there are no fetal movements during balloting.

Huge importance in the diagnosis of the dead fetus has additional research methods. Especially if there are twins, the signs of the cessation of the vital activity of one of the fruits is very difficult to determine with a simple examination.

Instrumental diagnosis of a dead fetus necessarily includes ultrasound diagnosis and cardiotocography. Cardiotocography normally allows you to determine the heartbeat of the fetus, the activity of movements, the tone of the uterus. If there is a frozen fetus, then the heartbeat can not be determined, which is an absolute sign of pregnancy fading. It may be that the bradycardia is first determined with gradual progression, and then cardiac contractions are not determined at all.

Ultrasonic diagnostics can identify fetal placement, its heart rate, size, position and blood flow. If there is a frozen fruit, then the size of the fetal egg will be less than it should correspond to this term of pregnancy. In dynamics there will be no growth of the fetal egg. If it is a question of twins, then one fetus may be significantly larger with more amniotic fluid, and another will have a decrease in mass.

For the purpose of diagnosis, biochemical indices are also determined. In the early stages, this is a very informative indicator, when the heartbeat is not yet established. The most informative is the definition of the chorionic gonadotropin. This hormone is synthesized by the placenta to maintain a normal pregnancy. If fetal fading occurs early, its level is significantly below the gestational age.

The diagnosis of a frozen pregnancy is not only to establish a diagnosis, but it is also necessary to establish the reason why it happened. Therefore, a very important task is also to study the fetus for anomalies that could cause fading. Conduct a comprehensive sectional study of the organs and tissues of the fetus. Genetic analysis of the dead fetus is conducted with the purpose of studying the genotype for the elimination of chromosomal mutations. Most often, the fading of pregnancy in the early stages is due to a genetic mutation. For the study, buccal epithelium is used most often. Cytogenetic analysis of the fetus after a frozen pregnancy allows you to determine under the microscope the number of chromosomes and their magnitude. Further necessarily carry out karyotyping. Karyotyping of the fetus in the case of a dead pregnancy consists in the distribution of chromosomes to special paired groups, where each chromosome has its own number. This allows you to compare the set of chromosomes and exclude aberrations.

The histology of a dead fetus is a study of tissues to identify abnormalities in their structure and anomalies in the structure of organs that may be incompatible with life. Often a histological examination of the heart of the fetus, lungs, and the brain is performed to exclude serious pathologies that can lead to this outcome. It is often possible to histologically determine changes in the tissue structure, which in the future requires an analysis for the presence of pathogenic microorganisms. Herpetic infection can cause characteristic changes in the brain tissues (cysts), the liver - such a complex diagnosis with the study of histology makes it possible to establish a preliminary cause of fetal fading.

[28], [29], [30], [31], [32], [33]

Differential diagnosis

Differential diagnosis of a dead fetus should be carefully performed when there is a pregnancy with twins. It is very important to diagnose in time the death of one of the fruits, since the products of vital activity from the deceased fetus through the common placenta can get to a healthy child. This threatens the development of neurological disorders in a live fetus in the future after birth. When there is a development of feto-fetal transfusion syndrome, one fetus has a strong decrease in amniotic fluid, so that the chorion fits tightly to the fetus. This immediately leads to the fading of this child. In the early stages of pregnancy, with ultrasound examination of the second frozen fetus, it is difficult to detect and often monotonous pregnancy is diagnosed. Therefore, it is important to conduct differential diagnosis with a large number of amniotic fluid with a possible multiple pregnancies.

Treatment of the dead fetus

Suspicion of fetal fading at any time of pregnancy requires the immediate hospitalization of a woman and treatment in a stationary setting. If the diagnosis of fetal fading is established with the help of additional diagnostic methods, then treatment with the purpose of evacuation of the fetus from the uterus cavity and termination of pregnancy must be carried out. Can the frozen fruit go out by itself? It is necessary to emphasize that tactics of waiting can not be adhered to, because if the fetus has died without the phenomena of miscarriage, then the probability that he will "come out" is very small. And if the frozen fruit lingers in the uterine cavity for a long time, it significantly increases the risk of bleeding and thrombotic complications.

Removal of the frozen fetus is medication or surgical. The smaller the gestation period, the more often surgical intervention is used. Cleaning of the dead fetus in the early stages passes by the type of operation. Under general anesthesia, an abortion is performed with the extraction of the fetus from the uterus and all the fetal membranes. If the fetus was in the uterus for a long time, then this increases the risk of bleeding, so it is necessary to have all the preparations for blood transfusion. After removal of the fetus, the uterine cavity is examined to avoid leaving parts of the membranes. After a week, ultrasound examination of the uterus is mandatory, in order to avoid complications of the operation.

In the second trimester of pregnancy, a medicamentous removal of the frozen fetus is carried out. To this end, use drugs that stimulate uterine contraction and the yield of the fetal egg. This is considered a less invasive intervention. Use prostaglandin drugs or oxytocin.

Parenteral administration of oxytocin solution is the most effective medication method for induction of fetal ejection in a stunted pregnancy. Oxytocin is usually administered at a concentration of 10 U / l (0.01 U / ml) of an isotonic solution of electrolytes or a 5% solution of glucose, but the dose must be individualized. Infusion begins at a rate of 0.01 U / min and increases in an arithmetic progression every 15 minutes, but not more than 0.15 U / min. A dose of more than 0.4 U / ml leads to kidney damage and can be used in very rare cases. When the intensity of uterine contractions is 40-60 (with internal monitoring) or their duration is 40-60 with intervals of 1-4 min, the dose of oxytocin is stopped. With a decrease in uterine contractions, oxytocin administration is continued. Infusion is slowed or stopped when the intensity of uterine contractions is greater than 60, lasting more than 60 seconds and intervals between them less than two minutes.

Individually appointed antibacterial drug with a preventive purpose.

Prevention

Preventing pregnancy fading is the timely diagnosis of inflammatory diseases of the sexual organs of a woman, identifying risk factors. For the prevention of pregnancy fading in women, which such a pathology has already happened, you need a thorough investigation after the first episode. It is very important to conduct genetic counseling for parents before planning the next pregnancy. Elimination of stress, improved diet, exclusion of environmental factors - all this is very important for the development of a normal pregnancy in the future.

Frozen fetus is one of the types of miscarriage, in which the fetus remains in the uterus and does not occur spontaneously. It is very important to diagnose this pathology on time, because clinical manifestations may not be expressed. The longer the frozen fetus remains in the uterus, the greater the risk of fatal complications for the mother. Given such a seriousness of this problem, it is necessary to prevent this condition by all methods.

[34], [35], [36], [37], [38]

Forecast

The prognosis for the next normal pregnancy is good, if pregnancy fading occurred the first time. With each miscarriage, the risk of a repeated unsuccessful pregnancy rises. The prognosis is favorable for women of younger age without accompanying pathologies.

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