Unintended pregnancy: causes and signs

A condition in which the growth of the fetus stops and its intrauterine death occurs is called a frozen or non-developing pregnancy. Such a pathology during the gestation period is considered one of the forms of miscarriage. In a non-developing pregnancy, the child dies in the mother's womb, and its exit from the uterine cavity does not occur. A lifeless fetus can remain in the uterus for quite a long time and does not leave it without medical intervention. In a spontaneous abortion, the fertilized egg is expelled from the uterine cavity with the corresponding symptoms.

[ 1 ], [ 2 ], [ 3 ], [ 4 ]

Causes unintended pregnancy

No woman is immune from miscarriage. The onset of a non-developing pregnancy can occur in any trimester, at any age of the expectant mother. After 40 years, the risk of miscarriage increases to 40%. There may be several reasons that influence the freezing of embryonic development. Most often, these are genetic pathologies incompatible with the life of the fetus. But only a specialist - a gynecologist or geneticist - can determine them.

Among the most common factors causing intrauterine fetal death are: genetic disorders, infectious diseases, immunological rejection of the fetus, endocrine pathologies of the mother, work in heavy or toxic industries. If pregnancy stops two or more times in a row, they say, habitual miscarriage. But even several miscarriages do not exclude the possibility of giving birth to a healthy child. It is necessary to find out the circumstances of what is happening and not despair.

[ 5 ], [ 6 ], [ 7 ], [ 8 ], [ 9 ]

Symptoms unintended pregnancy

At the beginning of the gestational period, in the first trimester, the distinctive features of a non-developing pregnancy are considered to be a dulling of individual sensitivity, characteristic of most women expecting a child:

• engorgement of the mammary glands practically disappears (both breasts become soft);
• the severity of nausea, vomiting and other signs of early toxicosis is reduced;
• the frequency of vomiting is reduced,
• the perception of strong odors is dulled,
• drowsiness and weakness decrease and practically disappear.

For the first trimester, the critical periods are 3-4 weeks of gestation, when the fertilized egg is attached to the wall of the uterus, in the 8-11th week many vital systems (digestive, bone, genitourinary, etc.) continue to form, and the umbilical cord is formed. During these periods, genetic problems manifest themselves in full, which leads to serious consequences.

But not every pregnant woman will pay attention to such minor changes in her well-being. For this reason, the death of the embryo occurs, but it is not determined immediately. For some time, many women expecting a child do not even suspect what has happened. During a gynecological examination, a discrepancy in the gestational age and the size of the uterus is determined. To make sure that the discrepancy is not caused by intrauterine death of the embryo or fetus, an ultrasound examination is prescribed.

A threatening sign of a non-developing pregnancy is spotting vaginal discharge from pinkish to brown, pain in the lower abdomen and altered uterine tone. The final verdict on the presence of a non-developing pregnancy will be made by ultrasound examination. The absence of a heartbeat is determined at 5-6 weeks, a deformed (often empty) ovum and discrepancy between the ultrasound results and the gestational age. Repeated ultrasound diagnostics can be prescribed in a week to exclude errors in establishing the diagnosis. If positive dynamics (growth of the ovum) is not noted within 7 days, the embryo is not visualized, then the pregnancy will be considered "frozen". The doctor chooses the tactics of further treatment.

The first signs of a non-developing pregnancy in the early stages

The first signs of a non-developing pregnancy in the early stages of pregnancy can be diagnosed by analyzing the level of hCG (human chorionic gonadotropin). Dynamics plays an important role here. If the embryo develops without pathologies, then the hCG levels almost double daily.

Measuring basal temperature when there is a suspicion of a frozen pregnancy will not be informative. During a normal pregnancy, the basal temperature is 37.3-37.5 ° C, and if the pregnancy does not progress, the temperature decreases.

Ultrasound will also not be informative, since at very early stages the fertilized egg and embryo are not visualized.

Non-viable pregnancy in the second trimester

In the early stages of gestation, the possibility of fetal development stopping is much higher than in the second trimester. But even at this stage of gestation, pregnancy "freezing" occurs quite often. Two periods are considered critical for the second trimester - 16-18 weeks and 22-24 weeks.

The causes of fetal death in the second trimester are: hereditary genetic pathologies, unhealthy lifestyle (smoking, alcohol and drug abuse), hormonal disorders, and various infections.

Genetic failures usually manifest themselves at earlier stages of pregnancy (by 6-7 weeks). If the pathology is severe, then the embryo in most cases does not survive until the second trimester. Genetic anomalies of the mother and father are very difficult to detect, and it is impossible to predict at what point they will affect the child's development.

Also, the balance of hormones is very important for the normal development of the embryo: if the balance is disturbed, the fetus stops developing.

Most often, this happens before the 8th-10th week, but it also happens in the second trimester. During the gestation period, the woman's immune system is weakened, the degree of vulnerability of the body increases. The penetration of pathogens of some infections through the placental barrier can lead to the death of the fetus. But such a danger remains throughout the entire 9 months. Therefore, you should very carefully protect yourself from any infections, take preventive measures and promptly seek help from specialists.

It is worth mentioning once again about the correct lifestyle that a future mother should lead. Stress, working on a computer, smoking, alcohol or drugs, lack of sleep significantly provoke a frozen pregnancy at any stage.

The appearance of vaginal bloody discharge, aching pain in the lower abdomen, cessation of breast enlargement (they become soft, colostrum may be released from them), a feeling of chills, an increase in body temperature, trembling, severe weakness, the disappearance of all signs of toxicosis, the absence of movements - these are very serious reasons for immediate medical attention. A gynecologist determines the freezing of the fetus in the second trimester of pregnancy by the discrepancy between the timing and size of the uterus, a change in the color of the vagina and the absence of audible heartbeat through a stethoscope. In this case, the pregnant woman is immediately sent for an ultrasound scan and, if necessary, urgently hospitalized. Signs of a non-developing pregnancy in the second trimester, unfortunately, appear very late. For a long time, the freezing of fetal development does not manifest itself in any way, and the severe poisoning of the mother's body with decay products is already occurring. A woman needs to contact a specialist as soon as possible to reduce the likelihood of tragic consequences. From 18-20 weeks, fetal movements are felt, they should be repeated more than 9 times a day. If there are fewer or no movements, this is a reason to visit a doctor.

During a normal pregnancy, the breasts increase significantly in size, but if there are problems with the fetus, they decrease in size and soften.

If the doctor does not listen to the heartbeat with a stethoscope, then there is no need to panic in advance, because the fat layer sometimes prevents auscultation. In this case, ultrasound will be very appropriate.

Normally, vaginal discharge is transparent or whitish, not very abundant, but if the volume of discharge increases, it is dark in color or bloody, then this is an emergency situation for an immediate visit to the antenatal clinic.

Treatment for non-developing pregnancy in the second trimester is surgical.

Signs of a non-developing pregnancy in the third trimester

Cases of non-developing pregnancy in the third trimester occur less frequently than at an earlier gestational age. This is explained by the fact that the fetus is already sufficiently formed. But the risk of non-developing pregnancy in the third trimester still remains. The older the woman, the greater the chances of developing miscarriage, especially critical in the third trimester - 26-28 weeks.

The causes of antenatal mortality of the fetus in the third trimester may be: infection with infectious diseases (rubella, influenza, toxoplasmosis, cytomegalovirus, syphilis, gonorrhea, etc.), hormonal disorders, genetic abnormalities in fetal development, diseases of the genitourinary and cardiovascular systems. Particularly dangerous is antiphospholipid syndrome, a characteristic feature of which is a tendency to form blood clots, including in the vessels of the uterus, as a result of which the fetus does not receive enough oxygen and nutrients and dies.

The first and most alarming sign of a non-developing pregnancy in the third trimester is the absence of fetal activity (movement) for more than 6 hours. This is a very serious cause for concern. To rule out fetal death, a tocogram is prescribed. It will either confirm or refute the fear. Ultrasound at a late stage of pregnancy is also informative. Brown spotting from the vagina with a "frozen" pregnancy in the third trimester is a consequence of the neglect of the process, which began quite a long time ago.

At later stages, a non-developing pregnancy may manifest itself as pain in the lower abdomen or lumbar region, altered uterine tone, and spotting (watery, bloody, brownish).

There is a very high probability of maceration of the dead fetus and its decomposition. Then, to certain signs of a non-developing pregnancy in the third trimester, symptoms of intoxication and high body temperature will join, provided there is no acute respiratory viral infection. A complication of infection of a non-developing pregnancy at a late stage can be a septic condition. At the slightest alarm and bad suspicions of a frozen pregnancy, it is necessary to urgently contact a specialist. Let him once again confirm that everything is normal with the fetus and the expectant mother.

Obvious signs of a non-viable pregnancy

Obvious signs of a "frozen" pregnancy in the early stages are:

• discrepancy between the fertilized egg, the size of the uterus and the gestational age;
• bloody or brown vaginal discharge;
• ultrasound results (the fetus is absent from the fertilized egg, the fertilized egg is deformed)
• stabilization or decrease in hCG levels;
• subjective sensations during a lost pregnancy in the early stages:
• pulling or cramping pain in the lower abdomen;
• significant reduction or cessation of toxicosis symptoms (nausea, vomiting, “sensitivity” to strong odors);
• spotting bloody vaginal discharge.

Gynecological examination: the gestational age and the size of the uterus are in significant discrepancy; the basal temperature decreases; the color of the vaginal walls changes.

Signs of a "frozen" pregnancy at a later stage:

• prolonged absence of fetal movements (more than 6 hours);

• the fetal heartbeat is not audible with a stethoscope or is not detected by a tocograph;
• There is a discrepancy between the gestational age and the size of the uterus.

Subjective sensations:

• the symptoms typical of toxicosis disappear, tension in the mammary glands decreases, and sometimes colostrum secretion is observed;
• aching pains occur in the lumbar region and abdomen;
• body temperature rises for no apparent reason;
• bloody discharge from the vagina.

Gynecological examination: the doctor determines how big the difference is between the gestational age and the size of the uterus, notes the change in the color of the vaginal walls, slight dilation of the cervix and discharge from the genital tract.

[ 10 ], [ 11 ]

Diagnostics unintended pregnancy

If there is a suspicion of a "frozen" pregnancy at any stage, an ultrasound examination will be quite informative.

The conclusion about the termination of embryo development at an early stage of pregnancy is made during an ultrasound scan in the following cases:

• anembryonic location of the fertilized egg in the lower part of the uterus;
• its deformation, distorted outline;
• the embryo is significantly smaller than the normal size typical for a given gestational age;
• At 5-6 weeks, ultrasound can already detect the fetus's heartbeat or lack thereof.

[ 12 ], [ 13 ], [ 14 ]