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Spontaneous abortion (miscarriage): diagnosis
Last reviewed: 19.10.2021
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Diagnosis of spontaneous miscarriages usually does not cause difficulties. It consists of complaints made by the patient; general and gynecological survey data; results of collicological, hormonal and ultrasound methods of investigation.
The general condition of the patient may be due to the presence of the pregnancy itself, and the degree of hemorrhage associated with the form of spontaneous miscarriage. With a threatening and started miscarriage, the condition of women is usually satisfactory, if early toxicosis of pregnant women does not overlap and miscarriage is not provoked by severe somatic pathology. With abortion "in motion", incomplete and complete abortion, the patient's condition depends on the duration, intensity and degree of hemorrhage. Prolonged, small bleeding leads to anemia of the patient, the severity of which determines the condition of the woman. Acute blood loss can cause a shock.
Data gynecological examination with a threatening miscarriage testify to the correspondence of the size of the uterus to the period of delay of the monthly. The uterus reacts to palpation by contraction. There are no structural changes on the part of the cervix. When the miscarriage begins, the cervix can be somewhat shortened with a slightly gaping external pharynx. The spastic body of the uterus, corresponding to the period of pregnancy, the lower pole of the fetal egg, easily reached through the cervical canal, testifies to an abortion "in motion". In case of incomplete abortion, the size of the uterus is less than the gestation period, and the cervical canal or the external crook is ajar.
To additional methods of diagnosing spontaneous miscarriages, there is no need to resort to all cases of the disease. Abortion "in motion" and, as a rule, incomplete abortion do not require the use of additional diagnostic methods. Only in some cases, an ultrasound is involved, helping to differentiate incomplete abortion from the beginning.
Laboratory and hardware methods are used for early diagnosis and dynamic observation of the initial stages of abortion.
Colpocytological studies help to identify the threat of abortion long before the onset of clinical symptoms. It is known that the karyopicnotic index (KPI) in the first 12 weeks of pregnancy should not exceed 10%, at 13-16 weeks it is 3-9%, in later terms the CPI is kept within 5 %. Increased CPI indicates a threat of termination of pregnancy and requires hormonal correction.
However, it should be remembered that in case of onset of pregnancy against the background of androgensis, a decrease in CPI is an unfavorable sign dictating the necessity of using estrogen preparations.
Prognostic value has a definition in the blood plasma of choriogonine, estradiol and progesterone. Termination of pregnancy in the first trimester becomes very real if the level of chorioronin is below 10 000 mIU / ml, progesterone is below 10 ng / ml, estradiol - below 300 pg / ml.
In women with androgenesis, a significant diagnostic and prognostic value is the determination of the level of 17-CS in the daily amount of urine. If the amount of 17-CS exceeds 42 μmol / l, or 12 mg / day, then the threat of spontaneous miscarriage becomes real.
The value of laboratory methods for diagnosing the threat of abortion increases if ultrasound is also performed simultaneously. Echographic signs of a threatening miscarriage in the early stages of pregnancy are the arrangement of the fetal egg in the lower parts of the uterus, the appearance of fuzzy contours, deformation, constrictions of the fetal egg. From the end of the first trimester of pregnancy, with the threat of its interruption, it is possible to identify areas of placental abruption, to measure the diameter of the isthmus.
[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13]