Symptoms of spontaneous abortion (miscarriage) are expressed in the presentation of the patient's complaints for bleeding from the genital tract, pain in the lower abdomen and in the lower back with a delay in menstruation.
Depending on the clinical symptomatology distinguish between threatening spontaneous abortion, abortion, abortion in progress (incomplete or complete), an undeveloped pregnancy, an infected abortion.
Threatening abortion is manifested by drawing pains in the lower abdomen and in the lower back, sometimes with scant bloody discharge from the genital tract. The tone of the uterus is increased, the cervix is not shortened, the inner yawn is closed, the uterus body corresponds to the gestation period. With ultrasound, the fetal heart rate is recorded.
Symptoms of abortion
With the onset of abortion, pain and spotting from the vagina are more pronounced, the cervical canal is ajar. It is necessary to diagnose the following obstetric complications: chorion abruption (placenta) and its size, presentation or low location of the chorion (placenta), bleeding from the second horn of the uterus at the developmental defects, the death of one fetal egg in multiple pregnancies.
Symptoms of abortion while on the move
With abortion, regular cramping contractions of the myometrium are determined during the abortion, the size of the uterus is less than the expected duration of pregnancy, in the later stages of pregnancy, leakage of amniotic fluid is possible. The inner and outer sores are open, the elements of the fetal egg in the cervical canal or in the vagina. Bloody discharge can be of different intensity, more abundant.
Symptoms of incomplete abortion
Incomplete abortion is a condition associated with a delay in the uterus of the elements of the fetal egg. Absence of full-scale reduction of the uterus and closure of its cavity leads to continued bleeding, which in some cases can lead to large blood loss and hypovolemic shock. It is more common after 12 weeks of pregnancy in the case when a miscarriage begins with a discharge of amniotic fluid. In a bimanual study, the uterus is less than the expected duration of pregnancy, spotting from the cervical canal is abundant, ultrasound in the uterine cavity determines the remains of the fetal egg, in the second trimester - the remains of the placental tissue.
Symptoms of an infected abortion
Infected abortion is a condition accompanied by fever, chills, malaise, lower abdominal pain, bloody, sometimes pus-like secretions from the genital tract. Physical examination reveals tachycardia, tachypnea, muscle defensiveness of the anterior abdominal wall, with bimanual examination - a painful, soft consistency of the uterus, the cervix is enlarged. The inflammatory process is most often caused by Staphylococcus aureus, streptococcus, gram-negative microorganisms, Gram-positive cocci. In the absence of treatment, generalization of infection in the form of salpingitis, local or diffuse peritonitis, septicemia is possible.
Non-developing pregnancy (antenatal fetal death) - death of an embryo or fetus in terms of up to 20 weeks of pregnancy in the absence of expulsion of elements of the fetal egg from the uterine cavity.
In the first trimester, miscarriage is characterized by a combination of pain and bloody discharge. In the second trimester, the initial manifestations of abortion are cramping pain in the lower abdomen, bleeding joins after the birth of the fetus. The exception is abortion on the background of placenta previa, when the leading symptom is bleeding, usually abundant.
A threatening miscarriage is manifested by minor pain in the lower abdomen. The miscarriage started is accompanied by increased pain and possible bleeding. For abortion "in motion" is characterized by a sharp increase in pain cramping character and heavy bleeding. For incomplete abortion, pain reduction is typical for continuing bleeding of varying severity. With complete abortion, the pain subsides and bleeding stops.
Features of symptoms of spontaneous miscarriage may be due to the etiological factor that caused it. So, abortion, the cause of which is istmiko-cervical insufficiency, occurs in the second trimester of pregnancy, begins with the outflow of amniotic fluid and ends with the rapid birth of the fetus in the foyer of weak, painless fights. Genetic factors lead to miscarriage in the early stages of pregnancy. Abortions against the background of androgenia in the early periods begin with bloody discharge, then it is joined by a pain symptom, often in such cases a frozen pregnancy is formed. In the late period, intrauterine fetal death is possible. The death of the fetal egg with subsequent expulsion from the uterus can be observed in the presence of chronic and acute infection, while bleeding is rarely abundant.
To clarify the diagnosis, it is necessary to examine the cervix and vagina in the mirrors (if there is a suspicion of neoplasms of the cervix produce colposcopy and biopsy), careful bimanual examination, determination of the level of chorionic gonadotropin.
In the development of tactics for managing pregnancy with bleeding in the first trimester of pregnancy, ultrasound plays a crucial role.
Unfavorable signs regarding the development of the fetal egg in uterine pregnancy with ultrasound:
the absence of a heartbeat embryo with a coccygeal-parietal size of more than 5 mm;
absence of an embryo at the size of a fetal egg more than 25 mm in 3 orthogonal planes with transabdominal scanning and more than 18 mm in transvaginal scanning.
Additional ultrasound signs, indicative of an unfavorable outcome of pregnancy, include:
an abnormal yolk sac, which may be longer than the gestational age, irregular in shape, displaced toward the periphery or calcified;
the heart rate of the embryo is less than 100 beats per minute with a gestational age of 5-7 weeks;
large dimensions of retrochorial hematoma - more than 25% of the surface of the fetal egg.
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Medical expert editor
Portnov Alexey Alexandrovich
Education: Kiev National Medical University. A.A. Bogomolets, Specialty - "General Medicine"
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