Treatment of abortive miscarriage

With undeveloped pregnancy (missed abortion), the embryo (fetus) dies without the appearance of signs of a threatening miscarriage. More often this type of termination of pregnancy is observed with habitual miscarriage, with hyperandrogenism, autoimmune disorders, etc. Clinically, the size of the uterus is less than the gestation period, the fetal heart rate is not determined, the subjective signs of pregnancy decrease, and sometimes spotting spotting can also occur.

The diagnosis is confirmed by ultrasound. When managing patients with a long delay in the fetal egg in the uterine cavity (4 or more weeks), coagulopathy complications are possible.

When conducting such patients, it is necessary to study the hemostasis system, determine the blood group and Rh-accessory, you need to have everything necessary to stop coagulopathic bleeding. At the term of pregnancy up to 12-14 weeks, one-stage removal of the fetal egg is possible (vacuum aspiration should be preferred). To remove the deceased fetus in the second trimester of pregnancy, specific methods can be used: intravenous administration of large doses of oxytocin by the method of Gurtovy BL, intra-amniotic injection of prostaglandin F2a, intravaginal injection of suppositories of prostaglandin E ,. Regardless of the chosen method of termination of pregnancy to improve the opening of the cervix, it is advisable to insert laminaria into the cervical canal at night before emptying the uterus.

With a prolonged course of spontaneous abortion (beginning, incomplete), it is possible to penetrate the microflora from the vagina into the uterine cavity with the subsequent development of chorioamnionitis, amnionitis, and endometritis. Infected (febrile) abortion can cause generalized septic diseases. Depending on the extent of infection, uncomplicated infection is isolated (the infection is localized in the uterus), complicated infected (the infection does not go beyond the pelvic floor) and septic (the process takes a generalized nature) abortion. The clinical course of an infected abortion is determined mainly by the extent of infection.

The mechanism of spontaneous termination of pregnancy can be different depending on the cause of abortion. In some cases, first there is a contraction of the uterus, which causes a detachment of the fetal egg. In other cases, the contraction of the uterus is preceded by the death of the fetal egg. Sometimes the detachment of the fetal egg and contraction of the uterus occur simultaneously.

With a failed abortion, undeveloped pregnancy after the death of the fetal egg, contractions of the uterus do not occur. The dead fetal egg is not expelled from the uterus and is subjected to secondary changes, the amniotic fluid is gradually absorbed. If the contractions of the uterus are insufficient to expel the deceased fetal egg, then a slow detachment of it occurs, which is accompanied by prolonged unpronounced hemorrhage leading to anemia. Such an abortion is called protracted.

With ischemic-cervical failure, abortion usually begins with a premature discharge of amniotic fluid. The fetal egg descends into the enlarged cervical canal, the membranes become infected and opened. Miscarriage, as a rule, occurs quickly and painlessly. However, there is also such an option for abortion in case of ischemic-cervical insufficiency, when as a result of the prolapse of the bladder and its infection, amniotic fluid pours out and a cervical canal spasm occurs, which sometimes lasts for a long time, and it is quite difficult to complete a miscarriage in these conditions.

To monitor the course of pregnancy in patients with habitual miscarriage currently used diagnostic tests, which allow long before the emergence of clinical signs of the threat of interruption to indicate a violation of pregnancy.