Antenatal fetal death management protocol. Causes of antenatal fetal death in early and late pregnancy, associated symptoms, recovery. Signs of intrauterine fetal death

The biggest tragedy for a pregnant woman is the antenatal death of the fetus. It happens during intrauterine development child and is a big shock not only for parents, but also for all relatives.

Pathologies of the placenta, fetus and umbilical cord

Many people want to figure out why this happened, to find out for themselves what caused the death of the unborn baby. But it is very difficult for doctors to answer this question unambiguously. difficult question. This is due to the large number of possible causes of antenatal death, as well as their complex nature.

Very rarely, the umbilical cord becomes entangled around the neck, which prevents nutrients from entering the body. If this process continues for a long time, suffocation occurs. Another danger associated with the umbilical cord is its location above the front of the fetus.

An equally rare cause of antenatal death is severe congenital pathology of the placenta. The presence of premature crusts, incorrect positioning, maternal falls, hematomas and other abnormalities negatively affect the transport of nutrients and oxygen. This provokes the appearance of growth disorders and intrauterine death. Premature aging placenta reduces its conductive functions. This contributes to the occurrence of morphological changes, which pose a great threat to the life and development of the unborn child.

Diseases of the pregnant woman and intrauterine death of the child

TO possible reasons Fetal death is often attributed to:

• the appearance of severe late toxicosis;
• various pathologies of the placenta (previa, premature detachment, malformations);
• diagnosing multiple pregnancy or oligohydramnios;
• incompatibility of Rh factors in the blood of mother and baby.

Not the last place in this list belongs to inflammatory processes in the genital organs, syphilis, hepatitis, and eczema.

For a more accurate determination, numerous specialized studies are required, which include an autopsy of a stillborn child, genetic testing, etc.

Factors leading to fetal death

Since the causes of fetal death have not yet been sufficiently studied, experts identify several factors:

• Disruption hormonal levels pregnant woman. This provokes progesterone deficiency, and the fetus does not receive enough nutrients. As a result, antenatal fetal death occurs. This condition is typical for the first trimester of pregnancy. In addition, early fetal death can be caused by thyroid disease and ovarian dysfunction (for example, polycystic disease).
• Stressful situations, abuse of various medications.
• Having bad habits.
• A variety of external influences (air travel, heavy lifting, radiation, prolonged exposure to the sun) and exposure to chemicals.

Immune and autoimmune factors

Recently, the immunological factor has become increasingly common. Since the fertilized egg consists half of the father’s genetic information, the expectant mother’s body can perceive it as a foreign body. This provokes the production of antibodies that interfere with the development of the fetus. In other words, the embryo is rejected by the woman’s immune system.

A large number of antibodies to phospholipids found in the blood plasma causes the appearance of autoimmune disorders. The first place among them belongs to antiphospholipid syndrome. Almost 5% of cases of fetal freezing occur due to the presence of this pathology. With subsequent pregnancies, this figure increases to 42%. The main reason for the appearance of this syndrome is heredity. The pathology provokes the formation of blood clots and significantly complicates the situation during pregnancy.

Impact of infectious diseases

Acute and chronic forms infectious diseases are also a great threat to the life of the fetus. The most common cases of fetal death are in the presence of herpes, mycoplasmosis, chlamydia, etc. They may appear earlier. But during this period there is a significant decrease in the woman’s immunity, and because of this, any illness during pregnancy manifests itself more intensely.

In the first trimester, cytomegalovirus poses a great threat, which very often causes pregnancy to fail. But more later it provokes the appearance of various developmental defects.

But, unfortunately, it is not always possible to determine why antenatal fetal death occurred. The reasons for it often remain unknown.

The first signs of antenatal death

It is very difficult to independently determine intrauterine fetal death in the early stages. This is due to the individuality of each pregnancy. Some people suffer from toxicosis, while others do not have it. Therefore, in the first trimester, the first symptom of intrauterine death of a child is the cessation of signs of pregnancy. This applies to those cases where they were present. If the woman initially feels well, antenatal fetal death is determined only during a visit to the doctor or an ultrasound scan.

Somewhat later, the main indicator of freezing is the lack of movement. Fetal death in the later stages is most often accompanied by spontaneous miscarriage. But there are also cases when a pregnant woman walks with the baby frozen inside for some time. The death of the fetus and the beginning of its decomposition process may be indicated by nagging pain in the abdomen and the presence of bloody discharge.

Maceration

The fetus can remain in a woman’s uterus from 1-2 days to several months, even years. In this case, maceration, mummification or petrification occurs in the uterine cavity. Approximately 90% of all cases are maceration - a putrefactive, wet process of tissue death. It is often accompanied by autolysis internal organs frozen child, their resorption.

The first time after death, maceration is aseptic in nature. And only after this does an infection appear, which very often provokes the development of sepsis in women.

Macerated fruit is characterized by flabby, soft, wrinkled skin with epidermis exfoliated in the form of bubbles. This explains the reddish coloration of the fetus's skin, which turns green when infected.

The head, like the chest and abdomen, has a flattened shape, soft, the bones of the skull are separated. The soft tissues are impregnated with liquid, separating the epophyses from the diaphyses. Bones and cartilage have a dirty red or brown tint.

Mummification and petrification of the fetus

Dry necrosis of the fetus is called mummification. Most often it occurs during multiple pregnancies. In this case, intrauterine death of one of the children occurs. Mummification is also observed when the umbilical cord is entwined around the fetal neck. As a result of this process, the fetus shrinks and amniotic fluid is absorbed.

A rarer case is petrification. Most often it is characteristic of ectopic pregnancy when calcium salts are deposited in the tissues of the mummified fetus. That is, the formation of the so-called lithopedion, or fossilized fruit, takes place. Its presence in a woman’s body can continue for many years. There are no symptoms intrauterine death fetus

Studies confirming the diagnosis

If there is a suspicion of intrauterine fetal death, the pregnant woman must be urgently hospitalized. To reliably confirm the diagnosis, FCG and ECG are used. Their results can confirm or deny the presence of heartbeats. An ultrasound examination of the fetus, which is also mandatory in this situation, in the early stages of pregnancy will help to see the absence of breathing and heartbeat, as well as blurry contours of the body. A little later, it can be used to detect the decomposition of the body.

Amnioscopy is one of the methods by which the condition of the waters and fetus is diagnosed. During this procedure, on the first day after the death of the fetus, a green tint of amniotic fluid can be detected. Later they acquire a less intense color and a blood admixture appears. The skin of the fetus has the same color. By pressing the amnioscope on the part of the fetus that is present, you can see the depression. This is explained by the lack of tissue turgor.

Quite rarely, X-ray examinations are used, during which it is possible to observe disturbances in the condition of the fetus:

• its size does not correspond to the period of pregnancy;
• flattened arch and blurred contours of the skull;
• the arrangement of the bones is imbricated;
• drooping lower jaw;
• curved spine;
• atypical nature of the arrangement of body members;
• decalcified skeleton.

Removing a dead fetus from the uterine cavity

If a suddenly terminated pregnancy (fetal death) was diagnosed in the first trimester of pregnancy, surgical intervention (curettage) is performed. Arbitrary miscarriages also occur.

If this problem arose in the second trimester and the placenta separated prematurely, an emergency delivery is performed. Determining its method depends on the degree of readiness of the birth canal. The likelihood of spontaneous expulsion of the fetus at this period is reduced to zero.

At the end of pregnancy, with intrauterine death of the fetus, spontaneous birth most often occurs. IN otherwise doctors stimulate labor.

Sometimes, if indicated, fetal-destroying operations take place. In the postpartum period, it is imperative to prevent endometritis and uterine bleeding.

Death of one fetus during multiple pregnancy

The incidence of death of one fetus during twin pregnancy is 1:1000. The causes of death in this case are different:

• pathology of the fetus during pregnancy;
• improper blood circulation;
• impaired development of the placenta or umbilical cord;
• the influence of mechanical factors (critical lack of oxygen in the common placenta or fetal sac).

This greatly affects the health of the second child, even leading to death. If one of the children dies in the first trimester of pregnancy, the probability that the second will survive is 90%. If fetal development stops before the third week, the frozen embryo resolves or softens. This is followed by drying. In this case, the woman may not feel absolutely any symptoms. And only ultrasound helps to identify pathology.

In later lines, the death of one of the twins can be provoked by fetal pathology during pregnancy associated with the development of severe damage to the central nervous system of the second. As a result, various pathologies of internal organs, and even death, can also occur.

Actions of medical workers

What the doctor will do when this problem is detected depends on the period of pregnancy. At a later date, he may decide to perform an emergency delivery, without taking into account the unpreparedness of the second fetus for birth. This happens when it would be safer for a living baby to be born than to be left with a dead fetus. And the sooner a living baby is removed from the uterine cavity, the less harm it will receive.

In the second trimester, if delivery is not possible, any relationship between the babies’ bodies can be stopped and blood transfused into a living fetus.

If this problem occurred in the last trimester, artificial birth is performed. Because the harm from having a dead child inside is caused not only to the healthy baby’s body, but also to the woman’s. This condition can provoke the appearance of coagulation disorders.

Ways to prevent intrauterine fetal death

It is very difficult to predict in advance whether intrauterine fetal death will occur. Therefore, before pregnancy, doctors recommend that absolutely all women, regardless of age, undergo a full examination. It consists of carrying out the following activities:

• Ultrasound of the pelvis;
• taking smears;
• carrying out urine and blood tests;
• thyroid examination;
• tests for the presence of infections and hormonal levels.

Additional studies may also be prescribed based on the individual characteristics of the female body.

Antenatal fetal death is not a death sentence. To prevent problems, future parents should conduct healthy image life, follow the doctor’s recommendations, conduct a full examination before planning a pregnancy and cure absolutely all existing diseases.

Oligohydramnios, incompatibility of the blood of mother and fetus according to the Rh factor. Factors contributing to fetal death include chronic intoxication of a pregnant woman (mercury, lead, arsenic, carbon monoxide, phosphorus, alcohol, nicotine, drugs, etc.), improper use (for example, overdose) of drugs, hypo- and trauma, as well as unfavorable socio-economic conditions. of the fetus in the intranatal period, in addition to the reasons mentioned, can be caused by birth trauma to the skull and spine of the fetus. The immediate cause of fetal death is often intrauterine infection. , acute and chronic (see Fetal hypoxia) , fetal deformities incompatible with life. Sometimes the cause of V. s. p. remains unclear.

After birth or removal from the uterine cavity of the dead fetus and placenta, a pathological examination is carried out. Macroscopically evaluate color, weight, size, consistency, presence pathological changes fetus and placenta, carry out morphological and placental examination. Due to cadaveric autolysis, examination of the internal organs of the fetus is often impossible.

Prevention of V. s. p. includes observance by pregnant women of hygiene rules (including diet and work regime), early diagnosis, adequate pregnancy complications, extragenital and gynecological diseases, proper management of childbirth. In the event of antenatal death of the fetus, it is advisable to conduct medical genetic counseling for the couple.

Bibliography: Becker S.M. pregnancy, L., 1975; Bodyazhina V.I., Zhmakin K.N. and Kiryushchenkov A.P. , With. 224, M., 1986; Grishenko V.I. and Yakovtsova A.F. Antenatal fetal death, M., 1978.

1. Small medical encyclopedia. - M.: Medical encyclopedia. 1991-96 2. First aid. - M.: Great Russian Encyclopedia. 1994 3. Encyclopedic Dictionary of Medical Terms. - M.: Soviet Encyclopedia. - 1982-1984.

See what “Intrauterine fetal death” is in other dictionaries:

INTRAuterine DEATH OF THE FETAL- – fetal death during pregnancy (antenatal death) or during childbirth (intrapartum death). The main causes of intrauterine fetal death are infectious diseases of the pregnant woman, in which pathogens and toxins are transmitted through... ... Encyclopedic Dictionary of Psychology and Pedagogy

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- (t. intrauterina) S. embryo or fetus that occurs inside the mother’s body at any stage of intrauterine life, including during childbirth ... Large medical dictionary

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- (toxicoses gravidarum, synonym of gestosis) pathological conditions pregnant women, causally related to the developing ovum and, as a rule, disappearing in the postpartum period. Toxicosis, manifested in the first 20 weeks. pregnancy, usually... Medical encyclopedia

Intrauterine fetal death is the death of a fetus during pregnancy or childbirth. Fetal death during pregnancy is classified as antenatal mortality, while death during childbirth is referred to as intranatal death. The causes of antenatal fetal death can be infectious diseases of the pregnant woman (influenza, typhoid fever, pneumonia, pyelonephritis, etc.), extragenital diseases ( birth defects heart disease, hypertension, diabetes mellitus, anemia, etc.), inflammatory processes in the genital organs. The cause of fetal death may be severe OPG-gestosis, pathology of the placenta (malformations, presentation, premature detachment) and umbilical cord (true node), entanglement of the umbilical cord around the fetal neck, oligohydramnios, multiple pregnancy, Rh incompatibility of the blood of the mother and the fetus. Fetal death in the intranatal period, in addition to the reasons mentioned, may be associated with traumatic brain injury and damage to the fetal spine during childbirth. The direct cause of fetal death is most often intrauterine infection, acute and chronic hypoxia, and fetal malformations incompatible with life. Sometimes it is not possible to determine the cause of intrauterine death. Stillbirth can remain in the uterine cavity for a long time (from several days to several months) and undergo maceration, mummification or petrification in utero. Most often, maceration occurs (putrefactive wet tissue necrosis), usually accompanied by autolysis of the internal organs of the fetus. In the first days after the death of the fetus, aseptic maceration occurs, and later an infection occurs, which can lead to the development of sepsis in the woman. The macerated fruit has a characteristic flabby appearance, soft consistency, skin of a reddish color, wrinkled with epidermis exfoliated in the form of bubbles. When infected, the skin turns green. The fetal head is soft, flattened, with separated skull bones. Rib cage and the abdomen also have a flattened shape. Congenital pulmonary atelectasis is a reliable sign of intrauterine fetal death. Clinical manifestations of antenatal fetal death are cessation of uterine growth and disappearance of engorgement of the mammary glands. The woman complains of malaise, weakness, a feeling of heaviness in the abdomen, and lack of fetal movements. During the examination, a decrease in the tone of the uterus and the absence of its contractions, heartbeat and fetal movements are noted. A sign of intrapartum fetal death is the cessation of its heartbeat. If antenatal fetal death is suspected, the pregnant woman is urgently hospitalized for examination. The diagnosis of fetal death is reliably confirmed by the results of FCG and ECG of the fetus, which record the absence of cardiac complexes, and ultrasound examination. With ultrasound in early dates after the death of the fetus, the absence of its respiratory activity and heartbeat is determined, the contours of its body are unclear; in later stages, the destruction of body structures is determined. In case of antenatal death of the fetus in the first trimester of pregnancy ovum removed by curettage of the uterine cavity. In case of fetal death in the second trimester of pregnancy and premature placental abruption, urgent delivery is required. In this case, the method of delivery is determined by the degree of readiness of the birth canal. In the absence of indications for urgent delivery, a clinical examination of the pregnant woman is carried out with a mandatory study of the blood coagulation system, then labor induction is started, creating an estrogen-glucose-vitamin-calcium background for 3 days, after which the administration of oxytocin and prostaglandins is prescribed. In order to speed up the first stage of labor, an amniotomy is performed. With antenatal death of the fetus in the third trimester of pregnancy, labor, as a rule, begins independently. In case of intrapartum fetal death, fetal destruction operations are performed according to indications. Fruit-destroying operations (embryotomies) are obstetric operations in which the fetus is dismembered in order to facilitate its extraction through the natural birth canal. As a rule, such operations are performed on a dead fetus. On a living fetus, they are permissible only as a last resort, when it is impossible to deliver it through the natural birth canal, in case of fetal deformities (severe hydrocephalus), severe complications of childbirth that threaten the life of the woman in labor, and in the absence of conditions for surgical delivery that would save the life of the fetus. Fertility-destroying operations are possible only with complete or almost complete dilatation of the uterine pharynx, a true pelvic conjugate of more than 6.5 cm. Fertility-destroying operations are accompanied by significant technical difficulties, pain, and severe moral trauma for the woman, so they require adequate anesthesia. For these operations, the method of choice for anesthesia is short-term endotracheal anesthesia. Fruit-destroying operations include craniotomy, decapitation, evisceration (exenteration), spondylotomy and cleidotomy.

Pregnancy does not always go according to plan. The process of bearing a child can be burdened with various complications. Antenatal fetal death is a common occurrence, which in 39-42% of cases is the cause of stillbirth. Why does this happen in early and late gestation? By what signs can this condition be recognized? How dangerous is intrauterine fetal death for a woman, and can it be prevented? How is this pathology treated? different terms pregnancy?

The concept of antenatal fetal death

In obstetric practice, this term refers to the death of a fetus during intrauterine development. Death of a child in in this case recorded in the period from 9 to 42 weeks of gestation. This concept should be distinguished from other types of perinatal mortality: intranatal, which is characterized by death during the process of expulsion of the fetus from the uterus, and neonatal, when the newborn dies during the first 7 days of life.

When diagnosed with antenatal fetal death, a woman experiences significant stress. In addition to the emotional shock, her physical health is at risk.

Intrauterine death of a child can lead to various complications. If measures are taken late or the wrong treatment tactics are chosen, this phenomenon can be fatal for the patient.

This pathology is detected in 6% of women bearing two or more children. The likelihood of its occurrence depends on the number of fetuses and chorions. The greater the degree of multiple pregnancy, the higher the risk of intrauterine death of one of the children. Unlike dichorionic twins, the threat of death of one of the fetuses having a common chorion is much higher.

Factors contributing to antenatal death of a child

There are many reasons for this type of perinatal mortality. In a number of situations, it is impossible to accurately determine the factor that provoked the death of the fetus. Both the wrong actions of the woman herself and various pathological processes can lead to the intrauterine death of a child. The causes of the development of this pathology are divided into endogenous (also called internal) and exogenous (external). The first type includes:

• infectious pathologies (influenza, pneumonia, measles, rubella, hepatitis);
• insufficient intake of useful elements into the body;
• somatic diseases (congenital heart defects, cardiovascular failure, severe liver and kidney damage, anemia);
• diabetes;
• disruption of the endocrine system;
• inflammatory processes in the genital area;
• gestosis;
• abnormal fetal development;
• conflict of Rh factors and blood groups of mother and child;
• excess or insufficient volume of amniotic fluid;
• disturbances of hormonal levels and uteroplacental blood flow;
• true umbilical cord knot;
• the umbilical cord entwined around the baby's neck;
• failure of blood clotting function;
• high blood pressure;
• autoimmune diseases.

The second group of causes of antenatal fetal death are:

• abuse of tobacco, alcoholic beverages, and drugs by the expectant mother;
• use of certain medications;
• acute and chronic intoxication with household and industrial chemicals;
• radioactive exposure;
• abdominal injury;
• excessive emotional stress.

Associated symptoms

Intrauterine fetal death can be recognized by a number of signs. The clinical picture in this case looks like this:

• the woman feels weakness, malaise, severe heaviness in the lower abdomen;
• the baby's movements stop;
• uterine tone decreases or increases;
• the mammary glands decrease in size and become flaccid;
• toxicosis and abdominal growth stop abruptly;
• In some situations, spontaneous abortion occurs.

In cases where several weeks have passed since the intrauterine death of the fetus, signs characteristic of a septic process are added to the listed symptoms.

This clinical picture manifests itself as:

• hyperthermic syndrome;
• severe pain in the abdominal area;
• attacks of dizziness;
• headache;
• depression of the central nervous system, manifested in the form of hypersomnia;
• disturbances of consciousness.

In severe cases, the death of a child in the antenatal period can lead to the death of the woman. To prevent this from happening, if you suspect this pathology, it is recommended to seek medical attention as soon as possible. medical care. In such a situation, the timeliness of taking therapeutic measures plays a decisive role.

Diagnostic methods

To confirm this diagnosis and determine the reasons why this pathology developed, certain diagnostic procedures are used. Drawing up a detailed research protocol is a mandatory stage of diagnosis. Using this document, the clinician gives the patient detailed explanations as to what could have caused the baby’s death, whether his death could have been prevented, whether this situation could subsequently recur, and how it affected the woman’s health. The table provides information about which diagnostic methods are used in this case.

Treatment tactics when pathology is detected at different stages of pregnancy

Therapeutic tactics in this case depend on the gestational age at which the child’s death occurred. To remove the fetus from the mother's womb, they resort to artificial interruption pregnancy or emergency childbirth. The table contains detailed information about what therapeutic measures are carried out if the fetus died in the 1st, 2nd and 3rd trimesters of gestation.

Consequences of pathology for the expectant mother and child

Development risk negative consequences in this situation depends on the timeliness of taking therapeutic measures. If medical help is sought immediately, there will be no negative impact on the woman’s physical health. Moreover, this pathology inevitably affects her psycho-emotional state.

In difficult situations, against the background of experienced stress, serious mental disorders develop, which can be expressed in attempts to inflict injuries on oneself and others or commit suicide. This condition should not be ignored. Such patients are prescribed a course of psychotherapy.

Almost all women who have experienced such a tragedy subsequently give birth to healthy children, and pregnancy and labor proceed without any complications. This occurs provided that at least six months have passed after artificial delivery before reconception.

If, upon detecting signs of death of a child in the womb, a woman consults a doctor too late, or the wrong treatment tactics were chosen to eliminate this problem, the following complications may develop:

• infection;
• sepsis;
• death.

Is it possible to prevent antenatal fetal death?

To avoid this problem, it is recommended:

• before conceiving a child, both spouses undergo a full examination, including genetic diagnosis;
• the expectant mother should regularly visit the gynecologist’s office;
• at least six months before the planned date of pregnancy, stop smoking (including passive smoking), drinking alcohol and narcotic drugs;
• while carrying a child, avoid exposure to radioactive radiation, as well as contact with household and industrial toxic substances;
• during gestation, take all medications in consultation with your doctor;
• avoid stress;
• See a gynecologist immediately if you experience pain in the lower abdomen, suspicious vaginal discharge, or deterioration in health;
• exclude increased physical activity, especially lifting heavy objects, and injury to the abdomen;
• establish a nutritious diet and consume foods rich in proteins, vegetables and fruits;
• take vitamin complexes, having previously agreed upon their intake with your doctor;
• take a walk in the fresh air every day;
• regularly engage in gentle sports (yoga, fitness, swimming);
• get enough sleep, spending at least 8 hours a day.

Intrauterine fetal death

Intrauterine fetal death- death of the fetus during pregnancy (antenatal death) or during childbirth (intrapartum death).

Among the causes of antenatal fetal death A significant place is occupied by diseases of a pregnant infectious nature (influenza, pneumonia, pyelonephritis, etc.), heart defects, hypertension, diabetes mellitus, anemia and other extragenital diseases, as well as inflammatory processes in the genital organs.

Cause of fetal death often severe late toxicosis pregnant women, pathology of the placenta (previa, premature detachment, malformations) and umbilical cord (true node), multiple births, oligohydramnios, incompatibility of the blood of mother and fetus according to the Rh factor.

Factors of fetal death

Factors contributing to fetal death include: include chronic intoxication of a pregnant woman (mercury, lead, arsenic, carbon monoxide, phosphorus, alcohol, nicotine, drugs, etc.), improper use (for example, overdose) of drugs, hypo- and avitaminosis, trauma, as well as unfavorable socio-economic conditions.

Fetal death in the intrapartum period, in addition to the reasons mentioned, can be caused by birth trauma to the skull and spine of the fetus.

Direct cause of fetal death More often there are intrauterine infections, acute and chronic hypoxia, and fetal deformities incompatible with life. Sometimes the cause of intrauterine fetal death remains unclear.

A dead fetus can linger in the uterine cavity from several days to several weeks or months.

In utero it undergoes maceration, mummification or petrification. In approximately 90% of cases, maceration is observed - putrefactive, wet tissue necrosis. It is often accompanied by autolysis of the internal organs of the fetus, sometimes by their resorption. In the first days after the death of the fetus, maceration is aseptic, then infection occurs.

In some cases, infection can lead to the development sepsis in a woman. The macerated fruit is flabby, soft, its skin is wrinkled, with exfoliated and deflated epidermis in the form of blisters. As a result of detachment of the epidermis and exposure of the dermis, the skin of the fetus has a reddish color, and when infected becomes green color. The fetal head is flattened, soft, with separated skull bones. The chest and abdomen are flattened. Soft fabrics the fruit may become saturated with liquid. The epiphyses of the bones are separated from the diaphyses. Bones and cartilage are dirty red or brown.

Sign of V. s. n. is congenital pulmonary atelectasis. Mummification is dry necrosis of the fetus, observed when one of the fetuses dies during multiple pregnancy, entwining the umbilical cord around the fetal neck. The fruit shrinks (“paper” fruit), amniotic fluid dissolve.

In rare cases, more often with ectopic pregnancy, the mummified fetus undergoes petrification (deposition of calcium salts in tissues) - a so-called lithopedion, or fossilized fetus, is formed, which can remain in the mother’s body for many years asymptomatically.

Clinical signs antenatal fetal death are the cessation of growth of the uterus (its size corresponds to the gestational age 1-2 weeks less than the true one), a decrease in the tone of the uterus and the absence of its contractions, the cessation of heartbeat and fetal movements, the disappearance of engorgement of the mammary glands, malaise, weakness, and a feeling of heaviness in the abdomen. A sign of intrapartum fetal death is the cessation of its heartbeat.

If antenatal fetal death is suspected, the pregnant woman must be urgently hospitalized. The diagnosis of fetal death is reliably confirmed by FCG and ECG of the fetus (absence of cardiac complexes) and ultrasound examination (in the early stages after fetal death, the absence of respiratory movements and heartbeat of the fetus, unclear contours of its body, and subsequent destruction of body structures are revealed).

During amnioscopy, on the first day after antenatal death of the fetus, greenish (meconium-stained) amniotic fluid is detected; subsequently, the intensity of the green color decreases, and sometimes an admixture of blood appears. The skin of the fetus and flakes of caseous lubricant are colored green. When pressing with an amnioscope on the presenting part of the fetus, a depression remains on it due to the lack of tissue turgor.

X-ray examination is rarely used. X-ray signs of a dead fetus: discrepancy between the size of the fetus and the gestational age, flattening of the vault and blurred contours of the skull, imbricated position of its bones, drooping of the lower jaw, curvature of the spine like lordosis, atypical articulation (splay of the lower limbs), decalcification of the skeleton.

When a diagnosis of antenatal fetal death is made in the first trimester of pregnancy, the fertilized egg is removed surgically (curettage); available spontaneous miscarriage.

In case of fetal death in the second trimester of pregnancy and premature placental abruption, urgent delivery is indicated (the method is determined by the degree of readiness of the birth canal). Spontaneous expulsion of a dead fetus in the second trimester of pregnancy is rare. If there are no indications for urgent delivery, a clinical examination of the pregnant woman is necessary with a mandatory study of the blood coagulation system.

Labor induction begins with the creation of an estrogen-glucose-vitamin-calcium background for 3 days. Then oxytocin and prostaglandins are prescribed. The introduction of uterine contractions can be combined with electrical stimulation of the uterus. Amniotomy is recommended.

In the third trimester of pregnancy, in case of antenatal death, labor, as a rule, begins on its own; in other cases, labor is stimulated. In the postpartum period, prevention of endometritis and uterine bleeding is indicated. In case of intrapartum fetal death, fetal-destroying operations are used according to indications.

After birth or removal from the uterine cavity of the dead fetus and placenta, a pathological examination is carried out. Macroscopically evaluate the color, weight, size, consistency, the presence of pathological changes in the fetus and placenta, and carry out a morphological and cytological examination of the placenta. Due to cadaveric autolysis, examination of the internal organs of the fetus is often impossible.

Prevention of V. s. P.

Includes compliance by pregnant women with hygiene rules (including diet and work regimen), early diagnosis, adequate treatment of pregnancy complications, extragenital and gynecological diseases, and proper management of childbirth. In the event of antenatal fetal death, it is advisable to conduct medical and genetic counseling for the couple.

Bibliography: Becker S.M. Pathology of pregnancy, L., 1975; Bodyazhina V.I., Zhmakin K.N. and Kiryushchenkov A.P. Obstetrics, p. 224, M., 1986; Grishenko V.I. and Yakovtsova A.F. Antenatal fetal death, M., 1978.

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