Antenatal fetal death

Asked by: Elena

Female gender

Age: 26

Chronic diseases: not specified

Hello! I really need expert advice.
At 36 weeks, the pregnancy ended in antenatal fetal death. I saw 4 doctors. Everyone says different reasons and further actions. What to do? Who should you listen to?
1st doctor: (passed tests for hormones + infections), not even a month has passed since birth. She identified ureoplasmosis (in me and my husband), HPV (removed papillomas), and erosion. Conclusion: antenatal death occurred due to infection that entered through erosion. I treated erosion (with applications), my husband was treated with antibiotics, and I was treated with suppositories. Repeated analysis: no infection. I didn’t do a colposcopy, but she says it’s possible to get pregnant.
2nd doctor: (passed tests: Polymorphisms of genes of the hemostasis system, full examination, 11 indicators (new block) and Polymorphism of vascular tone genes. Predisposition to hypertensive conditions, disorders
placental function, preeclampsia, myocardial infarction. Microcirculation, vascular tone. 6 show)
Result: Polymorphisms of genes of the hemostasis system:
> FII - 1
> FV - 1
> MTHFR - 1
>PAI1 - 2
>FGB-3
> FVII - 1
>FXI - 1
>FXII - 1
>GP1ba - 1
> GpIIIa - 1
>PLAT-3
> 1 - homozygote common allele, 2 - heterozygote, 3 - homozygote rare allele > Polymorphism of vascular tone genes:
>ACE - 1
>ADD - 1
>AGT-2
> ATGR1 - 1
> ATGR2 - 3
> CYP11B2 - 1
> 1 - homozygote common allele, 2 - heterozygote, 3 - homozygote rare allele Doctor's diagnosis: hereditary thrombophilia, from January 2015 start drinking TROMBOL ACC and become pregnant in February, continuing to drink TROMBOL ASS and during pregnancy, as soon as pregnancy occurs, take a test D-dimer and at the appointment to decide on subsequent actions.
3rd doctor:
Hemostasiologist + obstetrician-gynecologist.
She confirmed thrombophilia, BUT ordered additional tests, exactly at the clinic recommended to her! For comparison, the difference is 6,000 rubles. With other laboratories.
4th doctor:
She says the uterus is ready, even if you’re pregnant right now and give birth! BUT, it’s not possible yet, you need to take Trichopolum for 3 months during menstruation (since it’s unknown how long stillbirth was in my stomach) and from the 16th day of M. Ts. - 10 days - drink duphaston. In 3 months see her. My head is a mess, who to believe? Please advise!

Sincerely,
Makarova Elena

I'm planning a pregnancy. Caesarean section 26.06. 2015 total detachment. Antenatal fetal death 05/26/2015 Premature abruption of a normally located placenta. Antenatal fetal death. Ber-ti -5. 2nd birth is normal. 2 abortions 1 caesarean section. I really want to get pregnant again. I can't wait a year or more. Please consult. The other day I took the following tests on my own: white blood cell count. Formula: leukocytes - 2.8. red blood cells - 4.63. hemoglobin 118. hemotocrit-36.8 average. Erythrocyte volume - 79.5 avg. Sod. Hemoglobin in an erythrocyte is 25.5. avg. Hemoglobin concentration in er-te321 platelets 124. platelet breakdown by volume 21.7. average platelet volume 12.90. coefficient of large platelets 43.7 neutrophils 1.50 lymphocytes 39.0. ESR - 18. Please tell me how to treat it.

5 answers

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Hello! What expensive test were you prescribed?

Elena 2014-12-27 20:38

Examination for APS (APA+AT to phospholipid co-factors: annexin V, b2glycoprotein, prothrombin) + determination of homocysteine ​​level
Control D-dimer + Sail test at 20-25 dmts

Logical, but you can wait. Contact a geneticist for additional tests on this issue. And you can take them in the laboratory where you want. She has no right to tell you. Ureaplasma and HPV do not lead to intrauterine death fetus - this has already been proven. Therefore, for now we can consider the working version of doctors No. 2 and No. 3

Thanks a lot! I understand you. But what to do about the next pregnancy? Is it possible to rely on a second doctor, take Thrombo ACC and plan a pregnancy in February of this year?
How to deal with erosion? Could she have influenced what happened?
Another thing, after giving birth, the doctors said that I had practically no water? With what it can be connected?
Thanks again for the advice!

Erosion does not affect the death of the fetus, which has also been proven a long time ago. The lack of water could be due to the fact that you have been walking with a dead fetus for a long time, this happens. In any case, I don’t recommend you plan for now. You need to wait at least half a year - the body must come to its senses and cleanse itself. Therefore, the recommendations of the last doctor with the prescription of metronidazole are justified. I advise you to do so. You take metronidazole for 3 months, then an ultrasound for control. Thrombo ACC can also be taken longer. And after at least 4 months you can try. But even better - after 6

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Hello! Elena Petrovna, help me understand the situation. On January 15, I had an induced birth at 21 weeks due to antenatal fetal death. I'll tell you in order. First trimester screening was at 11 weeks 6 days. Then the doctor didn’t like the nasal bone (19 mm), everything else was fine. It was recommended to repeat the ultrasound after 2 weeks. I donated blood from a vein for defects on the same day. Everything is fine. The risks are low. A repeat ultrasound also showed that everything was fine. At 18 weeks I got mastitis. The gynecologist prescribed Amoxiclav antibiotics, took it on drink, and everything went away. I was worried that I did not feel the fetus moving (placenta along the anterior wall). Before the New Year, I visited the doctor, and she also said that I didn’t feel any movements. After measuring, the doctor said that the uterus was slightly smaller than normal. On January 4 I went for a second trimester ultrasound. Everything is fine with the fetus, the term was set at 20 weeks/2 days, but the doctor did not like the cervix (29 mm). Reading you, I know that the norm is 25mm and above. On January 14, I went to a consultation to have my cervix re-measured by another doctor. There it was discovered that there was no fetal heartbeat. At the same time, another doctor measured the neck at 43 mm. On January 15, she went to the hospital and had an artificial birth. The weight of the fetus was 450 g, height 23 cm. The fetus was not autopsied because the weight was less than 500g. A scraping from the uterine cavity was sent for histology. The answer came that chorionic villi were found in the scraping.

My husband and I were preparing for this pregnancy. We took all tests for infections in advance and took folic acid. During pregnancy, I often had headaches, sometimes I took paracetamol. At each appearance, the doctor measured the blood pressure: 120/80, 130/90. When I measured it myself at home it was 100/70, sometimes 110/80. My normal blood pressure is 100/60, 100/70. In the first trimester I donated blood for sugar, the result was 5.2. What did the gynecologist diagnose? diabetes and referred me to an endocrinologist. The endocrinologist did not confirm the diagnosis. I myself had my blood tested for sugar in another laboratory, the result was 4.3.

In 2013, I gave birth at 40 weeks. A boy was born, everything is fine. In 2006 there was a miscarriage at 7 weeks. (frozen ber). In 2010, I had a miscarriage at 5 weeks.

Answer please:

1. What could be the cause of antenatal fetal death? Could I have pregnancy hypertension or maybe diabetes?

2. I did not feel fetal movements until the very end. Could there be something wrong with the child, some kind of defects?

3. How can we explain the fact that one doctor measured the neck at 29 mm, and the other at 43 mm? Who to believe? Both measurements were taken with an external sensor.

4. After what time can you plan? new pregnancy? I don't want to wait long. I am 31 years old, my husband is 36 years old. What examination should be completed before planning? In what dose should I take folic acid?

5. What tests can be taken to at least somehow understand what was the cause of the death of the fetus? And how to reduce the risk of this happening again during the next pregnancy?

I will be grateful for your answer!

Hello!

I am 33 years old, I have a 4-year-old daughter. I had menstruation since I was 13 years old, my cycle was 26-28 days.

At the 26th week of pregnancy, an ultrasound was diagnosed: oligohydramnios, developmental delay, multicystic disease of both kidneys, the second sonographer added to this a heart defect and Dandy-Walker syndrome. The chorus insisted on an interruption. Initially we agreed. Then the LCD rewrote the card, reducing the pregnancy period to 22 weeks (since, according to our legislation, termination is possible before this period). Before the procedure itself, we decided not to terminate the pregnancy.

After that, I went through all the circles of hell: intimidation, blackmail, pressure from doctors, both from my residential complex and from all other institutions that I tried to contact. 3 months passed in a state of severe nervous disorder, depression and continuous tears. There were also several different ultrasounds with different diagnoses, including those without developmental defects.

On October 21, I came for a scheduled visit to the residential complex with severe swelling of my face and eyelids. After doing a CTG, they called an ambulance. There was a heartbeat, but weak. He was no longer in the hospital. The pressure was above 180.

Labor was stimulated. The autopsy result was copied from the chart and completely repeats the diagnosis of the last ultrasound. They weren’t even embarrassed by the baby’s weight of 3 kg at 33 weeks (they didn’t bother rewriting the card for me a second time).

Those. Today I have a strong desire to get pregnant in the fall. And I don’t have a clear understanding of what exactly happened and why. And how should I prepare...

Any pregnancy must be planned, this contributes to its favorable course without complications. But not everything always goes smoothly, and women, for certain reasons, have miscarriages, the fetus freezes, or have to have an abortion. How to plan a pregnancy after a pregnancy that does not end with the birth of a baby?

It happens that the fetus stops developing and freezes due to some genetic failures. Such a nuisance can happen to completely healthy parents; no one is immune from this. When can you get pregnant again, how to prepare to carry and give birth to a healthy baby?

Preparation for a second pregnancy after fetal death must begin immediately. It is necessary to find out whether there were any pathologies of the fetus. To do this, you need to ask for a histological examination of fetal tissue after curettage. This analysis helps to identify mutations and prevent recurrence of a missed pregnancy. Genetics is the cause of fetal death in 70-80% of all cases. Genes combined with external factors lead to unexpected consequences that cannot be prevented.

It is very important to recover before conceiving again. And we are talking not only about physical health, but also about the mental state of a woman. Often such a loss becomes a serious stress, and the woman is afraid of becoming pregnant again for a long time.

Experts recommend planning a second pregnancy at least six months after the miscarriage. It is imperative to use protection until the moment of expected conception, since until a full examination and all tests are completed, the reason for the unsuccessful pregnancy will be unclear.

A woman must see the following doctors:

After childbirth, the body must recover.

Gynecologist

You should visit a gynecologist first. The specialist will conduct an examination, take a smear from the cervix and give referrals to other specialists.

Endocrinologist

Often the causes of missed abortion are malfunctions of the thyroid gland. Therefore, it is important to get tested for your hormones and do an ultrasound of the thyroid gland.

It is very important to find out whether mom and dad have genetic mutations, or whether such mutations arose spontaneously in the unborn child.

Urologist (for men)

The urologist will conduct an examination and, if necessary, send the man for a spermogram.

Immunologist and therapist

If you have any chronic diseases, these specialists must be visited.

In addition, it is necessary to pass the following tests and undergo a full examination:

Ultrasound will help identify pathologies of the pelvic organs that could cause fetal fading. In addition, this study makes it possible to check whether there are any fertilized eggs or blood clots left in the uterine cavity.

1. Smear for STIs and flora

Many infectious diseases are asymptomatic and do not make themselves felt throughout for long years. And such illnesses often become the cause of missed pregnancies.

1. CBC, blood test for TORH– infections, as well as determine the blood type and Rh factor for both spouses.
2. for men
3. Level determination analysis hormones: LH, FSH, prolactin, testosterone, T3, T4, TSH.
4. Special analysis that makes it possible to determine AFS(antiphospholipid syndrome) in women.

Important: if you have a frozen pregnancy, it is better not to start planning until the cause of the frozen pregnancy is clear.

Features of planning after an abortion

Artificial termination of pregnancy is a serious stress for the body; a woman must recover from the abortion in order to become pregnant again. The fact is that abortion often causes the development complications:

1. Secondary infertility.
2. Hormonal disbalance.
3. Ovarian dysfunction.
4. Infection of the reproductive organs (inflammation of the uterus in most cases).
5. Bleeding that poses a threat to the woman's life.
6. The formation of adhesions that interfere with the normal attachment of the fertilized egg.
7. Damage to the walls or cervix.

No one is immune from the development of the above complications, but when proper preparation before pregnancy after an abortion, you can minimize all possible risks and carry a healthy baby. Preparing for another pregnancy involves doing the following: conditions:

1. After an abortion, strictly follow all the recommendations of the gynecologist and take prescribed medications.
2. Monitor your body temperature for a week after interruption.
3. 10-15 days after the abortion, visit a gynecologist for an examination and ultrasound.
4. Avoid sudden changes in temperature.
5. Use protection (it is recommended to become pregnant again at least six months after the abortion, when hormonal background the uterus will return to normal and recover).
6. Getting tested for STDs.
7. Taking a blood test to check hormone levels (this will allow the gynecologist to determine the body’s readiness for a new pregnancy).
8. Examination for TORCH - infections.
9. Change general analyzes urine, blood.
10. If you have chronic diseases, you need to consult with specialists.
11. Normalization of proper nutrition.
12. Taking vitamin complexes.

There is no need to rush; some experts recommend getting pregnant only a year after the abortion (six months - minimum term). During this time, the body will fully recover, hormones will “fall into place,” and the woman will mentally prepare for the upcoming motherhood. In addition, within a year you can undergo a high-quality, complete examination and treat all existing diseases in order to minimize the risk of complications.

What to do after a miscarriage?

It happens that the body independently gets rid of the fetus when it dies. A miscarriage is a spontaneous termination of pregnancy before 22 weeks. Miscarriage can be early (before 12 weeks) or late (after 12 weeks).

Spontaneous termination of pregnancy, unfortunately, occurs in 15-20% of women, and most often in the first trimester. Planning a pregnancy after spontaneous miscarriage is similar to preparing for conception after an abortion: you must be under the supervision of a doctor, undergo an examination and follow all recommendations.

Preparing for another pregnancy after an ectopic pregnancy

An ectopic pregnancy is a pregnancy during which ovum attaches outside the uterus (this pathology occurs in 3% of cases). Most often, the fertilized egg is attached to the cavity of one of the fallopian tubes. Ectopic pregnancy is extremely dangerous pathology, since after surgery to remove the tube, the possibility of getting pregnant is halved. But if it was possible to diagnose the pathology in the early stages, it is possible to perform the operation without removing the tube.

1. Compliance with all recommendations of the gynecologist in the postoperative period.
2. Abstinence from physical activity for 2 months after surgery.
3. If the presence of a massive adhesive process is confirmed, it is necessary to perform laparoscopy.
4. It is necessary to use protection for at least six months after surgery.
5. Sexual rest for a month.
6. Taking vitamin complexes as recommended by a specialist.
7. Regular visits to the gynecologist.
8. Testing for hormone levels.
9. Testing for STDs (for both spouses).
10. Ultrasound to monitor the formation of adhesions.

Unfortunately, often after this pathology not everyone is able to conceive a baby again. In most cases, the reason for this is the removal of one of the pipes. And if the root cause ectopic pregnancy there was an inflammatory process, almost always the infection affects the second tube. If tubal infertility is confirmed, the only solution becomes, the effectiveness of which in this case is quite high.

Consequences of antenatal fetal death

Antenatal (intrauterine) fetal death is the death of the fetus in the womb during pregnancy. This is extremely dangerous as it poses a threat to a woman’s life. This pathology can happen for many reasons: from bad habits women during pregnancy before hormonal imbalances and infectious diseases.

It is important to diagnose fetal death in a timely manner to avoid complications. Depending on the timing, condition of the woman and many other factors, the doctor may decide to terminate the pregnancy in one of several ways: medical abortion or surgery.

Since the pregnancy is terminated, you can plan the next one no earlier than six months after the operation. Before this, it is imperative to protect yourself and follow all the recommendations of a specialist. The woman needs to undergo examination and visit some specialists (the tactics here are the same as after an abortion). It is very important to find out the reason for the death of the fetus in order to eliminate the possibility of a recurrence of such trouble in the future.

No one is immune from this, but the risk group includes:

• women after several abortions,
• women who have had an ectopic pregnancy,
• future mothers after 30 years,
• if you have untreated STDs,
• those with an unusual uterine shape,
• uterine fibroids increase the possibility of complications,
• women with thyroid diseases.

Planning pregnancy after cesarean

Caesarean section is a serious operation, after which a scar remains not only on the abdominal wall, but also on the uterus. Pregnancy after cesarean section may have some complications, so preparation for it should be more thorough.

Pregnancy too early after surgery can lead to very sad consequences: scar rupture, which can result in a threat to the woman’s life. Planning a pregnancy after a pregnancy that ends in the birth of a baby by caesarean section, involves monitoring the condition of the scar. For these purposes, the following studies are carried out:

Ultrasound of the pelvic organs using a vaginal sensor makes it possible to:

• assess the thickness of the scar (optimal thickness is 10 mm),
• determine whether proper blood circulation is maintained in it,
• are there any hematomas in the scar area,
• evaluate its composition.

Hysterography – X-ray of the uterus, which allows you to study its condition from the inside.

Hysteroscopy – examination of the uterus using special optical instruments.

A woman needs to undergo all the same tests as during normal pregnancy planning. Please note that no one is immune from the development of complications during the process of bearing a baby after surgery. This may be rupture of the uterus along the scar, attachment of the placenta in the scar area, deterioration of blood circulation of the placenta (this can cause fetal hypoxia and a delay in its development).

How to plan a second pregnancy?

Planning a second pregnancy is no different from preparing for the first. The only condition that must be met is to maintain a temporary period of 1-2 years so that the body can fully recover and gain strength to bear the baby.

If the second pregnancy occurs very quickly, the risk of complications increases. Take your time, rest and gain strength. It is also important to think about what method you will use to protect yourself.

But this applies only to those women whose first pregnancy proceeded without complications, and childbirth passed naturally. Those who had difficulties during the period of bearing a child, as well as those women who had a difficult birth, should be under the supervision of a doctor and prepare for a second pregnancy carefully and with special responsibility.