Genetic causes of miscarriage. Causes of miscarriage

Sad stories patients suffering from recurrent miscarriage look approximately the same. Their pregnancies are terminated one after another - at approximately the same “critical” period. After several unsuccessful attempts to carry a child, a woman develops a feeling of hopelessness, self-doubt, and sometimes a feeling of guilt. This psychological state only aggravates the situation and can become one of the reasons for subsequent miscarriages. Will a woman be able to get out of this vicious circle? This largely depends on her.

What is recurrent miscarriage?

\First, let's define the subject of our conversation. Russian gynecologists make a diagnosis of “recurrent miscarriage” if the patient spontaneously terminates pregnancy at least twice before 37 weeks. In some other countries (for example, in the USA), miscarriage is considered common and has occurred at least three times.

Most often, pregnancy is terminated in the first trimester. Before 28 weeks, a miscarriage occurs, and after this period, premature birth occurs, in which the child has every chance of survival. This article will discuss cases of habitual termination of pregnancy up to 28 weeks.

Causes of early miscarriage

If the cause of a single miscarriage is usually any “external” factors: living conditions unfavorable for pregnancy (difficult family relationships, busy work schedule, etc.), stress, excessive physical activity (for example, heavy lifting), some biological factors (for example, age under 18 and after 35 years), then in the case of recurrent miscarriage, aspects related to the woman’s health most often come to the fore. It should also be noted that this condition is never caused by any one reason: there are always at least two factors leading to a sad outcome.

To identify the causes of recurrent miscarriage, the doctor will ask whether the woman has any general diseases, and will also clarify the gynecological history, including information about past inflammatory diseases, induced abortions and other interventions, number of miscarriages, timing of termination of pregnancies, prescribed treatment, etc.

What tests are needed for miscarriage?

But only an additional medical examination will help to dot the i’s, which, depending on the specific situation, may consist of various stages:

1. Ultrasound examination of the female reproductive system. With the help of this study, the condition of the ovaries is clarified; various changes in the structure of the uterus can be identified (malformations, tumors, endometriosis, adhesions in the uterine cavity), signs of chronic inflammation of the uterine mucosa. If isthmic-cervical insufficiency is suspected, the diameter of the internal os of the cervix in the second phase is measured during ultrasound menstrual cycle.
2. Hysterosalpingography 1 and hysteroscopy 2 are carried out mainly if intrauterine pathology or uterine malformations are suspected.
3. Rectal temperature measurement(i.e. temperature in the rectum) before pregnancy during 2 - 3 menstrual cycles - the easiest way to get an idea of ​​the hormonal function of the ovaries. Many women suffering from recurrent miscarriage experience insufficiency of the second phase of the menstrual cycle. This condition can be manifested either by an insufficient rise in rectal temperature (the difference in the first and second phases of the cycle is less than 0.4 - 0.5 degrees) or the duration of this phase is less than 10 - 12 days.
4. A blood test aimed at determining the levels of various hormones. The study of the level of sex hormones and hormones that regulate the functioning of the ovaries is carried out twice: the first time - in the middle of the first phase of the menstrual-ovarian cycle (on average 7-8 days from the start of menstruation), the second time - in the middle of the second phase (on average - on the 20th - 24th day). Hormonal imbalances associated with changes in ovarian function can cause early miscarriages for up to 16 weeks, since for more later the placenta almost completely takes upon itself the provision of hormonal levels conducive to the normal course of pregnancy. About a third of all patients with recurrent miscarriage experience hyperandrogenism (increased levels of male sex hormones in the female body), which can lead to isthmic-cervical insufficiency. It is very important to study not only the female and male sex hormones secreted in the female body, but also the thyroid hormones, which have a direct effect on the formation of tissues, the correct formation of the embryo and its development.
5. Blood test for viral infection(herpes, cytomegalovirus), examination of the genital tract for sexually transmitted infections (chlamydia, mycoplasma, ureaplasma, herpes, cytomegalovirus, etc.) in a married couple. The genital tract is also examined for opportunistic flora, which under certain conditions can cause infection of the fetus and lead to its death. Very often, this study reveals a combination of 2 - 3 infections. Sometimes, in order to exclude chronic endometritis (inflammation of the mucous membrane lining the inner surface of the uterus), an endometrial biopsy is performed on the 7th - 9th day of the menstrual cycle, in which a piece of the mucous membrane is pinched off and its structure and sterility are examined.
6. Blood tests that detect immune disorders, which sometimes cause miscarriage. These studies can be very diverse: searching for antibodies to cardiolipin antigen, to DNA, to blood cells, etc.
7. Study of the blood coagulation system. Doctors recommend abstaining from pregnancy until blood clotting indicators are stable, and regular monitoring is carried out during pregnancy.
8. If the pregnancy is terminated before 8 weeks, the couple must genetic consultation, since there is a high probability that the miscarriage occurred due to a genetic imperfection of the embryo. Genetic abnormalities in the development of the embryo can be hereditary, transmitted from generation to generation, or arise under the influence various factors environment. Their appearance can be assumed in closely related marriages, in the presence of a genetic pathology on the maternal or paternal side, when living in an area with an unfavorable radioactive background, in contact with harmful chemicals (for example, mercury, some solvents), and the use of certain teratogenic drugs (for example, cytostatics, some hormonal drugs, including contraceptives), as well as in case of viral infection (rubella, influenza, cytomegalovirus infection, herpes) transferred to early stages pregnancy.
9. Can be recommended for men sperm analysis, since sometimes the cause of embryo death can be defective sperm.
10. If necessary, carried out consultations with an endocrinologist, therapist, since miscarriages can also be caused by somatic diseases not related to the female genital area, for example, diabetes, hypertonic disease.

How to get pregnant after a miscarriage?

Constant emotional stress due to repeated miscarriages not only adversely affects a woman’s psychological state, but also worsens her physical health, even leading to the development of infertility. Therefore, in such a situation, we can advise you to temporarily give up trying to become a mother and relax, restore peace of mind - for example, go on vacation and change the environment. In some cases, you have to resort to the help of a psychotherapist and sedatives to help relieve anxiety. Sometimes mild sedatives are prescribed after pregnancy to relieve a woman’s mental stress during “critical” periods.

It is very important not to enter into the next pregnancy without examination and without preliminary preparation., since there is a high risk of repeated losses, especially since during the next pregnancy it is more difficult to find out the cause of previous miscarriages.

Partners should use contraception for at least 6 months (preferably 1 year) after the last miscarriage. Firstly, this will help the woman come to her senses and calm down, and secondly, during this time she will be able to be examined, find out what is causing the repeated failures, and undergo the necessary rehabilitation treatment. Such targeted preparation leads to a reduction in the amount of drug treatment during pregnancy, which is important for the fetus. With minimal signs of a threat of miscarriage, as well as during periods when previous miscarriages occurred, hospitalization in a hospital is necessary. During pregnancy, it is recommended to avoid physical activity.

Unfortunately, it happens that women seek medical help only after several unsuccessful pregnancies. There is no need to try to fight nature alone and tempt fate. Immediately after the first failure that befalls a woman, she needs to turn to specialists and begin to be examined in order to avoid, if possible, a repetition of the tragedy, because the modern arsenal of medical care in most such cases ensures the safe birth of a full-term child.

Update: October 2018

Today, miscarriage is considered one of the most important problems in obstetrics, given the variety of causes and the ever-increasing percentage of perinatal losses. According to statistics, the number of recorded cases of miscarriage is 10 - 25%, 20% of which are recurrent miscarriages, and 4 - 10% are premature births (relative to the total number of births).

What does this term mean?

• The duration of pregnancy is 280 days or 40 weeks (10 obstetric months).
• Full-term births are those births that occur between 38 and 41 weeks.
• Miscarriage is the spontaneous termination of pregnancy that occurs between fertilization (conception) and 37 weeks.

Recurrent miscarriage includes cases of spontaneous abortion that occurred twice or more times in a row (including frozen pregnancy and antenatal fetal death). The frequency of recurrent miscarriage in relation to the total number of all pregnancies reaches 1%.

The risks of miscarriage are directly proportional to the number of previous spontaneous abortions in history. Thus, it has been proven that the risk of interruption new pregnancy after the first spontaneous abortion it is 13–17%, after two miscarriages/premature births it reaches 36–38%, and after three spontaneous abortions it is 40–45%.

Therefore, every married couple who has had 2 spontaneous abortions should be carefully examined and treated at the stage of pregnancy planning.

In addition, it has been proven that a woman’s age has a direct relationship with the risk of spontaneous abortion in the early stages. If for women in the age category from 20 to 29 years the possibility of spontaneous abortion is 10%, then at 45 years of age and after it reaches 50%. The risk of miscarriage with increasing maternal age is associated with the “aging” of eggs and an increase in the number of chromosomal abnormalities in the embryo.

Classification

The classification of miscarriage includes several points:

Depending on the period of occurrence

• spontaneous (spontaneous or sporadic) abortion is divided into early (up to 12 weeks of gestation) and late from 12 to 22 weeks. Spontaneous miscarriages include all cases of termination of pregnancy that occurred before 22 weeks or with a fetal body weight of less than 500 grams, regardless of the presence/absence of signs of its life.;
• premature births, which are distinguished by timing (according to WHO): from 22 to 27 weeks, very early premature births, births that occurred from 28 to 33 weeks are called early preterm births, and from 34 to 37 weeks - premature births.

Depending on the stage, abortions and premature births are divided into:

• spontaneous abortion: threatened abortion, abortion in progress, incomplete abortion (with remnants of the fertilized egg in the uterus) and complete abortion;
• premature birth, in turn, is classified as: threatening, beginning (at these stages, labor can still be slowed down) and beginning.

Separately, there are infected (septic) abortion, which can be criminal, and failed abortion (frozen or non-developing pregnancy).

Causes of miscarriage

The list of causes of miscarriage is very numerous. It can be divided into two groups. The first group includes social and biological factors, which include:

To the second group relate medical reasons, which are caused either by the state of the embryo/fetus or the state of health of the mother/father.

Genetic causes of miscarriage

Genetic miscarriage is observed in 3–6% of cases of pregnancy loss, and for this reason, about half of pregnancies are terminated only in the first trimester, which is associated with natural selection. When examining spouses (karyotype study), approximately 7% of failed parents are found to have balanced chromosomal rearrangements that do not in any way affect the health of the husband or wife, but with meiosis, difficulties arise in the processes of pairing and separation of chromosomes. As a result, unbalanced chromosomal rearrangements are formed in the embryo, and it either becomes unviable and the pregnancy is terminated, or is a carrier of a severe chromosomal abnormality. The possibility of having a child with severe chromosomal pathology in parents who have balanced chromosomal rearrangements is 1–15%.

But in many cases, genetic factors of miscarriage (95) are represented by a change in the set of chromosomes, for example, monosomy, when one chromosome is lost, or trisomy, in which there is an additional chromosome, which is the result of errors in meiosis due to the influence of harmful factors (medication, radiation, chemical hazards and others). Genetic factors also include polyploidy, when the chromosomal composition increases by 23 chromosomes or the full haploid set.

Diagnostics

Diagnosis of genetic factors for recurrent miscarriage begins with collecting anamnesis from both parents and their close relatives: are there any hereditary diseases in the family, are there any relatives with congenital anomalies, were/are there children with a delay mental development in spouses, whether the spouses or their relatives had infertility or miscarriage of unknown origin, as well as cases of idiopathic (unspecified) perinatal mortality.

Of the special examination methods, a mandatory study of the karyotype of the spouses is indicated (especially at the birth of a child with congenital malformations and in the presence of recurrent miscarriage). early stages). A cytogenetic study of abortion (karyotype determination) is also indicated in cases of stillbirth, miscarriage and infant mortality.

If changes are detected in the karyotype of one of the parents, a consultation with a geneticist is indicated, who will assess the risk of having a sick child or, if necessary, recommend the use of a donor egg or sperm.

Pregnancy management

In case of pregnancy, mandatory prenatal diagnostics (chorionic villus biopsy, cordocentesis or amniocentesis) are carried out in order to identify gross chromosomal pathology embryo/fetus and possible termination of pregnancy.

Anatomical causes of miscarriage

The list of anatomical causes of miscarriage includes:

• congenital malformations (formation) of the uterus, which include its duplication, bicornuate and saddle-shaped uterus, uterus with one horn, intrauterine septum complete or partial;
• anatomical defects that appeared during life (intrauterine synechiae, submucosal myoma, endometrial polyp)
• isthmic-cervical insufficiency (cervical incompetence).

Habitual miscarriage, due to anatomical reasons is 10 - 16%, and the share birth defects development of 37% is due to a bicornuate uterus, 15% to a saddle uterus, 22% to a septum in the uterus, 11% to a double uterus and 4.4% to a uterus with one horn.

Miscarriage with anatomical uterine abnormalities is caused either by unsuccessful implantation of a fertilized egg (directly on the septum or next to the myomatous node) or insufficient blood supply to the uterine mucosa, hormonal disorders or chronic endometritis. Isthmic-cervical insufficiency is highlighted in a separate line.

Diagnostics

The anamnesis contains indications of late miscarriages and premature births, as well as pathology urinary tract, which often accompanies malformations of the uterus and features of the formation of the menstrual cycle (there was a hematometra, for example, with a rudimentary uterine horn).

Additional examination methods

Additional methods for miscarriage caused by anatomical changes include:

• metrosalpingography, which allows you to determine the shape of the uterine cavity, identify existing submucosal myomatous nodes and endometrial polyps, as well as determine the presence of synechiae (adhesions), intrauterine septum and tubal patency (carried out in phase 2 of the cycle);
• allows you to see with your eye the uterine cavity, the nature of the intrauterine anomaly, and, if necessary, dissect the synechiae, remove the submucosal node or endometrial polyps;
• Ultrasound of the uterus allows you to diagnose submucosal fibroids and intrauterine synechiae in the first phase, and in the second it reveals a septum in the uterus and a bicornuate uterus;
• in some difficult situations, magnetic resonance imaging of the pelvic organs is used, which makes it possible to identify abnormalities in the development of the uterus with concomitant atypical localization of organs in the pelvis (especially in the presence of a rudimentary uterine horn).

Treatment

Treatment of recurrent miscarriage caused by anatomical pathology of the uterus consists of surgical excision of the uterine septum, intrauterine synechiae and submucosal myomatous nodes (preferably during hysteroscopy). The effectiveness of surgical treatment of this type of miscarriage reaches 70–80%. But in the case of women with a normal course of pregnancy and childbirth in the past, and then with repeated miscarriages and having malformations of the uterus, surgical treatment does not have an effect, which may be due to other causes of miscarriage.

After surgical treatment, in order to improve the growth of the uterine mucosa, combined oral contraceptives are recommended for 3 months. Physiotherapy (,) is also recommended.

Pregnancy management

Pregnancy against the background of a bicornuate uterus or its doubling occurs with the threat of miscarriage at different times and with development placental insufficiency and delayed fetal development. Therefore, from an early stage, if bleeding occurs, bed rest, hemostatic agents (dicinone, tranexam), antispasmodics (magne-B6) and sedatives (motherwort, valerian) are recommended. It is also recommended to take gestagens (Utrozhestan, Duphaston) for up to 16 weeks.

Isthmic-cervical insufficiency

ICI is one of the most common factors for late pregnancy loss, mainly in the 2nd trimester. Isthmic-cervical insufficiency is regarded as incompetence of the cervix, when it cannot be in a closed position, and as it progresses it shortens and opens, and cervical canal expands, which leads to prolapse of the fetal bladder, its opening and discharge of water and ends in late miscarriage or premature birth. There are ICNs of a functional (hormonal imbalance) and organic (post-traumatic) nature. This cause of recurrent miscarriage occurs in 13–20% of cases.

Diagnostics

It is impossible to assess the risk of developing functional ICI before pregnancy. But in the presence of post-traumatic ICI, metrosalpingography is indicated at the end of phase 2 of the cycle. If an expansion of the internal os of more than 6–8 mm is diagnosed, the sign is regarded as unfavorable, and a woman with an ensuing pregnancy is included in the high-risk group for miscarriage.

During pregnancy, it is recommended to assess the condition of the cervix weekly (starting from 12 weeks) (inspection in mirrors, ultrasound scan of the cervix and determination of its length, as well as the condition of the internal os using transvaginal ultrasound).

Treatment

Treatment of miscarriage before pregnancy consists of surgical intervention on the cervix (for post-traumatic insufficiency), which consists of cervical plastic surgery.

When pregnancy occurs, surgical correction of the cervix (suturing) is performed in the period from 13 to 27 weeks. Indications for surgical treatment are softening and shortening of the neck, expansion of the external pharynx and opening of the internal pharynx. IN postoperative period vaginal smears are monitored and, if necessary, vaginal microflora is corrected. In case of increased uterine tone, tocolytics (ginipral, partusisten) are prescribed. Subsequent pregnancy management includes inspection of the cervical sutures every 2 weeks. Sutures are removed at 37 weeks or in the event of an emergency (leakage or rupture of water, the appearance of blood from the uterus, cutting of sutures, and in the event of the onset of regular contractions, regardless of gestational age).

Endocrine causes of miscarriage

Miscarriage due to hormonal reasons occurs in 8–20%. In the forefront are such pathologies as luteal phase deficiency, hyperandrogenism, hyperprolactinemia, thyroid dysfunction and diabetes mellitus. Among habitual miscarriages of endocrine origin, luteal phase insufficiency occurs in 20–60% and is caused by a number of factors:

• failure of the synthesis of FSH and LH in phase 1 of the cycle;
• early or late LH surge;
• hypoestrogenism, as a reflection of defective maturation of follicles, which is caused by hyperprolactinemia, excess androgens, etc.

Diagnostics

When studying the anamnesis, attention is paid to the late development of menstrual function and cycle irregularity, a sharp increase in body weight, existing infertility or habitual spontaneous abortions in the early stages. During the examination, the physique, height and weight, hirsutism, the severity of secondary sexual characteristics, the presence of “stretch marks” on the skin, and mammary glands are assessed to exclude/confirm galactorrhea. A graph of basal temperature over 3 cycles is also assessed.

Additional examination methods

• Determination of hormone levels

In phase 1, the content of FSH and LH, thyroid-stimulating hormone and testosterone, as well as 17-OP and DHES are examined. In phase 2, progesterone levels are determined.

Ultrasound monitoring is carried out. In phase 1, endometrial pathology and the presence/absence of polycystic ovaries are diagnosed, and in phase 2, the thickness of the endometrium is measured (normally 10 - 11 mm, which coincides with the level of progesterone).

• Endometrial biopsy

To confirm luteal phase deficiency, endometrial aspiration is performed on the eve of menstruation.

Treatment

If luteal phase deficiency is confirmed, its cause must be identified and eliminated. In case of NLF against the background of hyperprolactinemia, MRI of the brain or X-ray of the skull is indicated (evaluate the sella turcica - exclude pituitary adenoma, which requires surgical intervention). If no pituitary pathology is detected, a diagnosis of functional hyperprolactinemia is made and bromocriptine therapy is prescribed. After pregnancy occurs, the drug is discontinued.

If hypothyroidism is diagnosed, treatment with sodium levothyroxine is prescribed, which is continued after pregnancy.

Direct therapy for NLF is carried out in one of the following ways:

• stimulation of ovulation with clomiphene from days 5 to 9 of the cycle (no more than 3 cycles in a row);
• replacement treatment with progesterone drugs (Utrozhestan, Duphaston), which supports full secretory transformation of the endometrium in case of continued ovulation (after pregnancy, therapy with progesterone drugs is continued).

After using any method of treating NLF and pregnancy occurs, treatment with progesterone drugs is continued for up to 16 weeks.

Adrenal hyperandrogenism or adrenogenital syndrome

This disease is hereditary and is caused by a violation of the production of hormones of the adrenal cortex.

Diagnostics

The history includes indications of late menarche and an extended cycle up to oligomenorrhea, spontaneous abortions in the early stages, and possible infertility. Upon examination, acne, hirsutism, body type are revealed. male type and an enlarged clitoris. Based on basal temperature graphs, anovulatory cycles are determined, alternating with ovulatory ones against the background of NLF. Hormonal status: high content of 17-OP and DHES. Ultrasound data: the ovaries are not changed.

Treatment

Therapy consists of prescribing glucocorticoids (dexamethasone), which suppress excess androgen production.

Pregnancy management

Treatment with dexamethasone is continued after pregnancy until delivery.

Ovarian hyperandrogenism

Another name for the disease is polycystic ovary syndrome. The history includes indications of late menarche and cycle disorders such as oligomenorrhea, rare pregnancies that end in early miscarriages, and long periods of infertility. On examination, increased hair growth, acne and stretch marks, and excess weight are noted. According to basal temperature charts, periods of anovulation alternate with ovulatory cycles against the background of NLF. Hormonal levels: high levels of testosterone, possibly increased FSH and LH, and ultrasound reveals polycystic ovaries.

Treatment

Therapy for ovarian hyperandrogenism consists of normalizing weight (diet, physical activity), stimulating ovulation with clomiphene and supporting phase 2 of the cycle with progestin drugs. According to indications, surgical intervention is performed (wedge excision of the ovaries or laser treatment).

Pregnancy management

When pregnancy occurs, progesterone medications are prescribed for up to 16 weeks and dexamethasone for up to 12–14 weeks. The condition of the cervix is ​​checked and if ICI develops, it is sutured.

Infectious causes of miscarriage

The question of the significance of the infectious factor as a cause of repeated pregnancy losses still remains open. In the case of primary infection, pregnancy ends in the early stages, due to damage to the embryo that is incompatible with life. However, in the majority of patients with recurrent miscarriage and existing chronic endometritis, several types of pathogenic microbes and viruses predominate in the endometrium. The histological picture of the endometrium in women with recurrent miscarriage in 45–70% of cases indicates the presence of chronic endometritis, and in 60–87% there is activation of opportunistic flora, which provokes the activity of immunopathological processes.

Diagnostics

In case of miscarriage of infectious origin, there is a history of late miscarriages and premature birth (for example, up to 80% of cases of premature rupture of water are a consequence of inflammation of the membranes). Additional examination (at the pregnancy planning stage) includes:

• smears from the vagina and cervical canal;
• tank. sowing the contents of the cervical canal and quantifying the degree of contamination with pathogenic and opportunistic bacteria;
• detection of sexually transmitted infections using PCR (gonorrhea, chlamydia, trichomoniasis, herpes virus and cytomegalovirus);
• determination of immune status;
• determination of immunoglobulins for cytomegalovirus and herpes simplex virus in the blood;
• study of interferon status;
• determination of the level of anti-inflammatory cytokines in the blood;
• endometrial biopsy (curettage of the uterine cavity) in phase 1 of the cycle, followed by histological examination.

Treatment

Treatment of miscarriage of an infectious nature consists of prescribing active immunotherapy (plasmapheresis and gonovaccine), antibiotics after provocation, and antifungal and antiviral drugs. Treatment is selected individually.

Pregnancy management

When pregnancy occurs, the state of the vaginal microflora is monitored, and studies are also carried out for the presence of pathogenic bacteria and viruses. In the first trimester, immunoglobulin therapy is recommended (administration of human immunoglobulin three times every other day) and prevention of fetoplacental insufficiency is carried out. In the 2nd and 3rd trimesters, courses of immunoglobulin therapy are repeated, to which the administration of interferon is added. If pathogenic flora is detected, antibiotics and simultaneous treatment of placental insufficiency are prescribed. If the threat of miscarriage develops, the woman is hospitalized.

Immunological causes of miscarriage

Today it is known that approximately 80% of all “unexplained” cases of repeated pregnancy terminations, when genetic, endocrine and anatomical causes have been excluded, are due to immunological disorders. All immunological disorders are divided into autoimmune and alloimmune, which lead to recurrent miscarriage. In the case of an autoimmune process, “hostility” of immunity to a woman’s own tissues occurs, that is, antibodies are produced against one’s own antigens (antiphospholipid, antithyroid, antinuclear autoantibodies). If the production of antibodies by a woman’s body is directed towards the antigens of the embryo/fetus that it received from the father, they speak of alloimmune disorders.

Antiphospholipid syndrome

The frequency of APS among the female population reaches 5%, and the cause of recurrent miscarriage is APS in 27–42%. The leading complication of this syndrome is thrombosis; the risk of thrombotic complications increases as pregnancy progresses and after childbirth.

Examination and medicinal correction of women with APS should begin at the stage of pregnancy planning. A test is carried out for lupus anticoagulant and the presence of antiphospholipid antibodies; if it is positive, the test is repeated after 6 - 8 weeks. If a positive result is obtained again, treatment should be started before pregnancy.

Treatment

APS therapy is prescribed individually (the severity of the activity of the autoimmune process is assessed). Antiplatelet agents are prescribed ( acetylsalicylic acid) together with vitamin D and calcium supplements, anticoagulants (enoxaparin, dalteparin sodium), small doses of glucocorticoid hormones (dexamethasone), plasmapheresis if indicated.

Pregnancy management

Starting from the first weeks of pregnancy, the activity of the autoimmune process is monitored (lupus anticoagulant, antiphospholipid antibody titer are determined, hemostasiograms are assessed) and an individual treatment regimen is selected. During treatment with anticoagulants, OAC and platelet count determination are prescribed in the first 3 weeks, and then platelet levels are monitored twice a month.

Fetal ultrasound is performed from 16 weeks and every 3 to 4 weeks (assessment of fetometric indicators - growth and development of the fetus and the amount of amniotic fluid). In the 2nd – 3rd trimesters, study of the functioning of the kidneys and liver (presence/absence of proteinuria, level of creatinine, urea and liver enzymes).

Dopplerography to exclude/confirm placental insufficiency, and from 33 weeks conducting CTG to assess the condition of the fetus and decide on the timing and method of delivery. During childbirth and the day before, the hemostasiogram is monitored, and in the postpartum period the course of glucocorticoids is continued for 2 weeks.

Prevention of miscarriage

Nonspecific preventive measures for miscarriage include giving up bad habits and abortions, maintaining a healthy lifestyle and a thorough examination of the couple and correction of identified chronic diseases when planning pregnancy.

If there is a history of spontaneous abortion and premature birth, the woman is included in the high-risk group for recurrent miscarriage, and the spouses are recommended to undergo the following examination:

• blood type and Rh factor of both spouses;
• consultation with a geneticist and karyotyping of spouses if there is a history of early miscarriages, antenatal fetal death, the birth of a child with intrauterine developmental anomalies and existing hereditary diseases;
• screening for sexually transmitted infections for both spouses, and for the woman for TORCH infections;
• determination of a woman’s hormonal status (FSH, LH, androgens, prolactin, thyroid-stimulating hormones);
• exclude diabetes mellitus in a woman;
• if anatomical causes of miscarriage are identified, perform surgical correction (removal of myomatous nodes, intrauterine synechiae, cervical plastic surgery, etc.);
• preconception treatment of identified infectious diseases and hormonal correction of endocrine disorders.

What is miscarriage, of course, is better for no one to know. However, cases of threatened abortion still happen and therefore you need to be prepared for anything. We will tell you in the article what are the causes of miscarriage and how to avoid its possible recurrence.

Miscarriage is the spontaneous termination of pregnancy before 37 weeks. That is, the body rejects the fetus even before all its organs and systems have had time to form for a full life. Termination of pregnancy occurs in 15-25% of cases and this figure has not decreased over the years. How can you tell if something is wrong? What should you be wary of?

If during pregnancy you feel:

• persistent discomfort in the lower abdomen;
• cramping pain;
• see bloody discharge.

All this should be a serious cause for concern, as there is a danger of miscarriage.

When the expectant mother ignores these signs, the risk of miscarriage increases. After all, upon urgent receipt medical care, the loss of a child can often be avoided. But even if the pregnancy was saved, after such a diagnosis the girl should be under close medical supervision until the end of the term.

Three reasons for miscarriage

A high percentage of pregnancy terminations indicates the poor condition of the mother's body. Perhaps some unfavorable processes are occurring in it. Let's look at three main reasons for such deviations.

Endocrine causes of miscarriage

Often, embryo loss occurs due to severe developmental pathologies, which is called natural selection. It is possible to detect such a defect if you do a genetic study of both partners and study the family history.

If this is the reason for the miscarriage, then in subsequent attempts you can turn to in vitro fertilization (IVF). When using the IVF method, only healthy eggs are released and artificial insemination is performed.

Miscarriage can also be caused by diabetes, problems with the thyroid gland, sex hormones and other endocrine system problems.

Diabetes mellitus greatly complicates the course of pregnancy and requires constant monitoring of insulin.

Thyroid dysfunction is an insufficient amount of iodine-containing hormones (thyroiditis), which are necessary for a normal pregnancy.

A decrease in the hormone progesterone (a steroid hormone of the corpus luteum of the ovaries, necessary for all stages of pregnancy) leads to the fact that the fertilized egg cannot stay in the uterus and attach to its walls.

Anatomical causes of miscarriage

Such pathologies are considered to be an abnormal congenital structure of the uterus or changes in the reproductive organs during life. Surgeons can solve this problem. If a pregnant woman experiences a shortening of the cervix, then after the first trimester its premature dilatation may occur. This situation is very dangerous. Therefore, before pregnancy occurs, it is necessary to do plastic surgery to eliminate such an anomaly. If the mother finds out about this problem when the baby is already in her womb, then an operation is performed to suture the cervix.

Infectious diseases

About 40% of miscarriages occur due to infections and viruses. Therefore, all infections must be tested before conception. If you did not do this and still get sick, the doctor will prescribe treatment taking into account your period. Antibiotics are prescribed only after 12 weeks. Before this period, such drugs can cause serious harm to the child.

Classification of miscarriages

An early miscarriage is a spontaneous abortion before the end of the first trimester. From 12 to 22 weeks is a late miscarriage. In the period from 23 to 37 weeks, termination of pregnancy is called premature birth and birth premature baby. A baby born after 37 weeks is considered to be born at term.

Often a woman may not even know that she was pregnant. The period of termination of pregnancy can be so short that it can only be judged by special tests (hCG - determination in the blood of the “pregnancy hormone” - human chorionic gonadotropin). Outwardly, such a miscarriage can only manifest itself as a delay in menstruation or its more severe course.

Today, modern medicine saves even babies weighing 500-600 grams. This is approximately 22-23 weeks of pregnancy. And a seven-month-old child has many chances for a full life, even despite the fact that the first months will be under the constant supervision of doctors.

If we talk about the problem of miscarriage in the early stages of pregnancy, then there is a high probability of fetal malformation. To try to find out the root cause, you need to undergo an ultrasound examination (ultrasound). Based on its results, doctors will be able to see the condition of the embryo (the presence of a heartbeat and heart rate), see if there is increased uterine tone or premature dilatation of the cervix. It is also recommended to donate blood for progesterone and estrogen levels, general analysis urine and infection tests.

After all procedures, the doctor prescribes therapy. Treatment can be done at home. In more complex cases, with bleeding, the pregnant woman is sent to the hospital for preservation.

After an unsuccessful pregnancy, it is very important to get into the right psychological mood, enlist the support of loved ones and not be afraid to continue trying. Generally a positive attitude expectant mother greatly influences the result.

How to avoid repeat miscarriage

What to do after a miscarriage:

1. Wait to get pregnant again for six months. Otherwise, the probability of miscarriage almost doubles.
2. Monitor the choice and use of contraceptives during the period of treatment and recovery. Let these remedies be prescribed to you by a doctor who is aware of the current situation.
3. Find the right therapy with your doctor.

Now there are many clinics that focus on reproduction. There you can get all the research options and subsequent treatment. You shouldn’t leave everything to chance, as there is a possibility of missing a serious disease.

The most difficult test for a woman has always been and will remain the loss of a long-awaited child. A sudden interruption of a happy period of life, filled with excitement and anticipation, worries and care for the future baby, can be a serious blow to the psychological health of even the strongest and most confident woman. Alas, modern statistics also do not bring any consolation: recently, the number of diagnoses of “recurrent miscarriage” continues to grow inexorably. And, what is even more unpleasant, termination of pregnancy increasingly occurs when the expectant mother does not even suspect that it has begun.

A sudden miscarriage is certainly a great shock for a woman, but habitual miscarriage is sometimes perceived as nothing more than a death sentence. Is this really so or is such a conclusion based only on insurmountable fear? We will try to understand this problem in as much detail as possible so that you no longer have any questions or doubts.

The diagnosis of “recurrent miscarriage” is usually made after two consecutive miscarriages, especially if they occurred at approximately the same time. There are quite a lot of reasons for this condition, and the treatment cannot be called easy, but first things first.

What can cause termination of pregnancy?

There are six main causes of miscarriage, namely genetic, anatomical, endocrine (hormonal), immunological, infectious and as a result of thrombophilia.

1. Genetic causes or chromosomal abnormalities

This is the most common factor in premature termination of pregnancy. According to statistics, approximately 70% of all miscarriages occur due to abnormalities of somatic chromosomes. Moreover, most of these disorders are due to the fact that defective sperm or eggs were involved in the fertilization process.

Each of us knows that normally the number of chromosomes in germ cells is 23. However, it happens that there is insufficient (22) or, conversely, an excess (24) number of chromosomes in an egg or sperm. In this case, the formed embryo will initially begin to develop with a chromosomal abnormality, which will invariably lead to a miscarriage.

2. Anatomical reasons

Abnormal uterine structure is the second most common cause of recurrent miscarriage. The list includes the irregular shape of the uterus, the presence of a septum in it, and benign neoplasms that deform the organ cavity (for example, fibroids, fibroids, fibroids). Also included are scars formed as a result of previous surgical procedures (such as cesarean section, removal of fibromatous nodes, cauterization of cervical erosion with electric current, etc.).

In addition, weakness of the muscle ring of the cervix plays a large role in recurrent miscarriage. For this reason, miscarriage often occurs between 16 and 18 weeks of pregnancy. Such an anomaly can be either congenital or acquired: due to traumatic injuries due to frequent abortions, cervical rupture during childbirth or cleansing. It can also be caused by hormonal disorders (for example, an increase in the amount of male sex hormones).

3. Hormonal imbalance

It has been proven that a reduced level of the hormone progesterone is very important for maintaining pregnancy in the early stages. In some cases, severe hormonal imbalances may be a consequence of multiple cystic formations in the ovaries, thyroid diseases or diabetes.

Hormonal imbalance usually causes harm in the early stages of pregnancy, namely before the 16th week. In a later period, hormonal levels are provided by the placenta.

4. Immunological factors

This can be explained by the specific ability of each person's body to produce antibodies to fight infections. However, it happens that the expectant mother’s body begins to form antibodies that destroy its own cells (autoantibodies). Because of this, a woman may develop serious health problems and have a miscarriage.

5. Infectious causes

A special place among all the causes of recurrent miscarriage is given to infectious processes in the genital organs. The main pathogens in this case are ureaplasma and mycoplasma. The threat of a possible miscarriage can be prevented by an early scheduled examination with a doctor.

6. Thrombophilia

It is a disease characterized by a blood clotting disorder (blood thickening occurs). In cases of recurrent miscarriage, genetically inherited thrombophilia is usually noted. Presence of diseases in relatives of cardio-vascular system(for example, heart attack or stroke, high blood pressure, venous pathology, etc.) threatens that the expectant mother may develop hereditary thrombophilia. During pregnancy, microthrombi form in the placenta, which can impair blood circulation and lead to miscarriage.

Standard examinations for recurrent miscarriages

We invite you to familiarize yourself with the list of basic examinations and tests prescribed for recurrent miscarriage:

• consultation with a geneticist;
• Ultrasound or magnetic nuclear resonance imaging of the pelvic organs (according to indications);
• endoscopic examination of the uterine cavity (hysteroscopy);
• taking blood for hormone analysis (LH, FSH, TSH, progesterone hormone, testosterone, thyroid gland, etc.);
• checking the blood composition for the presence of infections such as herpes and cytomegalovirus;
• taking a smear from the genitals to check for chlamydia, ureaplasma, mycoplasma;
• bacteriological analysis of discharge from the cervix;
• with histological and bacteriological examination. Conducted to determine the availability bacterial infection on days 7-8 of the menstrual cycle;
• taking blood for antisperm, antiphospholipid antibodies, as well as antibodies to progesterone and hCG;
• immunological studies;
• determination of blood clotting rate (coagulogram);
• checking blood for a hereditary predisposition to thrombophilia.

If the causes of recurrent miscarriage were not discovered even after a comprehensive examination, spouses should not lose hope. According to statistics, in 65% of all known cases, after several miscarriages, a successful pregnancy still occurs. To do this, you must follow all doctor’s instructions and do not forget about the proper break between the previous and subsequent pregnancies.

Full physical recovery after spontaneous miscarriage occurs over a period of several weeks to one or two months (depending on the exact period at which the pregnancy was terminated). But emotional stabilization sometimes requires much more time.

Main methods of treatment

Contacting a qualified and experienced specialist is the key to a future full pregnancy. After conducting a series of examinations and identifying the main cause of miscarriage, treatment can begin.

In the event that a woman or her husband has been diagnosed with congenital genetic abnormalities , a genetic specialist can recommend an IVF procedure (in vitro fertilization or, in simpler terms, artificial insemination in vitro). In this case, a donor egg or sperm will be used for fertilization (depending on which partner was found to have chromosomal abnormalities).

If a woman has abnormalities in the structure of the uterus , treatment for recurrent miscarriage will involve addressing structural abnormalities and close monitoring throughout pregnancy. If the muscle ring around the cervix is ​​weak, a special suture is usually placed. This procedure is called "cervical seclage" and is performed very early in pregnancy.

At insufficient amount of progesterone in the blood (if a woman has a hormonal imbalance), the doctor is obliged to prescribe the use of drugs similar to the hormone - progestins. One of these medications is Utrozhestan. It is very convenient to use, as it can be taken either orally or by insertion into the vagina. The vaginal route of administration has more advantages, since local absorption ensures a faster entry of progesterone into the uterine bloodstream. The dosage and course of treatment should be prescribed only by the attending physician.

When identifying immunological reasons Treatment of recurrent miscarriage is based on the use of small doses of aspirin and other drugs that thin the blood. The same therapy is prescribed for thrombophilia.

For treatment infections the use of antibiotics is indicated: ofloxin, doxycycline or vibromycin. Antibiotic therapy should be prescribed to both partners. A control examination for the presence of the above-described pathogens in the body is carried out one month after treatment.

It is important to know that a pregnant woman with recurrent miscarriage should be monitored every week, and, if necessary, more often, with hospitalization in a hospital.

What signs indicate a threat of miscarriage?

After appropriate treatment and with the start of a new pregnancy, a woman should listen more carefully to her own body. This doesn't mean she needs to constantly worry about possible problems, but timely detection danger signs can help save the child in case of threat.

A characteristic symptom of a threatened miscarriage is appearance bloody discharge . Vaginal bleeding during spontaneous abortion usually begins suddenly. In some cases, it is preceded by nagging pain in the lower abdomen. These painful sensations resemble those that appear before menstruation.

In addition to bleeding from the genital tract, the following signs are considered dangerous: weakness throughout the body, general malaise, a sharp decrease in nausea that was present before, fever, severe emotional tension.

However, it is worth remembering that not all cases of bleeding in the initial stages result in miscarriage. If a woman experiences any vaginal discharge, she should see a doctor as soon as possible. Only a specialist will be able to conduct the necessary examination, determining the condition of the fetus, the presence of dilation of the uterine cervix, and prescribe the correct treatment that will help maintain the pregnancy.

If bloody discharge from the genital tract is detected in the hospital, a vaginal examination is performed first. In the event that before this miscarriage occurred only once and in the first trimester, then the study should be carried out shallow. If the miscarriage occurred in the second trimester or the woman had more than two spontaneous abortions, a full examination is indicated.

Remember that pregnancy will only go well if you sincerely believe in its happy outcome. The appearance of two long-awaited stripes on the test is just the beginning. The smooth course of your entire pregnancy will depend only on your emotional health, so try to worry less. Be attentive to all the signs of your body and do not forget to see a doctor more often, because children are our bright future, bringing joy to the drab everyday life and clearly showing that taking care of them from the very conception is the real happiness.

Reply

According to statistics, miscarriage is registered in 10-25% of pregnant women.

The cause of miscarriage can be various diseases that are difficult to cure or have become chronic. However, these diseases do not relate to the sexual sphere. Important feature This kind of pathology is due to the unpredictability of the process, since for each specific pregnancy it is difficult to determine the true cause of termination of pregnancy. Indeed, at the same time, the body of a pregnant woman is influenced by many different factors that can act covertly or overtly. The outcome of pregnancy in the case of recurrent miscarriage is largely determined by the therapy performed. If there are three or more spontaneous miscarriages before 20 weeks of pregnancy, the obstetrician-gynecologist diagnoses recurrent miscarriage. This pathology occurs in 1% of all pregnant women.

After the fertilized egg is “placed” in the uterine cavity, the complex process of its engraftment there begins - implantation. Future baby first develops from a fertilized egg, then becomes an embryo, then it is called a fetus, which grows and develops during pregnancy. Unfortunately, at any stage of bearing a child, a woman may encounter a pregnancy pathology such as miscarriage.

Miscarriage is the termination of pregnancy between the moment of conception and the 37th week.

Risk of primary miscarriage

Doctors note a certain pattern: the risk of spontaneous abortion after two failures increases by 24%, after three - 30%, after four - 40%.

In case of miscarriage, a complete or incomplete (fertilized egg has separated from the wall of the uterus, but remains in its cavity and does not come out) miscarriage occurs within a period of up to 22 weeks. At a later stage, between 22 and 37 weeks, spontaneous termination of pregnancy is called premature birth, resulting in an immature but viable baby. Its weight ranges from 500 to 2500 g. Premature and prematurely born children are immature. Their death is often noted. Developmental defects are often recorded in surviving children. The concept of prematurity, in addition to short term pregnancy, includes low fetal weight at birth, on average from 500 to 2500 g, as well as signs of physical immaturity in the fetus. Only by the combination of these three signs can a newborn be considered premature.

When miscarriage develops, certain risk factors are indicated.

Modern advances in medicine and new technologies, timeliness and quality of medical care make it possible to avoid severe complications and prevent premature termination of pregnancy.

A woman with first-trimester miscarriage should undergo a long-term examination even before the expected pregnancy and during pregnancy to identify the real reason miscarriage. Very a difficult situation occurs during spontaneous miscarriage during the normal course of pregnancy. In such cases, the woman and her doctor can do nothing to prevent such a course of events.

The most common factor in the development of premature termination of pregnancy is chromosomal abnormalities of the fetus. Chromosomes are microscopic elongated structures located in internal structure cells. Chromosomes contain genetic material that defines all the properties characteristic of each person: eye color, hair, height, weight parameters, etc. In the structure of the human genetic code there are 23 pairs of chromosomes, 46 in total, with one part inherited from the mother organism, and the second - from the father. Two chromosomes in each set are called sex chromosomes and determine the sex of a person (XX chromosomes determine the female sex, XY chromosomes determine the male sex), while the other chromosomes carry the rest of the genetic information about the entire organism and are called somatic.

It has been established that about 70% of all miscarriages in early pregnancy are caused by abnormalities of somatic chromosomes in the fetus, while the majority chromosomal abnormalities developing fetus occurred due to the participation of a defective egg or sperm in the fertilization process. This is due to the biological process of division, when the egg and sperm, during their preliminary maturation, divide in order to form mature germ cells in which the set of chromosomes is equal to 23. In other cases, eggs or sperm are formed with an insufficient (22) or excessive (24) set chromosomes. In such cases, the mature embryo will develop with a chromosomal abnormality, leading to miscarriage.

The most common chromosomal defect can be considered trisomy, in which an embryo is formed by the fusion of a germ cell with chromosome set 24, as a result of which the set of fetal chromosomes is not 46 (23 + 23), as it should be normally, but 47 (24 + 23) chromosomes . Most trisomies involving somatic chromosomes lead to the development of a fetus with defects incompatible with life, which is why spontaneous miscarriage occurs in the early stages of pregnancy. In rare cases, a fetus with a similar developmental anomaly survives to a long period.

An example of the most well-known developmental anomaly caused by trisomy is Down's disease (represented by trisomy 21).

A woman’s age plays a major role in the occurrence of chromosomal disorders. And recent studies show that the age of the father plays an equally important role; the risk of genetic abnormalities increases when the father is over 40 years old.
As a solution to this problem, married couples where at least one partner is diagnosed with congenital genetic diseases, mandatory consultation with a geneticist is suggested. In certain cases, it is proposed to carry out IVF (in vitro fertilization - artificial insemination in a test tube) with a donor egg or sperm, which directly depends on which partner has such chromosomal abnormalities.

Causes of primary miscarriage

There can be many reasons for the occurrence of such violations. The process of conceiving and bearing a baby is complex and fragile, it involves a large number of interrelated factors, one of which is endocrine (hormonal). The female body maintains a certain hormonal background so that the baby can develop correctly at every stage of his life. intrauterine development. If for some reason the expectant mother’s body begins to produce hormones incorrectly, then hormonal imbalances pose a threat of miscarriage.

Never take it yourself hormonal drugs. Taking them can seriously impair reproductive function.

The following congenital or acquired lesions of the uterus can threaten the course of pregnancy.

• Anatomical malformations of the uterus - duplication of the uterus, saddle uterus, bicornuate uterus, unicornuate uterus, partial or complete uterine septum in the cavity - are congenital. Most often, they prevent the fertilized egg from successfully implanting (for example, the egg “sits” on the septum, which is not able to perform the functions of the inner layer of the uterus), which is why a miscarriage occurs.
• Chronic endometritis is inflammation of the mucous layer of the uterus - the endometrium. As you remember from the section that provides information on the anatomy and physiology of a woman, the endometrium has an important reproductive function, but only as long as it is “healthy”. Prolonged inflammation changes the nature of the mucous layer and impairs its functionality. It will not be easy for the fertilized egg to attach and grow and develop normally on such endometrium, which can lead to pregnancy loss.
• Endometrial polyps and hyperplasia - proliferation of the mucous membrane of the uterine cavity - endometrium. This pathology can also prevent embryo implantation.
• Intrauterine synechiae are adhesions between the walls of the uterine cavity that prevent the fertilized egg from moving, implanting and developing. Synechia most often occurs as a result of mechanical trauma to the uterine cavity or inflammatory diseases.
• Uterine fibroids are benign tumor processes that arise in the muscular layer of the uterus - the myometrium. Myomas can cause miscarriage if the fertilized egg is implanted next to a myomatous node, which disrupts the tissue of the internal cavity of the uterus, “takes over” the blood flow and can grow towards the fertilized egg.
• Isthmic-cervical insufficiency. She is considered the most common cause perinatal losses in the second trimester of pregnancy (13-20%). The cervix shortens and then dilates, which leads to pregnancy loss. Usually, isthmic-cervical insufficiency occurs in women whose cervix has been damaged previously (abortion, rupture during childbirth, etc.), has a congenital malformation, or cannot cope with the increased load during pregnancy (large fetus, polyhydramnios, multiple pregnancy and so on.).

Some women have a congenital predisposition to thrombosis (thickening of the blood, the formation of blood clots in the vessels), which complicates the implantation of the fertilized egg and prevents normal blood flow between the placenta, baby and mother.

The expectant mother often does not know at all about her pathology before pregnancy, since her hemostatic system coped well with its functions before pregnancy, i.e., without the “double” load that appears with the task of bearing a baby.

There are other causes of miscarriage that need to be diagnosed for timely prevention and treatment. Correction methods will depend on the identified cause.

The cause of recurrent miscarriage can also be normal chromosomes, which do not cause developmental problems in both partners, but are latent carriers of chromosomal abnormalities, which affect fetal development abnormalities. In such a situation, both parents should have their blood tested for karyotype in order to identify such chromosomal abnormalities (carriers of silent chromosomal abnormalities). With this examination, the results of karyotyping determine a probable assessment of the course of a subsequent pregnancy, and the examination cannot give a 100% guarantee of possible anomalies.

Chromosomal abnormalities are varied and may also cause non-developing pregnancy. In this case, only the membranes are formed, while the fetus itself may not exist. It is noted that the fertilized egg is either formed initially, or it is early stages stopped its further development. For this purpose, in the early stages it is typical to stop characteristic symptoms pregnancy, at the same time dark brown vaginal discharge often appears. An ultrasound can reliably determine the absence of a fertilized egg.

Miscarriage in the second trimester of pregnancy is mainly associated with abnormalities in the structure of the uterus (such as an abnormal shape of the uterus, an additional horn of the uterus, a saddle-shaped uterus, the presence of a septum or a weakened continence of the cervix, the dilation of which leads to premature birth). Wherein possible reasons Late miscarriage may result from infection of the mother (inflammatory diseases of the appendages and uterus) or chromosomal abnormalities of the fetus. According to statistics, the cause of miscarriage in the second trimester of pregnancy in 20% of cases is chromosomal abnormalities.

Symptoms and signs of primary miscarriage

A characteristic symptom of miscarriage is bleeding. Bloody vaginal discharge during spontaneous miscarriage usually begins suddenly. In some cases, a miscarriage is preceded by nagging pain in the lower abdomen, which is reminiscent of pain before menstruation. Along with the discharge of blood from the genital tract, when spontaneous miscarriage begins, the following symptoms are often observed: general weakness, malaise, increased body temperature, decreased nausea that was present before, and emotional tension.

But not all cases of spotting in the early stages of pregnancy end in spontaneous miscarriage. If there is bleeding from the vagina, a woman should consult a doctor. Only a doctor will be able to conduct a proper examination, determine the condition of the fetus, determine the presence of cervical dilatation and select the necessary treatment aimed at maintaining the pregnancy.

If bloody discharge from the genital tract is detected in a hospital, a vaginal examination is performed first. If the miscarriage is the first and occurred in the first trimester of pregnancy, then the study is carried out shallowly. In the case of a miscarriage in the second trimester or two or more spontaneous abortions in the first trimester of pregnancy, a full examination becomes necessary.

The course of a full examination includes a certain set of examinations:

1. blood tests for chromosomal abnormalities in both parents (karyotype clarification) and determination of hormonal and immunological changes in the mother’s blood;
2. conducting a test for chromosomal abnormalities of aborted tissues (it is possible to determine if these tissues are available - either the woman saved them herself, or they were removed after curettage of the uterus in a hospital);
3. ultrasound examination of the uterus and hysteroscopy (examination of the uterine cavity using a video camera, which is inserted through the cervix and displays an image on the screen);
4. hysterosalpingography (x-ray examination of the uterus;
5. biopsy of the endometrium (inner layer) of the uterus. This manipulation involves taking a small piece of the uterine mucosa, after which a hormonal examination of the tissue is performed.

Treatment and prevention of primary miscarriage

If a woman’s pregnancy is threatened by endocrine disorders, then after laboratory tests the doctor prescribes hormonal therapy. In order to prevent unwanted hormone surges, medications can be prescribed even before pregnancy, with subsequent adjustment of dosage and medications during pregnancy. In the case of using hormonal therapy, the condition of the expectant mother is always monitored and appropriate measures are taken. laboratory research(analysis).

If miscarriage is caused by uterine factors, then appropriate treatment is carried out several months before the baby is conceived, since it requires surgical intervention. During the operation, synechiae are dissected, polyps of the uterine cavity are eliminated, and fibroids that interfere with the course of pregnancy are removed. Infections that contribute to the development of endometritis are treated with medication before pregnancy. Isthmic-cervical insufficiency during pregnancy is corrected surgically. Most often, the doctor prescribes suturing the cervix (at 13-27 weeks) when insufficiency occurs - the cervix begins to shorten, become softer, and the internal or external pharynx opens. Stitches are removed at 37 weeks of pregnancy. A woman with a sutured cervix is ​​advised to have a gentle physical regimen and no psychological stress, since even on a sutured cervix, leakage of amniotic fluid is possible.

In addition to suturing the cervix, a less traumatic intervention is used - placing a Meyer ring (obstetric pessary) on the cervix, which also protects the cervix from further dilatation.

The doctor will offer you the most suitable method for each specific situation.

Do not forget that not only ultrasound data are important, but also information obtained from vaginal examination, since the neck can not only be shortened, but also softened.

To prevent and treat problems associated with the hemostatic system of the expectant mother, the doctor will prescribe laboratory blood tests (mutations of the hemostatic system, coagulogram, D-dimer, etc.). Based on the published examination results, drug treatment (tablets, injections) that improves blood flow can be used. Expectant mothers with impaired venous blood flow are recommended to wear therapeutic compression hosiery.

There can be many reasons for miscarriage. We did not mention severe extragenital pathologies (diseases not related to the sexual sphere), which make it difficult to bear a child. It is possible that for a particular woman, not one reason “works” for her condition, but several factors at once, which, overlapping each other, give rise to such a pathology.

It is very important that a woman with a history of miscarriage (three or more losses) be examined and undergo medication preparation BEFORE your upcoming pregnancy to avoid this complication.

Treatment of such a pathology is extremely difficult and requires a strictly individual approach.

Most women do not require any treatment as such immediately after a spontaneous miscarriage in the early stages. The uterus gradually and completely cleanses itself, similar to what happens during menstruation. However, in some cases of incomplete miscarriage (partial remnants of the fertilized egg remain in the uterine cavity) and when the cervix is ​​bent, it becomes necessary to curettage the uterine cavity. Such manipulation is also required in case of intense and unstoppable bleeding, as well as in cases of threat of development of an infectious process or if, according to an ultrasound examination, remnants of membranes are detected in the uterus.

Anomalies in the structure of the uterus are one of the main causes of recurrent miscarriage (the cause in 10-15% of cases of repeated miscarriage in both the first and second trimesters of pregnancy). Such structural anomalies include: irregular shape uterus, the presence of a septum in the uterine cavity, benign neoplasms deforming the uterine cavity (fibroids, fibroids, fibromyomas) or scars from previous surgical interventions (cesarean section, removal of fibromatous nodes). As a result of such violations, problems arise for the growth and development of the fetus. The solution in such cases is to eliminate possible structural abnormalities and very close monitoring during pregnancy.

An equally important role in recurrent miscarriage is played by a certain weakness of the muscular ring of the cervix, and the most typical period for termination of pregnancy for this reason is 16-18 weeks of pregnancy. Initially, weakness of the muscular ring of the cervix can be congenital, and can also be the result of medical interventions - traumatic damage to the muscular ring of the cervix (as a result of abortion, cleansing, rupture of the cervix during childbirth) or certain types of hormonal disorders (in particular, increased levels of male sex hormones). The problem can be solved by placing a special suture around the cervix at the beginning of a subsequent pregnancy. The procedure is called “cervical cleavage.”

A significant cause of recurrent miscarriage is hormonal imbalance. Thus, ongoing studies have revealed that low levels of progesterone are extremely important in maintaining pregnancy in the early stages. It is the deficiency of this hormone that is the cause in 40% of cases. early interruption pregnancy. The modern pharmaceutical market has been significantly replenished with drugs similar to the hormone progesterone. They are called progestins. The molecules of such synthetic substances are very similar to progesterone, but they also have a number of differences due to modification. Drugs of this kind are used in hormone replacement therapy in cases of corpus luteum insufficiency, although each of them has a certain range of disadvantages and side effects. Currently, only one drug can be named that is completely identical to natural progesterone - utrozhestan. The drug is very convenient to use - it can be taken orally and inserted into the vagina. Moreover, the vaginal route of administration has a large number of advantages, since, being absorbed into the vagina, progesterone immediately enters the uterine bloodstream, therefore the secretion of progesterone by the corpus luteum is imitated. To maintain the luteal phase, micronized progesterone is prescribed in a dose of 2-3 capsules per day. If the pregnancy develops successfully while using utrozhestan, then its use continues and the dose is increased to 10 capsules (as determined by the gynecologist). As pregnancy progresses, the dosage of the drug is gradually reduced. The drug is reasonably used until the 20th week of pregnancy.

Expressed hormonal disorder may be a consequence of polycystic changes in the ovaries, resulting in multiple cystic formations in the body of the ovaries. The reasons for repeated failure in such cases have not been sufficiently studied. Habitual miscarriage often becomes a consequence of immune disorders in the body of the mother and fetus. This is due to the specific ability of the body to produce antibodies to fight penetrating infections. However, the body can also produce antibodies against the body's own cells (autoantibodies), which can attack the body's own tissues, causing health problems as well as premature termination of pregnancy. These autoimmune disorders are the cause of 3-15% of cases of recurrent pregnancy loss. In such a situation, it is first necessary to measure the existing level of antibodies using special blood tests. Treatment involves the use of small doses of aspirin and blood thinners (heparin), which leads to the possibility of bearing a healthy baby.

Modern medicine is paying attention to a new genetic abnormality - the Leiden mutation of factor V, which affects blood clotting. This genetic trait may also play an important role in recurrent miscarriage. Treatment for this type of disorder has not yet been fully developed.

Asymptomatic infectious processes in the genitals occupy a special place among the causes of habitual pregnancy failure. It is possible to prevent premature termination of pregnancy by routinely screening partners for infections, including women, before a planned pregnancy. The main pathogens that cause recurrent miscarriage are mycoplasma and ureaplasma. Antibiotics are used to treat such infections: ofloxin, vibromycin, doxycycline. The treatment carried out must be carried out by both partners. A control examination for the presence of these pathogens is performed one month after the end of antibiotic therapy. In this case, a combination of local and general treatment is extremely necessary. Locally, it is better to use broad-spectrum drugs that act on several pathogens simultaneously.

In the event that the reasons for repeated pregnancy failure cannot be detected even after a comprehensive examination, the spouses should not lose hope. It has been statistically established that in 65% of cases, after a missed pregnancy, spouses have a successful subsequent pregnancy. To do this, it is important to strictly follow doctors’ instructions, namely, take a proper break between pregnancies. For complete physiological recovery after a spontaneous miscarriage, it takes from several weeks to a month, depending on the period at which the pregnancy was terminated. For example, certain pregnancy hormones remain in the blood for one or two months after a spontaneous miscarriage, and menstruation in most cases begins 4-6 weeks after termination of pregnancy. But psycho-emotional recovery often requires much more time.

It should be remembered that observation of a pregnant woman with recurrent miscarriage should be carried out weekly, and if necessary, more often, for which hospitalization is carried out in a hospital. After establishing the fact of pregnancy, an ultrasound examination should be performed to confirm the uterine form, and then every two weeks until the period at which the previous pregnancy was terminated. If ultrasound data does not detect fetal cardiac activity, it is recommended to collect fetal tissue for karyotyping.

Once fetal cardiac activity is detected, additional blood tests are not necessary. However, in later pregnancy, evaluation of α-fetoprotein levels is advisable in addition to ultrasound. An increase in its level may indicate neural tube malformations, and low values ​​may indicate chromosomal abnormalities. Increased α-fetoprotein concentration without obvious reasons at 16-18 weeks of pregnancy may indicate a risk of spontaneous abortion in the second and third trimesters.

Evaluation of the fetal karyotype is of great importance. This study should be carried out not only for all pregnant women over 35 years of age, but also for women with recurrent miscarriage, which is associated with an increased likelihood of fetal malformations in subsequent pregnancies.

When treating recurrent miscarriage of unknown cause, IVF can be considered one of the alternatives. This method allows you to examine germ cells for the presence of chromosomal abnormalities even before artificial insemination in vitro. The combination of this technique with the use of a donor egg gives positive results in achieving the desired full pregnancy. According to statistics, full pregnancy in women with recurrent miscarriage after this procedure occurred in 86% of cases, and the frequency of miscarriages decreases to 11%.

In addition to the various methods described for the treatment of recurrent miscarriage, it is necessary to note nonspecific, background therapy, the purpose of which is to relieve the increased tone of the muscular wall of the uterus. It is the increased tone of the uterus of various nature that is the main cause of premature miscarriages. Treatment involves the use of no-shpa, suppositories with papaverine or belladonna (injected into the rectum), intravenous drips of magnesium.