Miscarriage syndrome. Early pregnancy loss: causes, diagnosis, prevention, treatment

Miscarriage is a serious problem that happens to be faced by about 15-25% of couples expecting a baby. Our article will tell you why some pregnancies are doomed to such a sad outcome, and whether it is possible to combat this problem.

Miscarriage is said to occur when, from the moment of conception to 37 weeks, all the hopes of the expectant mother are destroyed due to a spontaneous miscarriage. This phenomenon acquires the status of “habitual” when misfortune befalls a pregnant woman 2 – 3 or more times in a row. Statistics show that recurrent miscarriage competes with infertility for the right to be called the most common procreation problem.

Classification of cases of miscarriage

Depending on the timing of termination of pregnancy, there are:

1. Spontaneous abortions. If the miscarriage occurs before the 11th week, the abortion is considered early. If the accident happened during the period from 11 to 21 weeks of gestation, the abortion is late. The interruption occurs regardless of whether the child is alive or dead.
2. Premature birth. Pregnancy is terminated at 22–27 weeks, when the baby’s body weight fluctuates in the range of 0.5–1 kg.

There are several stages of abortion, based on which the following types of this condition are distinguished:

• threatened abortion;
• abortion is in progress;
• incomplete abortion;
• complete abortion.

In addition, when talking about abortion in general, they mean that it can be unsuccessful and infected.

Causes of miscarriage

A great many factors have been found that cause this pathology. Miscarriage is often stimulated by not one, but several reasons. Let's list them all.

Reasons depending on the expectant mother:

• endocrine diseases (for example, pathologies related to the health of the ovaries or adrenal glands);
• anatomical features of the female body (for example, an infantile uterus or serious anomalies of its development);
• pathological incompatibility of woman and child. We are talking about a phenomenon when, on immunological or genetic grounds, the maternal body rejects the embryo/fetus as a potential threat.

Complications that occur during pregnancy:

• gestosis, leading to various disorders of cerebral circulation;
• placenta previa or premature abruption;
• violation of the integrity of the membranes earlier than expected;
• polyhydramnios;
• the presence of 2 or more embryos in the uterus;
• pathological location of the fetus.

Factors not related to pregnancy:

• acute and chronic infectious diseases;
• pathologies of the heart and blood vessels;
• functional disorders of the genitourinary system;
• thrombophilic diseases;
• diseases of the abdominal organs.

Adverse environmental effects:

• bad ecology;
• hazards in production associated with a woman’s profession;
• physical or mental trauma to the expectant mother;
• bad habits.

It should also be noted that the causes of 27.5 – 63.5% of cases of miscarriage remain unclear. Pregnant women and the doctors treating them find themselves in this difficult situation so often that the phenomenon has even been identified as idiopathic (unexplained) abortion. Drug treatment in these cases is ineffective, and psychological support for the woman comes to the fore, helping her endure the pain of loss.

The mechanism of pathology development

At the heart of self-interruption intrauterine development In the fetus, there is a hidden pathological destruction of the connection between cortical and cortico-subcortical factors, which occurs under the influence of many prerequisites. Prerequisites mean the most complex reflex relationship between mother and child, as well as factors that can affect the nuances and strength of the reflex.

Today, 4 options for the development of pathology have been identified:

1. Termination of pregnancy is possible due to pathological changes in the immune and hormonal balance of the fetoplacental complex. In this case, miscarriage occurs early stages(up to 12 weeks).
2. Gestation is interrupted due to active contractions of the uterus: the fetus is rejected as if labor had begun. This happens mainly closer to the 3rd trimester of the “interesting” position, when the uterus has already undergone morphological and functional metamorphoses.
3. Death and rejection of the fetus occurs under the influence of mutations or genetic disorders.
4. Miscarriage occurs due to isthmic-cervical insufficiency (pathology of the isthmus and cervix) in the middle and at the end of gestation.

Scientists have combined all types of childbearing losses into fetal loss syndrome. The general concept implies:

1. One or more miscarriages in a row during pregnancy from 10 weeks or more.
2. Stillbirth in medical history.
3. Neonatal (infant) death.
4. 3 or more self-abortions during the preembryonic or early embryonic stage.

Diagnosis of pathology

Due to the fact that miscarriage is considered to be the result of a combination of the interaction of a number of unfavorable causes, the examination of affected patients is complex. It involves clinical, instrumental and laboratory diagnostic methods, during which the doctor must not only detect the “weak link” during pregnancy, but also study the state of the patient’s reproductive system in order to prevent a recurrence of the misfortune.

Features of examination before conception

Analyzing the medical history of a woman who has experienced recurrent miscarriage, the specialist will pay attention to the hereditary factor, cancer and neuroendocrine disorders. It is also necessary to find out whether the patient suffered from genital inflammatory diseases and viral infections in the past, whether she underwent surgery during childbirth, intentional or spontaneous abortions.

Clinical examination is represented by the following procedures:

• examination of a woman by a gynecologist;
• assessment of the patient’s skin condition;
• determination of quantity excess weight according to BMI;
• assessment of the thyroid gland condition;
• determination of the frequency of ovulation and functional viability of the ovaries based on data from rectal temperature and monthly calendar.

The following methods are used in laboratory and instrumental diagnostics:

1. Hysterosalpingography. The procedure is relevant in the period from 17 to 23 days monthly cycle. With its help, you can examine a woman’s body for the presence of defects and anomalies in the development of the internal genital organs, intrauterine synechiae, etc.
2. Ultrasound. During the procedure, the ovaries are examined and the uterus is checked for the presence of cysts, adenomyosis and polyps.
3. Infectious screening. The method involves examining biological material taken from the urethra, vagina and uterus under a microscope.
4. Hormonal analysis. Allows you to clarify the level of prolactin, testosterone, cortisol, luteinizing, follicle-stimulating hormones and other important active substances in the patient’s blood.

The potential father also undergoes an examination, during which his detailed spermogram is analyzed, the presence of immune and inflammatory factors and specific somatic diseases is clarified.

Features of examination after conception

If there is a risk of miscarriage in a pregnant patient, she is monitored with particular care. Management of such a pregnancy is necessarily accompanied by the following research methods:

• regular blood sampling to determine hCG levels;
• blood test for DHEA/DHEA sulfate (this is the main steroid hormone in a woman’s body, with the participation of which the glands endocrine system produce 27 more hormones);
• periodic consultations with a psychologist.

Symptoms and treatment of miscarriage

The discharge of a certain amount of blood from the vagina and painful discomfort in the lower abdomen are considered to be the main signs of spontaneous abortion. However, it should be taken into account that each stage of miscarriage has its own specific manifestations, and therefore requires a special approach to treatment.

Threatened abortion

A woman in this position is bothered by nagging pain in the lower abdomen and lower back. If alarming symptoms occur in mid-pregnancy, the pain usually resembles contractions. There is slight bleeding. The uterus is developing well, its volume corresponds to the gestational age, but there is hypertonicity.

The ultrasound procedure reveals symptoms of a threatened abortion, such as an unclear outline of the ovum or chorion/placental abruption in a certain area.

Before prescribing maintenance therapy to a pregnant woman with a threat of miscarriage, the doctor will certainly pay attention to the presence of factors associated with the woman’s condition, such as:

• cases of self-abortion in the past;
• age over 34 years;
• bradycardia;
• absence of heartbeat in the embryo during CTE;
• slow or absent growth of the fertilized egg within 10 days;
• an empty fertilized egg measuring 15 mm at 7 weeks of gestation and 21 mm at 8 weeks;
• the size of the embryo is significantly smaller than the size of the fertilized egg;
• decreased hCG levels;
• decreased levels of progesterone.

Despite the presence of all warning signs threatened abortion, targeted treatment helps maintain pregnancy. Supportive therapy in this case is complex: medications are prescribed to a minimum in minute doses, mainly focusing on safe procedures in the form of electroanalgesia, acupuncture, electrorelaxation of the uterus and herbal aromatherapy.

Abortion is on the move

At this stage of miscarriage, the embryo detaches from the uterine endometrium and leaves the uterus through the dilated cervical canal. A pregnant woman feels cramping pain in the abdomen and experiences heavy bleeding. A vaginal examination reveals a dilated cervix with parts of the fertilized egg in it. At 12 weeks of pregnancy, an ultrasound shows complete detachment of the egg or partial detachment of the placenta.

The tactics for further action are chosen taking into account the duration of pregnancy. Thus, at a gestation period of up to 16 weeks, curettage of the uterus is performed as an emergency procedure, followed by laboratory analysis of the rejected tissue. For a period of 16 weeks or more, they wait for the spontaneous complete rejection of the biological material and only then carry out vacuum cleaning or curettage of the uterus.

In case of severe bleeding, which can threaten the patient’s life, they act promptly: the embryo is removed from the uterus without waiting for its rejection, and hemodynamics are stabilized. If immediate surgery to curettage the uterus is impossible for some reason, in case of severe bleeding, the pregnancy is terminated abdominally.

Incomplete abortion

The embryo leaves the uterus, but some parts of it remain there. Outwardly, this is manifested by cramping pain and bleeding from the vagina, and these symptoms can be of varying degrees of intensity. Upon examination of the patient, the doctor determines that the cervix is ​​shortened and the pharynx is open. There is no uterine tone - the organ is soft and does not meet the gestation period. Ultrasound reveals unclear outlines of heterogeneous tissues in the cavity of the muscular organ.

In case of incomplete abortion, the uterine cavity is cleaned, removing rejected tissue from there, followed by laboratory testing. They resort to a surgical or medicinal method of ridding the uterus of parts of the embryo.

The choice in favor of surgery is made in the following cases:

• intense bleeding;
• the uterine cavity is open more than 50 mm;
• body temperature is about 38 0 C.

If the patient’s condition is satisfactory and the gestation period is 70 days from the first day of the last menstruation, preference is given to the medicinal method of cleansing. For incomplete abortion, large doses of prostaglandin are used (from 800 to 1200 mg). Most often they stop at the drug Misoprostol. 4 to 6 hours after intravaginal administration, the uterus begins to contract and completely expels the fertilized egg. The main advantage this method consider a low percentage of cases of pelvic infection.

Complete abortion

Under the influence of strong uterine contractions, the fertilized egg is rejected by the uterine cavity. External signs are either completely absent or expressed by scanty bleeding and nagging pain in the lower abdomen. Vaginal examination reveals a dense uterus with an open external os. If the patient’s condition is satisfactory, then instrumental examination of the walls of the uterine cavity is not performed.

Failed abortion

In this case, the embryo stops developing, but does not leave the uterus. At this time, the patient’s body temperature may rise and ichor may appear. Subjective sensations of an “interesting” situation disappear. An ultrasound shows that the size of the embryo lags behind the gestation period. In addition, there is no heartbeat or movement of the embryo. If the diagnosis of a failed abortion is confirmed, an emergency operation is required to remove embryonic or fetal material through surgery or medication.

Prognosis and measures to prevent recurrent miscarriage

The prognosis for the development of future pregnancy in a patient whose medical history contains a note of self-abortion depends on how the previous pregnancy ended. The most favorable prognosis is for women whose pregnancy was interrupted due to organic uterine pathology, endocrine or immune factors.

Despite the complexity and unpredictability of the phenomenon of recurrent miscarriage, you can try to avoid it. After a detailed study of the patient’s medical history, the doctor prescribes a comprehensive treatment, consisting of the use of medications and following the recommendations of a specialist. An approximate therapeutic complex for the treatment of recurrent miscarriage looks like this:

1. Bed rest and strict diet.
2. Use of sedatives (Sanosan, Diazepam, Phenazepam, tinctures of medicinal herbs).
3. Application hormonal drugs. Treatment is effective from the 5th week of gestation to the 28th week inclusive. The most popular drugs are progesterone, gonadotropin, Duphaston and Ethinyl estradiol.
4. Use of antibiotics to prevent infection.
5. Tocolytic treatment aimed at suppressing uterine contractions.
6. Work to improve the metabolism of the fetoplacental complex, for which the patient is prescribed multivitamin complexes, preparations of ascorbic acid and tocopherol acetate.
7. Surgical intervention (in case of urgent need) - a circular suture is placed on the uterus before the 38th week of gestation.

Prevention of miscarriage

Unfortunately, nature cannot be outwitted, and with all the desire of expectant mothers and their attending physicians, cases of recurrent miscarriage still occur. The search for methods to get rid of this pathology continues to this day and indicates that the already found treatment methods cannot be called 100% effective. However, one cannot give up - a woman must use every opportunity and chance to become a mother. Therefore, a lot important is planning a pregnancy after the previous one ended in spontaneous abortion.

The patient should consult a doctor for a thorough examination of the body for the presence of diseases that may complicate the course of pregnancy, and tests for analysis hormonal levels and bacteriological examination of the microflora of the internal genital organs, determination of blood group and Rh factor. In addition, the future father must undergo a thorough examination.

If the etiology of the causes of miscarriage is unclear, the woman may be sent to a specialized hospital for a thorough analysis of the state of her endocrine and immune systems.

How to deal with the problem. Video

Miscarriage- This is the primary problem of today's society. The essence of the existing problem is spontaneous abortion from the time of fertilization to 37 weeks. WHO explains the existing term as the rejection or removal of an embryo or fetus with a total weight of 500 grams or less from the mother's body.

According to generally accepted rules, it is believed that miscarriage that occurs before twenty-eight weeks is a spontaneous miscarriage or abortion. While when it occurs after twenty-eight weeks, this process is called premature birth. The public faces a serious family-psychological problem for families who have experienced such grief. And this is also a problem that occupies leading place in medical topics, about solving the issue of early diagnosis and prevention of this pathology, but there is also a problem of socio-economic significance for the country as a whole.

The pathology is diagnosed twice as often in women with obvious discharge, starting in the early stages, of a hemorrhagic nature (12%), rather than in patients with no such discharge (4%). The most dangerous thing in all this is an unreasonable interruption in the first trimester, namely, from the sixth to the eighth week. It is during this time interval that about 80% of miscarriages occur. Most of them occur before the appearance of a heartbeat, that is, the embryo dies. At the same time, a woman may not even know about a previously occurring and already terminated pregnancy. After the eighth week, the probability of a pathological process occurring, with the heart already beating, is only 2%. And with a period of ten weeks and a satisfactory heartbeat, the threat reaches only 0.7%.

Often, in the early stages, scientists associate pathology with developmental deviations; the mechanism of so-called biological natural selection is activated. And it was proven that the embryos had a chromosomal defect in 82% of cases.

The causes of miscarriage cannot always be accurately determined, because... they are of somewhat mixed origin. The age indicator is also important, so if a girl of twenty has a history of two miscarriages, then the favorable outcome of the subsequent pregnancy will be 92%, and in a similar situation at 45 years old - 60%.

Risk of miscarriage

The risk of this pathological condition can be classified into several subcategories, but the main shaping factor is the number of previous miscarriages. With a primary occurrence, the probability of a subsequent one increases by 16%, with the second case in a row the figure increases to 28%, with three in a row it reaches 44%, with all subsequent cases over 55%. Secondary infertility develops in a similar way, due to this pathology, the incidence of damage reaches 35%. Thus, treatment not started in a timely manner leads to an increase in the subsequent threat of miscarriage to 52%.

Risk is divided into the following subcategories:

— Pathological changes body of the expectant mother: heart and vascular diseases, asthmatic phenomena, kidney disease, diabetic manifestations.

- Short social factor: abuse of alcohol-containing beverages, tobacco and drug addiction, difficult physical working conditions, constant stress loads, unsatisfactory living conditions, food factor and poor environmental background.

- Factor of complications: oligohydramnios or polyhydramnios, premature detachment or severe toxicosis, transverse or buttock presentation of the child, the presence of intrauterine or intrauterine infections.

Recurrent miscarriage

Every day, the diagnosis of recurrent miscarriage, which is characterized by the repetition of spontaneous miscarriage more than 3 times in a row, is becoming more and more common. In world practice, out of 300 women, one will have this diagnosis. Often, a miscarriage specialist diagnoses this pathology as a diagnosis after the second miscarriage in a row. The process of interruption itself is repeated at approximately the same time, which puts the woman into a state of melancholy, and life begins with a sense of guilt. In the future, in such a situation, and untimely help from a professional psychologist, all subsequent attempts to endure will also not be crowned with success.

Do not equate habitual miscarriage with accidental miscarriage. The second option occurs under the influence of temporary negatively damaging factors, which ultimately leads to the initial non-viability of the embryo. This phenomenon is rather sporadic and is not considered as a threat of recurrence and subsequent impact on the ability to become pregnant and, subsequently, bear a child.

The causes of recurrent miscarriage are multifactorial. These include:

— Disorders of the internal secretion system: increased production of the hormone prolactin, pathology of the luteal phase.

— Viruses that persist in the body: , . Pathogenic and conditionally pathogenic flora: gono- and streptococci gr. B, myco- and ureoplasma, chlamydia. And also, among them, various variations of a viral and bacteriological nature.

— Congenital pathologies of the uterus: bicornuate, saddle-shaped, adhesions, additional septa, scars of any origin, cervical-isthmus incompetence and multiple myomatosis. In this case, surgical intervention is performed.

— Deviation of carityping.

— The presence of antibodies that interfere with the gestation process: antisperm, antibodies to chorionic hormone, pathology of human leukocyte antigens.

— Genomic mutations of various origins.

As a consequence, the reasons given prevent normal physiological development placenta and contribute to damage to the embryos, which entails, first of all, the inability to carry a child to term normally.

Already with a diagnosis, and, in turn, the desire to give birth, a woman needs to plan and undergo examinations in advance. There are a number of specific techniques, these include:

— Determination of the quantitative component of the hormones responsible for reproduction - estradiol, progesterone, androgens, prolactin, DHEAS, testosterone, 17-OP, measurement of basal temperature, hCG level. Bacterial seeding is carried out on flora from cervical canal, determination of virological factors and sexually transmitted diseases.

— Autoimmune analysis for antibodies (AT): phospholipid antibodies, antisperm antibodies, karyotype of a married couple, human leukocyte antibody.

- To exclude concomitant pathology, ultrasound examination from 12 weeks, Doppler ultrasound from 28 weeks of fetal-placental blood flow, cardiotocography from 33 weeks, hysteroscopy, salpingography.

It is reasonable to undergo an anti-relapse and rehabilitation course of treatment before pregnancy in order to eliminate the etiopathogenetic factor. To summarize, we can say that the diagnosis of recurrent miscarriage is not a death sentence, but requires careful research and timely treatment for complete elimination, which is entirely possible.

Causes of miscarriage

The reasons are extremely varied. Significant difficulties are presented by the presence of an etiopathogenetic factor, but the pathology is caused, rather, by the combination of several etiologies at once.

Factors are divided into those coming from the pregnant woman, the compatibility of the fetus and the female body, and the impact of the surrounding climate. The most significant are the following:

— Genetic disorders, that is, changes in chromosomes. By location they can be intrachromosomal or interchromosomal, and by quantity: monosomy (absence of a chromosome), trisomy (additional chromosome), polyploidy (increasing set to full haploid).

During a karyotypic study of a married couple, if no anomalies are detected, the probability of failure in subsequent pregnancies is negligible - up to 1%. But, when one of the couple is diagnosed, the risk increases significantly. If such a case occurs, genetic counseling and perinatal diagnosis are recommended. They often have a family hereditary nature, the presence in the family of relatives with congenital developmental defects.

Changes in gene structures are the most common and studied, accounting for about 5% in the structure of the etiopathogenesis of the given anomaly. It is known that over half of cases of miscarriage occurring specifically in the first trimester are caused by abnormalities of the chromosomes of the embryo. And, as mentioned earlier, it is interpreted by the scientific community as a result of natural selection, which leads to the death of a damaged, pathologically developing, and initially non-viable embryo. That is, the genetic-etiological factor depends on the intensity of mutation and effective selection.

Chromosomal aberrations deserve special attention. Thus, autosomal trisomy, the most common subtype of chromosome abnormalities, provokes more than half of all pathological karyotypes. Its essence lies in the nondisjunction of oocyte chromosomes in mitosis, which is directly related to an increase in the age indicator. In all other aberrations, age has no meaning.

— Thrombophilic causes: lack of protein C or S, mutational changes in the prothrombin gene, hyperhomocysteinemia, antithrombin III deficiency. It is difficult to determine only if the family history and the presence of abnormalities in it are known in advance (thromboembolism, thrombosis, miscarriages, stillbirth, IUGR, early).

- Inflammatory diseases, with various types associations of viruses and bacteria and colonization of the inner wall of the uterus, an inadequate immune response with the inability to eliminate the foreign agent from the body.

The role of infections has not been fully proven, since having initially provoked a miscarriage, it is not a fact that history will repeat itself again, the probability is negligible. The reason is rather isolated and is highly debated in the scientific world. In addition, no single proven agent has been identified that provokes recurrent miscarriages; a viral complex prevails in the endometrial flora.

According to the data studied, persistent infections can independently trigger immunopathological processes, causing disruptions in the functioning of the entire organism. CMV, herpes, Coxsackie viruses, and enteroviruses are found in patients with miscarriages more often than in those with a normal course.

Colonization occurs when the immune system and complement system, phagocytic forces, are unable to completely overcome the infection. In all likelihood, it is precisely this condition that prevents the formation of local immunosuppression in the preimplantation period, during the formation of the protective barrier and preventing the expulsion of a partly foreign fetus.

Placentitis often develops along the way, with thinning of the walls and leading to the unprotection of the fetus from penetration. The blood and airborne mechanism is observed only in the first trimester; from the second, the ascending path becomes dominant. Infection occurs through amniotic fluid or foreign agents, along the amniotic membranes, approaching the umbilical cord. Chorioamnionitis develops due to the effects of prostaglandins with increased uterine contractions. Also when performing a diagnostic biopsy.

The state of the vaginal flora plays an important role, as it is the entry point for infection into the uterine cavity, and is the leading cause of intrauterine infection.

— Endocrine causes account for 9-23%. But! The very influence of hormonal imbalances has not been thoroughly studied. Varieties include: luteal phase disorders, disruptions in the secretion of androgens, thyroid diseases, insulin-dependent diabetes.

Luteal phase deficiency is explained by a decrease in the pregnancy hormone progesterone. Its level plays a vital role in the attachment of the fertilized egg to the uterine wall and its further retention. Without a sufficient level, pregnancy is terminated and subsequent development of infertility occurs.

Excess androgens are associated with increased testosterone production. adrenal gland is a genetically hereditary abnormality. At the same time, the ovarian comes from. Their combination, that is, mixed genesis, can be detected when the hypothalamic-pituitary function fails. In addition, antidepressants and oral contraceptives can provoke hyperprolactinemia.

Of the thyroid gland disorders, the most dangerous are thyroiditis, in which it is impossible to normally support the development of the fetus due to a lack of hormones and iodine deficiency.

— Immunological factors account for about 80% of all scientifically unknown cases of repeated child loss. Divided into two subcategories:

In autoimmune diseases, the response of aggression is directed towards its own tissue antigens; in the blood there are antibodies to thyroid peroxidase, thyroglobulin, and phospholipids. Under current conditions, the fetus dies from damaged maternal tissue. The leading culprit in fetal death is.

With alloimmune, there are common histocompatibility complex antigens with the partner that are foreign to the mother’s body, the response is disrupted and it will be directed against fetal antigens.

That is, groups of immunity breakdowns have been revealed: humoral, associated with APS and cellular, the response of the mother’s body to the embryonic antigens of the father.

— Organic defects of the genital area:

Acquired (isthmic-cervical insufficiency, or).

Congenital (uterine septa, saddle, one- or two-horned, anomalies of the uterine arteries).

The deviations described above lead to the impossibility of implanting the abnormal uterine wall of the fertilized egg so that full development occurs.

With intrauterine septa, the risk of miscarriage is 60%, with fusions - 58-80%, depending on the location. If the branching of the arteries is incorrect, the normal blood supply is disrupted.

With myomatous changes, the activity of the myometrium is increased, the fermentation of the contractile complex is increased, caused by a malnutrition of the nodes.

ICI is caused by damage to the cervix during abortion and childbirth. It is characterized by softening and gaping of the cervix, as a result of which the fetal bladder prolapses and the membranes exit into the cervical canal, opening it. This phenomenon is observed towards the end of a pregnant woman’s pregnancy, but it may appear slightly earlier.

The threat and timing are determined by specific reasons for each period; there are “gestational vulnerable phases of miscarriage,” namely:

5-6 weeks are represented by genetic reasons.

7-10 weeks: hormonal disorders and disorders of the relationship between the endocrine and autoimmune systems.

10-15 weeks: immunological reasons.

15-16 weeks: ICI and infectious etiology.

22-27 weeks: ICI, malformations, breaking of water, multiple births with the addition of infection.

28-37 weeks: infection, breaking of water, fetal distress syndrome, stress not related to the gynecological area, autoimmune attacks, conditions in which the uterus is overdistended, uterine defects.

Symptoms of miscarriage

The symptom complex does not clearly manifest itself, which complicates the diagnosis of the disease, complicates the process of finding the root cause, establishing the correct diagnosis and finding optimal ways to resolve the problem as such.

The symptom complex includes the following manifestations:

— The main and most significant manifestation is intermittent, increasing bleeding or bloody drips outside of menstruation, without significant reasons.

- Spasmodic pain that is difficult to relieve with medications.

— Pain spreading downwards into the pubic region, as well as radiating to the lumbar area, unstable, changing from time to time, intensifying and subsiding, regardless of activity, stress and treatment.

— It is possible, rather as a sporadic case, for a slight rise in the patient’s body temperature against this background, being causeless, in the absence of infectious symptoms or another origin.

- Alternating weakness, nausea and vomiting may occur.

As can be judged from the above, the symptomatic manifestations are not so extensive and are disguised as many other diseases that even the patient herself, with the resulting pathology, will not suspect termination of pregnancy, but rather will associate it with the onset of menstruation or mild poisoning, neuralgia.

Diagnosis of miscarriage

It is advisable to carry out diagnostic measures before the child is conceived, and then be examined at each stage of pregnancy.

First of all, the life history of each applicant is scrupulously studied, the doctor notes: the number of previous pregnancies, their course, the presence of monitoring, the period of interruption, the use of medications, attempts to preserve and specifically applicable medications, available tests and their interpretation, pathohistology of abortion.

Genealogical diagnostics is the collection of information to clarify causal and hereditary deviations. They study the family genealogical tree of the woman and man, the presence of hereditary diseases in the family, developmental disabilities of the couple’s parents or their relatives. It turns out whether the woman was born full-term and whether she has brothers and sisters, whether they are healthy or not. The frequency of morbidity, the presence of chronic diseases, and the social standard of living are determined. They conduct a survey regarding the nature of menstruation, what was the beginning, their abundance and duration. Were there any inflammatory diseases and whether therapy was used, whether gynecological operations were performed. And most importantly, determining childbearing reproductive capacity from the beginning intimate life until the onset of pregnancy, methods of contraception used previously. All these factors together determine further tactics, taking preventive measures and developing a protocol for managing a pregnant woman.

Clinical examination is a general examination of the skin and mucous membranes, determination of body type, body mass index, whether secondary sexual characteristics are present and to what extent, examination for the appearance of stretch marks, listening to cardiac activity, studying liver parameters, measuring blood pressure, identifying signs of disorders metabolism, examine the breasts for. The examination also includes an assessment of the psychological and emotional sphere - nervousness or apathetic signs in the patient, resistance to stress, vegetative and neurotic disorders. They examine absolutely everything systematically.

The gynecological status is also determined: the condition of the ovaries, ovulation processes according to the basal temperature and the menstrual calendar maintained by the woman. Determination of hair growth by female type, neck sizes. Detection of existing condylomas, defects, hypoplasia, tumors, scars on the cervix. For this type of diagnosis, the following is carried out:

— Culture, general urine test and Nechiporenko test, biochemistry and general blood test, examination for STIs and TORCH-complex.

— Hysterosalpingography to exclude anatomical defects of the uterus and cervical isthmus incompetence.

— Ultrasound assessment of internal organs and endometrium. Sonohysterosalpingography with the introduction of physiological 0.9% sodium chloride solution into the uterine cavity.

— MRI and laparoscopy, if it is impossible to verify the diagnosis.

— Measuring basal temperature and drawing its graph to assess the luteal phase.

— Infectious screening. Includes microscopy of smears from the urethra, cervix and vagina, examination for virus carriage, blood for Ig M, Ig G for CMV, PCR for carriage of VH, CMV, STIs, determination of immunity status, examination of the cervix for pathogenic bacteria and lactobacilli and their number, determination of the sensitivity of lymphocytes to interferon inducers, study of the concentration of cervical contents for cytokines, biopsy with endometrial histology, background examination and PCR to confirm the presence of an infectious factor.

— When studying hormonal levels, they primarily determine progesterone function in women with regular menstruation. Conducting a small test using Dexamethasone and its further use with the calculation of individual doses is carried out when failures of the adrenal etiology are detected, the issue of corrective therapeutic doses of drugs is resolved in case of an incompetent luteal stage and the definition of hormone imbalance. For auxiliary purposes, groups of hormones of the adrenal glands, thyroid gland, ovaries, and hypothalamus are studied.

— An immunological study that determines the presence of immunoglobulins in the blood, the titer of autoantibodies to phospholipids, somatotropin, glycoproteins, human chorionic gonadotropin, prothrombin, progesterone and thyroid hormones. A study of interferons is carried out to determine the personal sensitivity of lymphocytes to interferon inducers, an endometrial biopsy is performed, and the quantitative content of pro-inflammatory cytokines is determined.

— Hemostasiogram, represents an analysis of the quantity and qualitative definition, the functioning of the blood coagulation system as a whole. Thromboelastography is performed with blood plasma, which reflects the very dynamics of coagulation, the quality of indicators, and whether the cells cope with the task. Study of coagulogram and platelet aggregation. Finding features and D-dimer. Study of gene polymorphism, a decrease in trophoblastic globulin is investigated as a primary indicator of the risk of a pathological placenta.

— Genetic studies are mandatory for older couples, recurrent miscarriages, stillbirths, and lack of treatment effect. Includes the genealogy described earlier and cytogenetic studies - karyotyping to detect chromosomal abnormalities, abortion analysis and karyotyping of neonatal deaths.

— If there is a difference in the blood groups of partners, an analysis is performed for immune antibodies; in case of Rh conflict, the presence of Rh antibodies is performed.

— Lupus antigen, antichoriotropin to determine aggression of autoimmune origin.

— The examination of a man consists of a spermogram (detailed), a survey about related diseases, the presence of somatic diseases, and immune diseases.

In addition, diagnostic activities are classified weekly:

15-20 weeks: examination in a gynecological chair and ultrasound to exclude cervical-isthmus incompetence, taking smears to determine microflora, testing alpha-fetoprotein, beta-choriotopin.

20-24 weeks: glucose tolerance test, ultrasound with a vaginal probe and, if indicated, manual assessment of the genital tract, taking smears for pro-inflammatory cytokines and fibronectin, assessment of blood flow using a Doppler probe.

28-32 weeks: Ultrasound, prevention of Rh sensitization, study of fetal activity, control of uterine contractile processes, hemostasis.

34-37 weeks: cardiotocography, blood tests for sugar, protein, urine analysis and culture, repeat hemostasiogram, examination of vaginal smears, tests for hepatitis, immunodeficiency virus and Wasserman reaction.

The frequency of examinations should be carried out every week, more often if necessary, with possible observation in the hospital.

Treatment of miscarriage

If the miscarriage is complete and the uterine cavity is clean, no special treatment is usually required. But when the uterus is not completely cleaned, a curettage procedure is performed, which consists of carefully opening the uterus and removing the fetal remains or placenta. An alternative method is to take specific medications that cause the contents of the uterus to be rejected, but this is only applicable in normal health conditions, since this requires costs vitality to restore the body.

Today, there is no approved treatment protocol for miscarriage; they vary. Since none of the protocols are supported scientific research and does not meet the criteria for the effectiveness of treatment, then therapy is carried out taking into account personal characteristics of the woman who applied, but not according to a unified standard.

Among the routine methods of treating miscarriage, as a reinforcement to the main methods, the following are used:

— Vitamin therapy. Especially Tocopherol (fat-soluble vitamin E, vitamin of life) 15 mg twice a day, it has been proven that in combination with the use of hormones the therapeutic effect is higher. Electrophoresis with B1 is used - this stimulates the sympathetic central nervous system, thereby reducing the contractility of the uterine muscles.

— Neurotropic therapy normalizes existing functional disorders nervous system, use sodium bromide in droppers or per os, as well as Caffeia for neuromuscular blockades.

Treatment measures are carried out after a thorough examination and identification of the leading factor in the development of pathology, since treatment is directly distributed according to etiology:

— Treatment for infectious diseases depends on the microorganism that provokes the disease. They try to use gentle methods with complete elimination of the pathogenic agent, these include immunoglobulin therapy, antibiotic therapy with determination of individual sensitivity for quick and effective resolution of the disease, interferon therapy - KIP-feron suppositories, Viferon suppositories, Betadine, Klion-D, intravenous human immunoglobulin or Octagam. Tocolytic therapy that relieves excessive contractile impulse is applicable - Ginipral, Partusisten. For fungal etiology, Pimafucin in suppositories or orally. Afterwards, vaginal normobiocenosis and the normal concentration of lactobacilli are examined. If necessary, biological products are used - Acylak and Lactobacterin. If the indicators are normal, you can plan a pregnancy.

— Treatment of genetic abnormalities in partners with congenital disease consists of conducting a genetic consultation and subsequent treatment using the method, with a donor egg or sperm, depending on who has the deviation. An alternative is artificial insemination with one's own cells, but with preimplantation genetic diagnosis.

— Anatomical pathology can only be corrected surgically. For example, hysteroscopic access to remove intrauterine septa and concomitant administration of hormonal drugs to stimulate the growth of endometrial tissue. In case of cervical-isthmus incompetence, a circular suture is placed on the cervix until 14-20 weeks. But, this manipulation is contraindicated during labor and the opening of the external pharynx over 4.5 centimeters. They are expected to be removed by the 37th week or much earlier in the event of a term birth.

— Progesterone is preferably used to treat luteal phase deficiency. The most effective gestagens are Duphaston or Utrozhestan. The combination of Duphaston with Clostilbegit has a positive effect, which improves the maturation of the follicle, supporting the first phase and the formation of a full-fledged corpus luteum. When choosing any method, treatment with progesterone drugs should last up to 16 weeks. In case of sensitization to progesterone, immunoglobulins and immunotherapy with the introduction of the spouse's lymphocytes are administered.

If an MRI examination excludes the pathology of the sella turcica - pituitary adenoma, then treatment with Bromocriptine or Parlodelay is carried out. For concomitant pathology of the thyroid gland, sodium Levothyroxine is added and continued after pregnancy.

The use of antispasmodics - Papaverine, No-shpa, herbal sedatives - Valerian infusions, Magne B6 is also applicable.

— In the treatment of antiphospholipid syndrome, which leads to placental thrombosis, antiplatelet drugs are used — Heparin subcutaneously and Aspirin. They are especially effective when taking vitamin D and calcium simultaneously, since there are not isolated cases of development. Due to strong side effects, the use of corticosteroids - Dexamethasone or Metipred in individual doses - is limited, and it is advisable to use it together with low molecular weight heparin subcutaneously. The provided schemes are very dangerous for the woman and the fetus, but the AF syndrome itself deals a significant blow to the body. Another method is plasmapheresis, but it is also limited due to the individually significant effect. Plasmapheresis, a course of three sessions, consists of removing the bcc of 600-1000 ml of plasma per session and replacing it with rheological solutions, thus eliminating toxins, partially antigens, improving microcirculation, and reducing increased coagulability.

— For normalization and prevention placental insufficiency Actovegin, Piracetam, Infezol are used, mainly intravenously. If there is a threat, you need strict rest, taking magnesium sulfate and hexoprenaline sulfate, fenoterol, NPPs - Indomethacin, Nifedipine, oxyprogesterone capronate. Used to relax the uterus non-pharmacological means— electrorelaxation and acupuncture.

— For hyperandrogenism, treatment should begin with weight correction, normalization of carbohydrate and fat metabolism. In preparation for conception, administer Dexamethasone therapy under supervision.

Resolving the issue of miscarriage is not a problem. The main thing is to carry out targeted diagnosis in a timely manner, a thorough examination before pregnancy, pathogenetically based and methodologically constructed treatment, and dynamic monitoring throughout pregnancy.

Prevention of miscarriage

Prevention consists of initially serious attitude To women's health the patient herself and the competence of the doctor who treats her. Prevention of miscarriage is carried out to most thoroughly identify the causes and timely prescribe rehabilitation therapy.

There are basic principles for preventing miscarriage:

— Determination of the initial risk group and their clinical care by a gynecologist.

— Initially, examination of both partners when planning pregnancy and their preventive preparation. Determination of compatibility by Rh group, human leukocyte antigen and similar diagnostic methods.

— With manual assessment, diagnosis of cervical-isthmus insufficiency, using an intravaginal sensor during ultrasound examination up to, and in case of twins up to 26 weeks.

— Prevention and adequate treatment of extragenital pathologies and exclusion of exposure to strong stress factors.

— Timely treatment of thrombophilic diseases from early pregnancy.

— Elimination and prevention of placental insufficiency.

— Sanitation of chronic foci of infection.

— In case of a known pathological hormonal background, selection of treatment and timely preventive correction. So with a known infectious background, immunoglobulin therapy.

— If harmful consequences are identified and cannot be avoided, carefully provide the woman with information and search for alternative individually selected methods for conceiving and giving birth to a child.

— The expectant mother herself should be involved in preventive measures: eliminate bad habits, lead healthy image life, exclusion of uncontrolled sexual intercourse and adequate contraception during such, refusal of induced abortions.

The sad stories of 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 future miscarriages. Will a woman be able to get out of this vicious circle? This largely depends on her.

First, let's define the subject of our conversation. Russian gynecologists make a diagnosis of “habitual miscarriage” if the patient experiences spontaneous abortion at least twice. In some other countries (for example, in the USA), miscarriage is considered common, and it has occurred at least three times.

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

Causes and diagnosis of 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. But only an additional medical examination will help to dot the i’s, which, depending on the specific situation, may include the following diagnostic procedures:

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 (malformations, tumors, adhesions in the uterine cavity), and signs of chronic inflammation of the uterine mucosa can be identified. If isthmic-cervical insufficiency is suspected (1), the diameter of the internal os of the cervix in the second phase of the menstrual cycle is measured during ultrasound.
2. (2) and hysteroscopy(3) are carried out mainly when 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 manifest itself either as 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 the second phase is less than 10 - 12 days.
4. A blood test aimed at determining 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 on the 7th - 8th day from the start of menstruation), the second time - in the middle 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. In about a third of all patients with recurrent miscarriage, it occurs (an increase in the level 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, 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, the couple needs 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 for viral infections (flu, cytomegalovirus infection, herpes) suffered in early pregnancy.
9. Can be recommended for men 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 mellitus, hypertension.

If you are suffering from recurrent miscarriage...

Constant emotional stress due to repeated miscarriages not only adversely affects psychological state women, but also worsens her physical health, up 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.

1 Isthmic-cervical insufficiency is a condition when the isthmus (in Latin “isthmus”) and the cervix (“cervex”) of the uterus cannot cope with the increasing load (growing fetus, amniotic fluid) and begins to open prematurely.
2 An X-ray research method that allows you to get an idea of ​​the internal contours of the uterus and the lumen of the fallopian tubes.
3 Examination of the uterine cavity using optical instruments.

Jasmina Mirzoyan,
obstetrician-gynecologist, candidate of medical sciences, Medical Center "Capital-2"

Discussion

2 undeveloped pregnancies. Can anyone tell me? good specialist in Moscow, dealing with this problem. After the first pregnancy, I was examined, the doctor gave the go-ahead for pregnancy... but froze again, all the time at the same period of 8 weeks at 13 weeks according to my calculations.

And when everything is over, and in the most respectable honey. they cannot say anything to the city institution - how can we understand this?

Nothing new or useful. I join the opinion of previous readers.

Unfortunately, it appears that following the medical research circuit may not work. The article highlights studies carried out everywhere and in the same sequence.....But, unfortunately, in practice, a woman finds herself in the hellish millstone of tests and not every doctor can clearly explain the reasons for what happened....
Important, very important aspect- experiencing loss and feelings of loneliness.
The article does not provide any valuable or necessary information.

03/12/2003 16:19:59, Participated

Comment on the article "Recurrent miscarriage"

With my “habitual miscarriage”, I see Guzov. The problem is the same - habitual miscarriage. I'm looking for a center where I can be observed.

Cytomegalovirus infection (CMVI) is the most common intrauterine infection, one of the causes of miscarriage and the occurrence of congenital pathologies. In Russia, 90%-95% of expectant mothers are carriers of the virus, many of whom have virtually asymptomatic disease. Vasily Shakhgildyan, Candidate of Medical Sciences, Senior Researcher, Federal Scientific and Methodological Center for the Prevention and Control of AIDS Federal Budgetary Institution "Central Research Institute of Epidemiology" of Rospotrebnadzor: "Cytomegalovirus...

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Discussion

Is there a chance for a woman diagnosed with hepatitis to give birth? healthy child? Or will the baby also have such a diagnosis?

Amniocentesis, that is, puncturing the bladder and collecting amniotic fluid, is not a necessary test for hepatitis C in the mother. It is prescribed for suspected congenital malformations, including genetic diseases. Hepatitis C affects the course of pregnancy and the fetus, however, does not provoke the formation birth defects development

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A friend of mine in her youth miscarried her pregnancy 3 times at a very short term and developed recurrent miscarriage.

Discussion

Are you sure it was a miscarriage? Somehow the period is too short to diagnose pregnancy at all. If you still have a miscarriage, you need to first find out its cause and then plan again so that it doesn’t happen again. A friend of mine in her youth miscarried her pregnancy 3 times at a very short term and developed recurrent miscarriage. When I started planning there were several miscarriages at a short period of time. It is advised to wait with planning precisely to make sure that the cycle has been restored. Everyone's health is different. There are women who, even after an abortion, become pregnant in the first cycle and carry and give birth normally, it’s like a lottery. But it's better not to take risks.

So miscarriage or delay? If there is a 3-day delay even with stripe tests, and then regular menses begin, then there is no need to wait for anything and this is not considered a miscarriage.

Two - habitual miscarriage. Tanya, after two - this is already a HUMAN miscarriage. At least that’s how it works for me.

Discussion

Once again I sympathize! I was told that if the ST is the first (and hopefully the only one), then we are not talking about miscarriage yet and there is no need to be examined. After ST, I was prescribed OK for at least 3 months, then an ultrasound and examination of the uterus. What tests are you taking??? The doctor told me that it is useless to take many tests in the first 3 months

I’m very sorry that this happened:(((((((((((((((hang in there! everything will be fine @@
I would wait six months to recover, get examined and calm down completely. because For me personally, the roof began to move at first right away, then there was a lull, and then, after 3 months, it completely hit: (after six months, somehow everything is not so acute. And a positive attitude is important for recovery

I have a friend who has recurrent miscarriage and has already had more than 5 miscarriages at 11-13 weeks.

If involuntary labor occurs before the twenty-third week, this is a sign of miscarriage. A child born at this stage is not a survivor, and its weight may be less than half a kilogram.
Miscarriage is diagnosed if you have had at least three miscarriages before the twentieth week of your pregnancy.

There are a number of prerequisites that can cause a woman to be unable to bear a desired child:

Hormonal disbalance;
Genetic changes in the unborn child. The likelihood of having a sick child increases in proportion to the age of the mother. Women over thirty, when planning pregnancy, must undergo necessary tests;
Serious illnesses suffered by a woman at the beginning of pregnancy;
Sexual infectious diseases;
Deviations in the development of the uterus and ovaries;
Abortion in early age;
Pathological diseases;
Negative habits that prevent the fetus from forming correctly;
Severe fatigue, heavy physical activity;
Environment, hazardous work;
Incompatibility of the blood of the expectant mother and child;
Severe bruises;
Woman's age;
Underweight or overweight.

Do not forget that only a specialist can give you an accurate diagnosis, and it is possible that by identifying the cause in the early stages, you will even avoid sad consequences.

Symptoms of miscarriage

These basic observations of changes in the body are necessary for you to be able to prevent the loss of your child. Please pay special attention that at the slightest similar symptoms, you must urgently call an ambulance.

Vaginal discharge (bloody, spotting);
Unbearable pain in the abdomen and back;
Deterioration in the quality of vision, loss of consciousness.

What to do in case of miscarriage

If at least one of the above symptoms appears, you must immediately call an ambulance.
If the doctor determines that the pregnancy can be saved, be prepared for long-term bed rest. It happens that constant supervision of a specialist in a clinical setting is necessary. In the worst case, it will be impossible to get up even for natural needs.

To prevent abortion, hormones may be prescribed, but this is in extreme cases and only under the supervision of a doctor. This is very dangerous because these drugs also affect the hormonal changes of the child, and therefore they are born transvestites.

If the baby inside has already died, then a vacuum abortion is performed under anesthesia. If the baby is removed, but something remains inside the woman, curettage is prescribed.

If the baby is already formed, then special drugs are administered to induce labor.
Everything that is removed from the uterus is examined in the most thorough manner in order to determine what was the cause of miscarriage and to exclude it in subsequent pregnancies.

Prevention of miscarriage

Usually, if a diagnosis of miscarriage has already been made, doctors try to determine what is causing it and prescribe the following examinations:

Survey amniotic fluid on genetics.
Identification of pathological diseases in a woman.
Testing for hormones.
Blood tests for immunology, which can subsequently cause miscarriage.
Identification of the Rh factor of mother and fetus.
Using special tests, the condition of the uterus is determined.
If doctors have determined the cause of the miscarriage, they may give you the following recommendations:
If the cause is abnormalities in the uterus, then before the next attempt to get pregnant, a special operation is necessary.
If the cervix is ​​weakened, it is necessary to apply stitches, but only until the fourteenth week of pregnancy.
If a woman registers on time, regularly visits her gynecologist and follows all recommendations, then she has Great chance give birth to a healthy baby on time.

Early pregnancy loss

Ninety percent out of a hundred, pregnancy loss occurs before twelve weeks. The reasons for this are:
Genetic disorder in the fetus.
Hormonal imbalance in a woman, also contributes to miscarriage. (Increased amounts of male hormones, as well as thyroid hormones).
Different rhesus – blood group factors in mother and child. In this case, there are drugs that help maintain pregnancy.
Sexual infections. It is necessary to cure such diseases even before conceiving a child.

Colds and inflammatory diseases with increased temperature also contribute to miscarriage.
Abortion at any stage of pregnancy can not only cause subsequent miscarriages, but also contribute to infertility. This is due to the fact that abortion is a huge stress for a woman’s entire body.
Various medicines and herbs. During pregnancy, it is advisable to completely avoid taking any medications, even seemingly safe ones. The fact is that during pregnancy, a woman’s body weakens and may be susceptible to allergic reactions.

And in the very early stages, medications can cause genetic changes in the fetus, or even provoke a miscarriage. Also pay attention to the fact that herbs and oils can cause irreparable harm instead of the expected benefits.

Avoid moral stress, try to rest more and not get upset over trifles. If you have severe depression, you should contact your doctor for advice. There are certain types of sedatives that will help a pregnant woman calm down without harming her or the unborn child. You can also try to relax with the help of meditation and aromatherapy.
Those who, through their incorrect lifestyle, endanger themselves and the unborn child are also subject to miscarriage. It is worth thinking about this a long time before conception, since the body needs time to recover.

Do not lift heavy objects under any circumstances, Limit yourself from strenuous physical activity. Also consult your gynecologist regarding lovemaking. For some women, restrictions are set.

Complications and consequences of miscarriage

Miscarriage;
Heavy bleeding;
The infection can get into abdominal cavity, which will significantly worsen the situation;
Death of a child after birth.

If your cervix is ​​already dilated, the doctor will most likely stitch you up to try to maintain the pregnancy.
If premature birth occurs, you need to make sure that everything comes out of the uterus completely, in otherwise cleaning is prescribed. Only after this the body will be able to restore the menstrual cycle.
We all, for the most part, think that bad situations happen to everyone except us. And God grant that it be so. But, unfortunately, we all have to face some problems one day. For many women, pregnancy is long-awaited and desired, and we all want to have healthy and happy children. But this needs to be taken care of.

When planning a pregnancy, you need to consult a gynecologist and undergo all the necessary examinations and tests to avoid unwanted consequences.

Also, for greater effectiveness, your partner must pass all tests to check his health and do a compatibility test.
If you are pregnant, you need to register as early as possible. antenatal clinic, for constant monitoring by a gynecologist. It is important to follow all the doctor’s advice and recommendations, because warning that undesirable consequences are much better than subsequent long-term treatment.

According to the World Health Organization (WHO), miscarriage is “the expulsion or removal from the mother of an embryo or fetus weighing 500 g or less.” The frequency of spontaneous abortion is about 15-20% of the total number of all detected pregnancies.

In the early stages of pregnancy, at 6-8 weeks, 40-80% of all spontaneous miscarriages occur. Moreover, almost half of these women did not even imagine that they were pregnant. Accordingly, as the gestational age increases, the frequency of spontaneous abortions decreases. In cases where a woman has three spontaneous miscarriages in a row, a diagnosis is made "habitual miscarriage". This pathology occurs with an average frequency of 1 in 300 pregnancies. Termination of pregnancy and curettage of the uterus causes subsequent development of severe inflammatory diseases genital organs, adhesions, pathology of the uterus and tubes, recurrent miscarriage and infertility.

Miscarriage, as a rule, is the result of several causes that act simultaneously or sequentially. In clinical practice, in 45 - 50% of women it is not possible to establish the real reason, due to which spontaneous abortion occurred. These patients form a group "unexplained" miscarriage .

Causes of miscarriage

Let us consider in more detail the influence of the main factors leading to miscarriage and the features of diagnostic and treatment measures in these situations.

Genetic factor. Genetic disorders leading to spontaneous abortion account for about 5% of the causes of this pathology. From 40 to 60% of miscarriages that generally occur in the early stages of pregnancy are caused by chromosomal abnormalities of the embryo. So, with autosomal trisomy, which is the most common type chromosomal pathology, the embryo is usually absent (anembryony) or there are multiple malformations of its development. Most autosomal trisomies result from failure of chromosome segregation during the first mitotic division of the oocyte, and the incidence of this phenomenon increases with maternal age. Other chromosomal disorders include monosomy X; triploidy and tetraploidy; translocation; various shapes mosaicism, double trisomies and other rare pathologies. Spontaneous miscarriages that occur as a result of chromosomal pathology during short-term pregnancy serve as a reflection of the universal biological natural mechanism of natural selection that ensures the birth of healthy offspring. Chromosomal abnormalities can only be detected by determining the karyotype using special technologies.

Infectious factor. Miscarriage due to an inflammatory process is caused by the penetration of infectious agents from the mother's body through the placenta to the fetus. The presence of microorganisms in the mother may be asymptomatic or accompanied characteristic features inflammatory disease. Bacteria (Gram-negative and Gram-positive cocci, Listeria, Treponema and Mycobacteria), protozoa (Toxoplasma, Plasmodium) and viruses can penetrate from the mother into the fetus's body. The fetus becomes infected with contaminated amniotic fluid or infectious agents spreading through the amniotic membranes and further along the umbilical cord to the fetus. Some acute infections accompanied by severe intoxication and elevated temperature can stimulate an increase in contractile activity of the uterus and thereby lead to termination of pregnancy. In addition, infectious agents can lead to disruption of the structure of the membranes, which causes premature rupture of amniotic fluid and termination of pregnancy. It should be noted that the effect of infection on the fetus depends on the state of its body and the duration of pregnancy. The severity of the lesion and the prevalence of the pathological process in the embryo/fetus depend on its ability to resist infection, the type and number of microorganisms that have penetrated, the duration of the mother’s illness, the state of her protective and adaptive mechanisms and other factors. Given the lack of a formed placental barrier in the first trimester, any type of infection poses a danger. At this time, the most common complications of pregnancy are pathology of fetal development and spontaneous miscarriage.

The main source of infection of the fetus most often are foci of infection located in the vagina and cervix. The presence of nonspecific inflammatory diseases of the vagina and cervix (acute or chronic endocervicitis, structural and functional inferiority of the cervix) is one of the predictive factors for a similar inflammatory process in the endometrium. This inflammatory process increases the likelihood of infection of the amniotic sac and is thus an important cause early interruption pregnancy. Infectious processes in the vagina and cervix belong to a group of diseases, the consequences of which during pregnancy can be largely prevented by their timely detection and appropriate treatment. Smear examinations help to navigate possible pathology and determine the need, sequence and scope of additional studies. Unfortunately, therapeutic measures in the early stages of pregnancy (up to 12 weeks) are limited due to the danger of using certain medications during embryogenesis. However, with a pronounced inflammatory process, a complicated pregnancy, as well as with structural and functional inferiority of the cervix, the use of certain drugs is possible. The question of the use of certain drugs is decided only strictly individually by the attending physician, and subsequent treatment is carried out under medical supervision. Self-medication can be very dangerous and lead to negative health consequences.

Endocrine factor. Endocrine factors of miscarriage, which are detected in 17-23% of cases, include: insufficiency of the second (luteal) phase of the menstrual cycle; adrenal gland disorder; thyroid diseases; diabetes mellitus, etc. For complete secretory transformation and preparation of the endometrium for implantation of a fertilized egg, a sufficient concentration of estrogen and progesterone is required and the maintenance of their normal ratio during the menstrual cycle and, especially in the second phase of the cycle. The results of a hormonal examination indicate the presence of an inadequate luteal phase of the cycle in 40% of women with recurrent miscarriage and in 28% with infertility and a regular rhythm of menstruation. Inadequacies of the second phase of the menstrual cycle are often accompanied by: impaired growth and full maturation of follicles; defective ovulation; pathology of the corpus luteum. Hormonal insufficiency of the ovaries is also manifested by a decrease in estrogen levels during the menstrual cycle and a change in the ratio between estrogen and progesterone, especially in the luteal phase. Possible reason Impaired maturation of follicles is a pathological condition of the ovaries, which can be caused by a chronic inflammatory process, surgical interventions on the ovaries, which in turn leads to a decrease in their functional activity, especially in women over 35 years of age. Against the background of ongoing hormonal changes, the structure of the endometrium is disrupted, which ultimately prevents the implantation of a fertilized egg and normal development pregnancy, and dysfunction of the corpus luteum, which secretes an insufficient amount of progesterone, is the cause of spontaneous miscarriage in early pregnancy. To correct this pathology, progesterone-based drugs are prescribed.

Hyperandrogenism. Hyperandrogenism is a pathological condition that is caused by increased levels of androgens in certain diseases of the ovaries or adrenal glands. Hyperandrogenism is the cause of spontaneous miscarriage in 20-40% of women. Regardless of the type of hyperandrogenism, termination of pregnancy occurs in the early stages and proceeds as anembryonic or non-developing pregnancy. With each subsequent miscarriage, the nature of hormonal disorders becomes more and more severe, and in 25 - 30% of cases secondary infertility joins the problem of miscarriage. During pregnancy, patients with hyperandrogenism experience three critical periods when the level of androgens in the mother's body increases due to androgens synthesized by the fetus: at 12 - 13 weeks; at 23 - 24 weeks and at 27 - 28 weeks.

For hyperandrogenism identified before pregnancy, preparatory therapy with dexamethasone is carried out, the dose of which is selected individually, and the effectiveness of treatment is constantly monitored by determining the level of androgens once a month. The duration of therapy before pregnancy is 6-12 months. and, if pregnancy does not occur during this time, secondary infertility should be considered. During pregnancy, the dose and duration of taking the drug are determined by the characteristics of the clinical course of pregnancy, the presence of symptoms of threatened miscarriage, as well as the dynamics of hormone levels. The timing of discontinuation of dexamethasone ranges from 16 to 36 weeks and is determined individually for each patient.

In patients with thyroid diseases such as hypo-, hyperthyroidism, autoimmune thyroiditis, etc., it is recommended to eliminate the identified disorders before the next pregnancy, as well as select the dose of thyroid hormones and clinical and laboratory monitoring throughout pregnancy.

Pregnancy in women with diabetes mellitus It is recommended after examination by an endocrinologist and correction of the underlying disease. During pregnancy, the patient is under the supervision of both an endocrinologist and a gynecologist, and the tactics of pregnancy management and the nature of delivery are decided depending on the patient’s health status.

Autoimmune factor. The incidence of miscarriage due to exposure to immune factors is 40 - 50%. When studying the role of the immunological factor in the clinical picture of miscarriage, two groups of disorders were identified: in the humoral and cellular components of immunity. Violations in the humoral immunity are associated with antiphospholipid syndrome. The second, no less complex mechanism of miscarriage is due to disturbances in the cellular immunity, which is manifested by the response of the mother’s body to the paternal antigens of the embryo. In this group of patients, the relationship between hormonal and immune factors is most clearly defined. It is believed that among these mechanisms progesterone plays a significant role, which is involved in the normalization of the immune response to early stages pregnancy. It is believed that unexplained forms of miscarriage may be caused precisely by disorders in the cellular and humoral immunity. An important role in preventing spontaneous miscarriages and maintaining pregnancy in the early stages is played by the effect on progesterone receptors. In this regard, progesterone is prescribed to prepare for pregnancy and prevent spontaneous miscarriages. It is noted that the immunomodulatory effect of hormones is important for maintaining normal endometrial function, stabilizing its functional state and relaxing the effect on the muscles of the uterus. It is believed that the protective effect of progesterone, in particular the stabilization and reduction of endometrial tone, is a consequence of a decrease in the production of prostaglandins by endometrial cells, as well as blocking the release of cytokines and other inflammatory mediators.

Pathology of the genital organs. Organic pathology of the genital organs, which is a factor in miscarriage, is of two types - congenital and acquired. Congenital pathologies (developmental defects) include: malformations of the uterus itself; isthmicocervical insufficiency; anomalies of divergence and branching of the uterine arteries. Acquired pathologies include: isthmicocervical insufficiency; Asherman's syndrome; uterine fibroids; endometriosis. The frequency of spontaneous miscarriages in women with uterine malformations is 30% higher than in the population. At the same time, many women with certain disorders of the uterus carry a pregnancy without any problems.

Termination of pregnancy due to malformations of the uterus is mainly associated with disruption of the processes of implantation of the fertilized egg, defective secretory transformations of the endometrium due to reduced vascularization, close spatial relationships of the internal genital organs, functional features myometrium, increased excitability of the infantile uterus. The threat of miscarriage is observed at all stages of pregnancy. With an intrauterine septum, the risk of spontaneous abortion is 60%. Miscarriages most often occur in the second trimester. If the embryo is implanted in the area of ​​the septum, abortion occurs in the first trimester, which is explained by the inferiority of the endometrium in this area and a violation of the placentation process.

Anomalies in the origin and branching of the uterine arteries lead to disturbances in the blood supply to the embryo and placenta and, accordingly, to spontaneous termination of pregnancy. Intrauterine synechiae are the cause of abortion in 60-80% of cases with this pathology, which depends on the location of the synechiae and the degree of their severity.

Spontaneous abortion in the presence of uterine fibroids is associated with progesterone deficiency, increased contractile activity of the uterus, malnutrition in the fibroid nodes, and changes in the spatial relationship between the size of the fibroid nodes and the growing fertilized egg. The pathogenesis of habitual spontaneous abortion in endometriosis has not been fully studied and is possibly associated with immune disorders, as well as with the actual pathological state of the endo- and myometrium.

Diagnosis of developmental defects and others pathological conditions The uterus is established on the basis of clinical and gynecological examination, ultrasound, x-ray examination, hysteroscopy and laparoscopy. Currently, most of the organic pathology that causes habitual spontaneous abortion can be corrected with the help of plastic surgery. During hysteroscopy, it is possible to remove a submycotic myomatous node, destroy intrauterine synechiae, and remove the intrauterine septum.

Isthmic-cervical insufficiency More often it is a consequence of traumatic injuries to the cervix during intrauterine interventions, abortion and childbirth. The frequency of isthmic-cervical insufficiency ranges from 7.2 to 13.5%. Pregnancy in the case of isthmic-cervical insufficiency usually proceeds without symptoms of threatened miscarriage. A pregnant woman may not make any complaints. The normal tone of the uterus is determined. At vaginal examination shortening and softening of the cervix is ​​detected, the cervical canal freely passes the finger beyond the area of ​​the internal pharynx. When intrauterine pressure increases, the membranes protrude into the dilated cervical canal, become infected and open.

In the presence of isthmic-cervical insufficiency, termination of pregnancy occurs, as a rule, in the second and third trimesters and begins with the rupture of amniotic fluid. Currently, there is a tendency to increase the frequency of functional isthmic-cervical insufficiency, which occurs with endocrine disorders (inadequate luteal phase, hyperandrogenism). To correct isthmic-cervical insufficiency, sutures are placed on the cervix. The issue of suturing the cervix is ​​decided individually in each specific clinical situation. The optimal time for suturing a pregnant woman is 14-16 weeks; in some cases, the operation can be performed later, at 22-24 weeks. If the situation is favorable, the suture is removed at 37-38 weeks or at any time when labor begins.

To other factors, which accounts for about 10% of all causes of miscarriage, include: unfavorable environmental factors (including environmental), exposure to drugs and radiation therapy, infectious and viral diseases during pregnancy, diseases of the partner (including impaired spermatogenesis), sex life during pregnancy, heavy physical activity, stress.

Taking into account that miscarriage is a multifactorial disease, in which most patients have a combination of several causes, the examination of patients should be comprehensive and include all the necessary modern clinical, instrumental and laboratory methods.

Tests for miscarriage

When examining before the next pregnancy, the following activities are performed. The presence or absence of hereditary, oncological, somatic and neuroendocrine diseases is clarified. The presence of inflammatory diseases of the genital organs and their causative agents (bacteria, viruses, fungi, protozoa) are determined. The features of menstrual and reproductive function (abortion, childbirth, spontaneous miscarriages, including complicated ones), other gynecological diseases and surgical interventions that have occurred before are clarified. As part of the clinical examination, they perform an examination, assess the condition of the skin, the degree of obesity, and determine the condition of the external and internal genital organs. The functional state of the ovaries, the presence or absence of ovulation is analyzed by tests functional diagnostics(temperature data in the rectum, menstrual calendar indicators).

Instrumental research methods are also used. X-ray examination of the uterus and appendages ( hysterosalpingography) - is performed on the 17-23rd day of the menstrual cycle and allows you to exclude malformations of the uterus, intrauterine synechiae, and other intrauterine pathologies. By using Ultrasound assess the condition of the ovaries, the presence of cysts, uterine fibroids, and endometriosis. If intrauterine pathology and/or endometrial pathology is suspected, separate diagnostic curettage is performed under hysteroscopy control. If you suspect the presence of endometriosis, tubal pathology and adhesions in the pelvis, with uterine fibroids and scleropolycystic ovaries, it is necessary operative laparoscopy .

When testing for infections, microscopic examination of smears their urethra, cervical canal and vagina, PCR diagnostics, bacteriological examination of the contents of the cervical canal, examination for virus carriage. Hormonal testing is performed on the 5-7th day of the menstrual cycle with regular menstruation and on any day in patients with menstrual irregularities. At the same time, the content of hormones such as prolactin, LH, FSH, testosterone, cortisol, DHEA, 17-hydroxyprogesterone, progesterone is determined. The function of the adrenal cortex is also assessed using a dexamethasone test. In order to clarify the autoimmune origin of miscarriage, the presence of lupus antigen, anti-CG, anticardiolipin antibodies is determined, Features of the blood coagulation system .

Examination of the patient's husband includes the clarification of hereditary diseases, clarification of the presence of previously suffered or currently existing diseases of various organs and systems, a semen analysis, and an examination for infections. After the examination, a set of relevant therapeutic measures, depending on the identified factors of miscarriage.

A thorough and complete examination of women before pregnancy, especially after spontaneous miscarriages, reliable diagnosis of the causes of miscarriage, timely and reasonable treatment, dynamic comprehensive monitoring during pregnancy make it possible to significantly reduce the risk of threatened miscarriage .