The stood pregnancy
Contents:
Description:
Not developing pregnancy — a complex of the pathological symptoms including pre-natal death of a fruit (embryo), pathological inertness of a myometrium and disturbance of system of a hemostasis.
Symptoms of the Stood pregnancy:
The clinical picture of a cancelled abortion has characteristics. At the patient subjective signs of pregnancy disappear, mammary glands decrease in sizes and become soft. The periods are not recovered. In the expected time do not note stir of a fruit. However if the movements of a fruit appeared, then they stop.
At a delay of a dead fruit in a uterus over 3-4 weeks of 10% of women are celebrated by a febricula, weakness, dizziness, fervescence. Disappearance of nausea, vomiting, hypersalivation — characteristic subjective signs of death of fetal egg in the first 12 weeks of pregnancy. In the second half of pregnancy the woman notes the termination of stir of a fruit. The symptom of a softening of mammary glands arises for the 3-6th days after death of a fruit. In mammary glands instead of colostrum milk appears. Nagrubaniye of mammary glands and allocation of a significant amount of colostrum is observed at women at the death of a fruit which occurred after 25 weeks of development.
Clinical signs of NB (pain, blood allocations from a genital tract, lag of the sizes of a uterus from estimated duration of gestation) appear in 2–6 weeks after the termination of development of an embryo. Stages of interruption of NB correspond to misbirth stages:
· the menacing abortion;
· the begun abortion;
· abortion in the course;
· incomplete abortion.
Complete abortion at NB owing to the pathogenetic reasons is not allocated.
Not developing pregnancy as an anembrioniya
Not developing pregnancy as death of an embryo
The reasons for the Stood pregnancy:
NB — a polyetiological complication of pregnancy, is the most frequent reason a chronic endometritis with a persistention of uslovnopatogenny microorganisms and/or viruses. It is known that at primary infection on early durations of gestation damages of an embryo, incompatible with life, leading to a sporadic spontaneous abortion are possible. At most of women with NB and a chronic endometritis note a prevalence in an endometria of two-three and more types of obligate anaerobic microorganisms and viruses. But also other factors promoting NB are possible:
· anatomic anomalies;
· chromosomal defects;
· disturbances of coagulant system of blood.
Now the greatest interest is attracted by the genetic, immune, trombofilichesky factors which are the least studied. Trombo-filichesky factors are genetically determined.
Fetal egg with a maternal organism — functionally uniform hormonal system. Ability of a fruit to take active part in synthesis and metabolism of progesterone is proved. At the menacing not incubation these processes are broken. Deficit of progesterone leads to pathology of a detsidualization of a stroma of an endometria, weak invasion of a cytotrophoblast and, as a result, to decrease in matochnoplatsentarny blood circulation. At not incubation
as NB there is a termination of fetalis metabolism of progesterone — an important distinguishing character of NB from spontaneous abortion.
Refer the chromosomal anomalies of an embryo or fruit formed at merge of two parent cells to existence of dot mutations in chromosomal complement to genetic factors. At a research of material of abortions the majority of the found chromosomal disturbances — quantitative (95%).
The duration of gestation at the time of death of fetal egg is less, the frequency of aberation chromosomes is higher. In the presence of aberation chromosomes the embryogenesis is impossible or sharply broken at early stages. Assume communication of disturbances of development at aberation chromosomes with the lowered ability of cells to division. At the same time there is a sharp desynchronization of developments of a germ, development of a placenta, induction of a differentiation and migration of cells.
Reasons of quantitative aberation chromosomes.
· Failures of meiotic division: cases of not discrepancy of pair chromosomes, it leads to emergence of a monosomy or trisomy. Not discrepancy of chromosomes in ova and spermatozoa can happen in any period of meiotic division.
· The failures arising at fertilization: cases of fertilization of an ovum two spermatozoa (dyspermia), the triploid germ results.
· The failures arising during the first mitotic divisions: the full tetraploidiya arising at the first division of a mitosis leads to chromosome doubling and lack of division of cytoplasm. Mosaics arise in case of similar failures at a stage of the subsequent divisions.
Treatment of the Stood pregnancy:
Treatment of NB consists in evacuation of the died fetal egg and purpose of antiinflammatory therapy.
At NB to 14–16 weeks evacuation of fetal egg is carried out in one step by means of tool emptying of a cavity of the uterus, with expansion of the cervical channel and a curettage, or use vacuum aspiration. In both cases gisteroskopichesky control is necessary. At hysteroscopy estimate localization of fetal egg, a condition of an endometria, then delete fetal egg with aim capture of histologic material from a placental bed and washing of a cavity of the uterus antiseptic agent solution. According to indications enter antibiotics.
