Non-developing pregnancy symptoms. Non-developing pregnancy: causes and consequences

Gynecologists say that during each month a woman experiences all four seasons. After all, the level of hormones in her body fluctuates all the time, which affects both our well-being and mood. All these processes are aimed at ovulation and further fertilization of the egg. And if this happens, then hormonal activity will be aimed at preserving the fertilized egg and its successful development.

Not all, but the vast majority of women certainly feel these changes on a physical and emotional level. Often, even intuitively, a woman feels that she is pregnant. We listen to our body from the first weeks, trying to determine what is happening to us. And sudden changes or disappearance of certain signs and sensations can frighten us greatly. Most often this happens at the stage when the body is already getting used to functioning in a new mode, that is, closer to the second trimester. But still, if your intuition tells you that something is wrong, then it is better to play it safe and go to the gynecologist. Unfortunately, it is not so rare that a pregnancy stops developing due to the death of the embryo. And this can happen at any time.

A pregnancy that is not developing is also called a frozen pregnancy. Its outcome is always the same: interruption by natural, medicinal or surgical means. Such a pregnancy has no chance of developing, because there is either no embryo or it died.

In the first case, obstetricians talk about anembryonia- this is one of the types of non-developing pregnancy, in which the fertilized egg turns out to be empty, without an embryo inside. This pathology is detected at the earliest stages, usually during the first ultrasound.

But it also often happens that an embryo that has begun its development turns out to be non-viable or dies under the influence of certain pathological factors. The first signs of an undeveloped pregnancy may appear after a certain time, because at first there are no signals about the tragedy from within.

Most often, pregnancy ends in the first trimester. It is not always possible to determine this on your own, but sometimes a woman can still suspect something is wrong based on changes in her condition.

Breasts during frozen pregnancy

The breast is one of the first to react to the new condition of a pregnant woman. It becomes heavier, fills up, increases in size, the sensitivity of the nipples increases, they darken, and a painful sensation may occur. These changes, like all others, occur under the influence of hormones. If pregnancy stops developing, then the level of these hormones will begin to decrease, and its early symptoms will begin to disappear.

So, if in the first weeks, in the early stages, the chest suddenly stopped hurting, toxicosis and other early signs (irritability, drowsiness, etc.) disappeared, and the woman no longer feels what she used to, then it is better to consult a doctor for consultation and examination . It is likely that early toxicosis has ended - and the most pleasant period in terms of well-being is beginning. However, if you are tormented by any doubts, it is better to dispel them.

Temperature during non-developing pregnancy

If a woman kept a chart of basal temperatures before conception and continues to do so in the first weeks after, then when the embryo freezes, she may notice some changes in the chart. In particular, BT, which was fixed at elevated levels, will begin to decline. However, very often it remains elevated for a long time after the death of the fetal egg, and in general, BT can behave differently in each individual case, and very often errors and errors are made when measuring BT. Therefore, doctors do not recommend using this method to assess the well-being of embryo development.

As for general health, then, of course, when a miscarriage begins due to a non-developing pregnancy, the body temperature may rise - as a reaction to the pathological process. But this is not a prerequisite and does not always indicate an ST.

The developing fertilized egg actively produces the hormone human chorionic gonadotropin, so pregnancy can be diagnosed at the earliest stages. A blood test for hCG is perhaps the earliest reliable method of determining it.

The level of hCG in the blood and urine of a pregnant woman doubles every two days in the first days and weeks. If there is a suspicion of pathological development of pregnancy or its fading, a woman is often prescribed this test to monitor the level of hCG over time. That is, if several studies conducted in a row (usually at intervals of a day) show that the hCG level does not increase or even decreases, then they come to a disappointing conclusion.

What will the test show during a frozen pregnancy?

For the same reason, a test performed during a frozen pregnancy may show a pale second line or even give a negative result if enough time has passed since the death of the embryo and the level of human chorionic gonadotropin has significantly decreased.

However, you should never trust this method alone. Remember: tests quite often produce false positive and false negative results, for which there can be many different reasons.

By and large, none of the signs described above should lead a woman to think that the embryo has frozen. And only if these signs are combined with each other, you can start to worry. And if, in addition, bloody discharge from the vagina appears, then you should definitely consult a doctor, even if there are no other reasons for concern. Bleeding, brown discharge or even spotting indicate that the ovum has begun to detach, and it is very likely that the pregnancy can still be saved.

If the fetus has frozen for quite some time, then the woman will certainly notice that no movements are noted for a long period of time. However, even such a very eloquent sign cannot accurately indicate fetal freezing.

A woman’s own feelings cannot be any reliable signs of an undeveloped pregnancy. In combination with various circumstances and accompanying symptoms, they can only lead to the idea that perhaps not all is well. But in general, gynecologists say that a non-developing pregnancy is often not accompanied by any specific characteristic clinical manifestations. The diagnosis of ST can only be made on the basis of laboratory tests.

Among the signs already mentioned, only the hCG level has an important diagnostic value. But even if its concentration is low, a woman who is suspected of fetal failure will definitely be sent for an ultrasound.

Even during a personal examination in the office, the gynecologist is able to predict a delay in the development of pregnancy if the size of the uterus, which he palpates with his hands, does not correspond to the expected gestation period. Ultrasound examination can more accurately determine this discrepancy. In addition, it will evaluate the signs of embryonic life: the presence of heartbeats and motor activity. In case of a non-developing pregnancy, the uzist will see damage to the structures of the placenta, deterioration or complete cessation of uteroplacental blood flow, damage to the endometrium of the uterus due to the decomposition of dead tissue, and a hematoma at the site of detachment of the fertilized egg.

If the pregnancy has stopped and a spontaneous miscarriage begins (the woman’s immune system rejects foreign cells), then the ultrasound will also show detachment of the fertilized egg or placenta.

In the short term, the doctor can take a wait-and-see approach: that is, wait until the fertilized egg leaves the woman’s body on its own. And very often this is exactly what happens.

However, it is also not uncommon for a dead embryo to remain inside the womb for a long period of time, soon beginning to decompose. This outcome is very undesirable and is fraught with serious consequences, and therefore doctors are forced to intervene in this process: they resort to medical abortion (interrupting pregnancy with hormonal medications) or perform curettage during a frozen pregnancy. A non-developing fetus is disposed of only when the absence of a heartbeat is confirmed by at least 2 ultrasound examinations.

I would like to note that, despite the prevalence of this problem, the majority of women who have had an undeveloped pregnancy successfully carry and give birth to healthy children in the future. In Western countries, even after three cases of fetal death in a row, 75% of women still get pregnant and give birth.

Therefore, you should not be overly upset and upset: the best is yet to come! However, doctors advise women who are at risk for miscarriage to prepare and plan their next conception:

suffering from sexually transmitted infections;
those who have had infectious diseases during pregnancy;
suffering from endocrine disorders;
those giving birth for the first time over the age of 30 or becoming pregnant after 40 years;
have had abortions in the past;
alcohol abusers, drug users, heavy smokers;
taking antidepressants or suffering from nervous disorders;
in whom the fetus has repeatedly died (especially in the later stages);
having a uterus with developmental pathologies (small, bicornuate, etc.) or uterine fibroids.

Especially for - Larisa Nezabudkina

Waiting for the birth of a baby is one of the happiest periods in the life of future parents. They endure all the hardships and hardships of pregnancy, hoping to soon see a miracle - their newborn child. However, some women may suddenly experience great grief, which is called a non-developing pregnancy. Most often this problem occurs in the 1st trimester, although it can occur at any time.

A non-developing or frozen pregnancy is a stoppage of fetal development due to its death, in which there are no signs of miscarriage. More often, this pathology occurs in the early stages - in the 1st trimester. Another type of it is a non-developing pregnancy of the anembryonic type. This is a situation in which fertilization has occurred and the membranes have begun to form, but there is no embryo in the fertilized egg.

A frozen pregnancy is a very terrible blow to the psychological and emotional state. However, learning how a woman's body can recover from it is very important to increase her chances of having a healthy baby in the future.

Causes of frozen pregnancy

Unfortunately, it is not always possible to establish why a particular woman experiences a non-developing pregnancy. If embryonic death occurs during the 1st trimester, it is usually caused by problems in the unborn baby. Approximately 3/4 of miscarriage cases occur during this period.

If the fetus dies during the 2nd or 3rd trimester, this may be due to the presence of diseases in the mother.

Causes of frozen pregnancy in the 1st trimester

Most often, a non-developing pregnancy in the early stages is caused by problems with the fetal chromosomes. They are made of DNA, which contains a detailed set of instructions that control a wide range of different factors - from the development of the cells of the unborn child's body to the color of his eyes.

Sometimes an error occurs at the moment of conception due to which the embryo receives too many or not enough chromosomes. The cause of this phenomenon remains unknown, but its consequences include abnormal fetal development and miscarriage.

Doctors estimate that approximately 2/3 of early pregnancy loss is due to chromosomal abnormalities. It should be remembered that the re-development of a non-developing pregnancy for this reason occurs very rarely, since most often future parents do not have any problems with chromosomes.

Intrauterine fetal death in the 1st trimester can also be caused by problems with the development of the placenta, the organ that connects the blood circulation of the mother with the child.

The following factors can increase the risk of a non-developing pregnancy in the early stages:

Mother's age is more than 35 years.
Obesity.
Smoking during pregnancy.
Drug and alcohol use during pregnancy.
Drinking large amounts of caffeine, which is found in coffee, tea, chocolate, energy drinks and some carbonated drinks.

Causes of frozen pregnancy in the 2nd and 3rd trimesters

As a rule, in the 2nd and 3rd trimesters, health problems of the expectant mother can lead to a non-developing pregnancy.

Causes of non-developing pregnancy in the 2nd and 3rd trimesters:

Type of reasons	Diseases
Chronic diseases in women	Poorly controlled Severe hypertension Systemic lupus erythematosus Kidney diseases Hyperthyroidism or hypothyroidism
Infectious diseases
Food poisoning	Listeriosis - most often develops from consuming unpasteurized dairy products Toxoplasmosis - can develop from eating raw or undercooked infected meat, especially lamb, pork or venison Salmonellosis – most often caused by eating raw or undercooked eggs
Problems with the uterus	Availability Abnormal structure of the uterus

Myths about the causes of undeveloped pregnancy

Despite common stereotypes, miscarriage is not associated with:

emotional state of the mother during pregnancy;
fright;
physical exercise (however, you should discuss its type and intensity with your doctor);
working during pregnancy;
having sex;
traveling by plane;
eating spicy food.

Symptoms of a non-developing pregnancy

Unfortunately, in most cases, a woman does not know that her child has already died, since a non-developing pregnancy in the early stages does not have the clear symptoms that are characteristic of a miscarriage. With this pathology, the placenta does not stop producing hormones, which is why the woman continues to feel pregnant.

However, in some cases, a woman may notice that her symptoms such as breast tenderness, nausea and fatigue have disappeared. At later stages, fading pregnancy is characterized by the absence of fetal movements in the uterus.

Diagnosis of non-developing pregnancy

If you have any concerns or suspicions about the possibility of a frozen pregnancy, you should immediately consult a doctor for a full examination.

The diagnosis of a non-developing pregnancy is most often made after an ultrasound examination, which detects the absence of a heartbeat in the fetus. Ultrasound is performed through the anterior abdominal wall or transvaginally. The latter method is more accurate, but its implementation is accompanied by some discomfort. To exclude errors in diagnosis, at least two examination procedures are performed.

The doctor can detect the absence of a heartbeat in the fetus in later stages of pregnancy using auscultation with an obstetric stethoscope. Cardiotocography, a technique for recording the fetal heartbeat and uterine tone, will help confirm fears.

Levels of human chorionic gonadotropin and progesterone, hormones associated with pregnancy, may also be measured.

In some cases, a diagnosis cannot be made immediately. For example, it is difficult to confirm a non-developing pregnancy before the gestational age of 6-7 weeks, since only at this time does the fetus begin to have a heartbeat. In this case, doctors usually recommend re-examination after 1-2 weeks.

Sometimes fetal death is discovered accidentally during a screening ultrasound examination.

After a miscarriage occurs, a man and woman need to undergo a full examination, with the help of which specialists will try to identify possible causes of fetal death. Unfortunately, in half of the cases the etiology of a non-developing pregnancy cannot be detected.

In case of repeated cases of miscarriage, women and men undergo an even more detailed examination, including:

Karyotyping is a test to detect abnormalities in chromosomes that can cause fetal death during intrauterine development. If problems are detected, partners are referred to a geneticist for consultation, who explains to the couple their chances of a successful pregnancy in the future and talks about possible solutions - for example, in vitro fertilization.
Ultrasonography. To study the structure of the uterus and identify its pathology, a transvaginal ultrasound examination is performed.
Blood tests that measure levels of antiphospholipid antibodies and lupus anticoagulant. Antiphospholipid antibodies increase the risk of blood clots and affect the formation of the placenta, which can impair the blood supply to the fetus, causing its death.

Treatment of non-developing pregnancy

After a diagnosis has been made, a woman often faces a difficult choice regarding which treatment tactics to choose for an undeveloped pregnancy. In any case, a long stay in the uterine cavity of a dead fetus is dangerous for the health and life of the woman, since this increases the risk of severe bleeding and infectious complications.

As a rule, a woman is offered one of the options:

Waiting tactics. In the early stages of pregnancy, if the embryo dies in utero, it is possible to wait for the natural rejection of its tissues by the woman’s body. During this time, careful monitoring and surveillance is carried out. However, you cannot wait too long - it is dangerous. As a rule, active treatment can only be delayed until 2 weeks after diagnosis. Doctors are not too fond of expectant management during a missed pregnancy.
Surgical tactics. After establishing and clarifying the diagnosis, a minor obstetric operation is performed - dilatation of the cervix and curretage (curettage of the uterine cavity). During this surgical procedure, fetal tissue, membranes and placenta are removed from the uterine cavity. The operation is usually performed under general anesthesia.
Medication tactics. Termination of a non-developing pregnancy in the early stages (up to 8 weeks of gestation) can also be carried out using a conservative method. For this purpose, drugs are used that cause the uterus to contract and push fetal tissue and placenta out of its cavity.

In case of intrauterine fetal death in the 3rd trimester, delivery is necessary. For this purpose, doctors either stimulate labor through the natural birth canal or perform a cesarean section.

It should be remembered that a non-developing pregnancy is a severe emotional blow. Therefore, a pregnant woman really needs the support of both medical personnel and people close to her.

Complications and consequences of frozen pregnancy

A serious danger to the health and life of a woman during a non-developing pregnancy is the risk of severe bleeding and infections.

Most often, a pregnancy that does not develop has serious emotional consequences not only for the woman, but also for her partner, as well as for people close to them. They may need psychological support during this time.

Survivors may develop fatigue, poor appetite and sleep disturbances, and experience feelings of guilt, shock, sadness and anger. People cope with loss in different ways. Some of them find solace in telling others about their feelings, while others do not want to communicate about their grief. Some women start planning their next pregnancy within a few weeks, while others cannot even think about it.

The child's father may also be suffering from loss. Men find it more difficult to express their emotions, especially when they know that they should support their partner with their actions. A miscarriage can sometimes cause relationship problems.

The concern for many women who have suffered this grief is whether pregnancy can occur again after suffering a non-developing pregnancy. Fortunately, in most cases, they give birth to a healthy child after a certain time, since most often chromosomal abnormalities develop in the fetus itself, and are not inherited from the parents. As a rule, doctors advise planning the next pregnancy 3-6 months after the previous one is terminated.

Prevention of antenatal fetal death

In most cases, the cause of a non-developing pregnancy remains unknown, so it is not possible to prevent this pathology.

However, compliance with certain conditions will help reduce the risk of frozen pregnancy:

quitting smoking, alcohol, drugs;
maintaining a healthy, balanced diet rich in vegetables and fruits;
trying to avoid contracting certain infectious diseases during pregnancy (for example, rubella);
avoiding consumption of certain foods that can harm a pregnant woman and her baby;
normalization of weight before pregnancy;
Taking prenatal vitamins and folic acid before pregnancy may also reduce the risk of antenatal fetal death and birth defects.

When the causes of a non-developing pregnancy are identified, they are treated to prevent similar cases in the future.

Useful video about non-developing pregnancy

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How beautiful pregnant women are! But sometimes an inexorable fate brings terrible and unbearable trials upon their shoulders.

One of them is non-developing pregnancy, death of the unborn baby.

This can happen at any stage of pregnancy. This pathology occurs in 10-20% of cases.

Crisis periods have been identified when the fetus is most vulnerable to negative influences:

7-12 days of development (implantation period);
3- development (embryogenesis period);
first (formation of the placenta);
20- development (formation of the most important functions in the fetal body).

The most dangerous are the first days and weeks of the baby’s development. In the early stages of its development, the fetus is most sensitive to damaging, destructive factors.

What should a pregnant woman be wary of?

Diagnosis of the disease

Signs and symptoms

In most cases, a stop in the development of a child is not felt by pregnant women and is not accompanied by pronounced symptoms.

In the early stages:

disappearance;
increase in appetite;
reduction of pain in the mammary glands.

In the later stages:

the appearance of bloody discharge;
increased body temperature;
nagging pain in the lower back.

Such signals can also accompany the normal course of pregnancy. Only a specialist can definitively confirm the death of the embryo through ultrasound and research. Who is to blame for failed motherhood?

Causes

As a rule, a frozen pregnancy is the result of a combination of unfortunate circumstances and factors.

The reasons can be divided into several groups.

Genetics. Sometimes during the formation of an embryo, various changes occur in chromosomes, genetic disorders (a larger or smaller set of chromosomes).

The reason for this may be hereditary predisposition, drug use, alcohol use, or living in environmentally unsafe areas.

Genetic disorders are the most important causes of this pathology (up to 70% of all cases). “Wrong” genes can be inherited from both parents.

Infections. Infectious diseases of the expectant mother are the second most common cause of undeveloped pregnancy:

viral - enterovirus;
bacterial - mycoplasmas, streptococci, gonococci, chlamydia, ureaplasmosis.

As a result of any infection, acquired or chronic, in a pregnant woman, the fetal egg becomes infected.

Infection can occur in three ways:

With the inflammatory process of the uterine mucosa and its appendages(endometritis, salpingoophoritis) microbes penetrate the fertilized egg. In this case, the woman’s uterus itself is not ready to bear a child, the fertilized egg is not attached tightly enough, and it is rejected.
With inflammatory processes in the vagina itself(fungi,) bacteria penetrate the fertilized egg through the cervix. Infection of the embryo and amniotic fluid occurs, which can lead to rupture of the amniotic sac itself.
In case of previous viral infections(, acute respiratory infections,) microbes penetrate the fertilized egg through the bloodstream through the placenta. The supply of oxygen and nutrients to the unborn baby is significantly deteriorating

When infected, the fetus stops developing and the child dies.

Do not forget that pregnancy is accompanied by severe suppression of the entire immune system. An exacerbation of all latent infectious diseases in a woman may begin.

Therefore, it is very important to treat all hidden infections in a timely manner before planning motherhood and do everything possible to avoid catching a cold while pregnant.

Immunology. Sometimes a woman may have various predisposing factors that can cause the death of the embryo. This is the appearance of protective antibodies to the hormone produced by the fertilized egg (antiphospholipid syndrome), incompatibility at the immune level of the father and mother.

Immunological incompatibility can be expressed by increased thrombus formation. In all cases, the nutrition of the embryo is disrupted, its development stops and the death of the fetus occurs.

Endocrinology. The pathological state of the endocrine system of a pregnant woman can provoke fetal death. There can be many reasons for disruption of the proper functioning of the endocrine system and hormonal disorders.

The most common of them are:

increased amount of sex hormones according to the male type (hyperandrogenism). In 20% of cases during pregnancy, there is a sharp jump in the level of male hormones.
increased amounts of the hormone that stimulates milk production (hyperprolactinemia).
disruption of the proper development of the ovaries (), which affects the menstrual cycle and the production of female sex hormones.
improper functioning of the thyroid gland (dystrophy, obesity).
underdevelopment of the female reproductive organs (infantilism).

In case of disruption of the endocrine system The body produces in insufficient quantities a hormone that is responsible for preparing the entire female body for pregnancy. The embryo, which is weakly attached to the uterus, receives insufficient nutrients and dies.

Women may be considered at risk who lead an incorrect lifestyle that is harmful to the state of pregnancy. Constant stress, overexertion, long-term depression. Work in unsuitable conditions (high humidity, constant stuffiness).

All this can lead to the appearance and abruption of the placenta, which disrupts the supply of oxygen and nutrients to the fetus and, as a result, the death of the unborn baby.

Multiple abortions, transferred . Woman's age(in case of the first one), features of the anatomical structure of the uterus(saddle-shaped,) - all this refers to the provoking factors for the appearance of pathology during pregnancy.

According to the observations of experts, pregnancy, compared to natural pregnancy, has a greater chance of becoming frozen and ending in the death of the embryo.

What awaits a woman who has had one or more unsuccessful pregnancies, what do doctors say about this?

Consequences of a non-developing pregnancy

As a rule, the vast majority of women have every chance of conceiving a child again and carrying it safely to term.

According to statistics, this is 80-90% of all women who are faced with a frozen pregnancy.

If conception ends in the death of the fetus in two or more cases of pregnancy, then the non-developing pregnancy becomes “habitual”.

In this case, in order to safely carry the baby, a thorough examination of both spouses is required.

Pregnancy after illness

Planning your next pregnancy permitted six months after failure.

This break is aimed at the complete restoration of hormonal status and reproductive functions of the body and includes the following mandatory examinations:

Ultrasound of the pelvic organs;
PCR diagnostics (detection of urogenital infections);
blood test for autoantibody levels;
blood test to detect antibody titer;
determination of the level of thyroid hormones in the blood.

This list may have many more items. Each woman is treated with an individual examination plan, which is prescribed by a gynecologist.

But how is a non-developing pregnancy treated, what do doctors do in this case?

Treatment of non-developing pregnancy

If a pregnant woman is found to have a frozen fetus, doctors develop tactics for taking measures for delivery, based on each specific case.

Spontaneous. Shortly after the death of the embryo, the woman’s level of placental hormones sharply decreases, which leads to spontaneous miscarriage.

With the help of medications. In the early stages of a frozen pregnancy (up to 8 weeks), doctors can use the antagonist drug mifepristone (progesterone) in combination with misoprostol (an analogue of prostaglandin E1). After these two drugs enter the body, the embryo is rejected and miscarried.

Surgical treatment. This method is carried out in a hospital setting. Curettage (curettage of the uterine cavity) is prescribed on an individual basis. The operation is similar to an abortion and is performed under general or local anesthesia.

Not a single woman is immune from this misfortune. Non-developing pregnancy– this is not a disease, not a diagnosis, not a sentence. This is a warning that motherhood needs to be carefully and intelligently planned.

Update: October 2018

Many couples dream of having a baby, but for some reason their dreams fail to come true. One of these reasons is frozen pregnancy.

Not only the mother, but also the father may be to blame for this pathology, so it is important, even at the planning stage of pregnancy, to have a full examination and start leading a healthy lifestyle for both partners.

According to statistics, frozen pregnancies are not recorded so rarely, in 15 - 20% of all wanted pregnancies.

Definition of “frozen pregnancy”

A frozen or non-developing pregnancy is a pregnancy that suddenly stops progressing, and the fetus stops growing and developing, and, accordingly, dies. At the same time, there are no signs of spontaneous abortion for the time being and the embryo is in the uterine cavity, so another name for this pathology is a failed miscarriage. Pregnancy miscarriage can occur at any stage of gestation (up to 28 weeks), but, as a rule, it happens in the first trimester. Threatened pregnancy periods due to a failed miscarriage are 3–4 weeks, 8–10 and 16–18 weeks.

A missed miscarriage, like other spontaneous abortions, is classified as miscarriage. But recurrent miscarriage is spoken of only in the case of two or more spontaneous abortions.

The essence of a frozen pregnancy is the fertilization of the egg, its transportation to the uterus, where it is implanted and continues to develop for some time, but then the development of the embryo stops. Also, one of the options for frozen pregnancy is anembryonia or “empty ovum” syndrome. In this case, the membranes develop, human chorionic gonadotropin is synthesized, as evidenced by a positive pregnancy test, but the embryo itself is absent. Often this pathology is caused by chromosomal pathologies.

What can cause a fetus to “freeze”?

The causes of frozen pregnancy are very numerous. They can be divided into several groups:

Chromosomal and genetic abnormalities

This is one of the largest and main etiological factors of a failed miscarriage. If an embryo inherits an extra chromosome or a pathological gene, then during development it develops multiple malformations that are incompatible with life and in this case the pregnancy is terminated. The action of natural selection is evident - nature decides that producing an incapacitated baby into the world is unprofitable and depletes the strength of the mother’s body, and therefore stops the progression of pregnancy.

But a genetic anomaly can arise precisely during a given pregnancy, when exposed to any harmful external factors (radiation, drug addiction, drinking alcohol, smoking), or it can be inherited from parents, for example, when a malfunction occurs in “predisposition genes.” So, if the fertilized egg “accepted” the “thrombophilia gene” from its parents, then during its implantation in the uterus and the chorionic vessels grow into the mucous membrane, microthrombi form in them, which leads to disruption of the nutrition and blood supply of the embryo and its death.

Infections

Infectious diseases play a huge role in the genesis of both spontaneous abortion and frozen pregnancy. First of all, these are viral diseases of the TORCH infection group. These include rubella, toxoplasmosis, herpes and cytomegalovirus infections. Primary infection with these infections during pregnancy is especially dangerous.

In the early stages, this leads to the “fading” of pregnancy, in the later stages to the formation of developmental anomalies. Sexual infections (gonococcal, chlamydia, ureaplasma and others) also do not lose their importance. Even common colds (flu, ARVI) in the early stages are the cause of a failed miscarriage. The death of the embryo is caused by three mechanisms.

On the one hand, infectious agents, having penetrated the placenta, have a direct effect on the fetus.
On the other hand, the infection triggers the production of prostaglandins in the maternal body, which either have a toxic effect on the embryo or disrupt the microcirculation between the fetal membranes and the endometrium, as a result of which the supply of nutrients and oxygen to the embryo stops.
And on the third hand, a chronic inflammatory reaction in the uterus disrupts the normal implantation of the fertilized egg and leads to a deficiency in its nutrition.

Hormonal disorders

Lack of the most important pregnancy hormone is often one of the factors of miscarriage. High levels of androgens or disruption of the hormonal function of the thyroid gland also play a role.

Autoimmune pathology

Autoimmune diseases are characterized by the formation of antibodies in the mother's body that fight not foreign agents, but their own cells. Since the embryo inherits 50% of its genes from the mother, maternal antibodies begin to attack the cells of its body, which leads to a frozen pregnancy.

For example, with antiphospholipid syndrome, the mother has antibodies to phospholipids in her body, without which the construction of new cells is impossible. During pregnancy, these antibodies attack the developing embryo, which leads to its death.

Teratozoospermia

The failed father of the child may also be guilty of stopping the development of the embryo and its death. A pathology such as teratozoospermia more often causes infertility of a partner, but pregnancy in some cases, although it can occur, will most likely end in a failed miscarriage. Teratozoospermia is a pathology of spermatozoa, which is expressed in their abnormal structure. Anomalies in the structure of sperm cells can manifest themselves in the form of a short tail, an irregularly shaped head, vacuolar cells present in the head, a missing chromosome, a bend in the tail or its thickening.

Teratozoospermia is said to exist if a man's ejaculate contains more than 50% (usually 80%) abnormal sperm. Conception is either completely impossible, for example, due to a short tail, sperm motility is low, or fertilization of the egg occurs if the sperm has abnormalities in the head, which leads to improper development of the embryo and the cessation of pregnancy progression. After examination (see) and treatment of the man, many couples are forced to turn to assisted reproductive technologies, for example, artificial insemination.

Wrong lifestyle

Of course, the occurrence of a frozen pregnancy can be affected by diet, daily routine, occupational hazards, and bad habits. We should also not forget about the dangerous side effects of medications taken during pregnancy, especially in the early stages. The age of the woman is also important. The older the expectant mother, the higher her risk of developing a non-developing pregnancy (35 years or more).

Other factors

Constant stress, sudden climate change and other factors can lead to a non-developing pregnancy. In addition, they cause endometrial failure, which leads to disturbances in nutrition and oxygen supply to the embryo and the development of the described pathology. After IVF, cases of frozen pregnancy are also common, but the causes of this pathology are due to the diseases that forced the woman to turn to assisted reproductive technologies.

Failed Abortion Clinic

Symptoms of a frozen pregnancy have characteristic features. First of all, the woman’s possible signs of pregnancy disappear (in the first trimester). Nausea and vomiting, odor intolerance disappear, the mammary glands lose tension and become soft. However, the disappearance of these symptoms does not always indicate the death of the embryo.

Early toxicosis may be absent, as well as engorgement of the mammary glands.
Often the moment of embryo death goes unnoticed.
The pregnancy test remains positive for another 2 to 4 weeks, since hCG is not immediately cleared from the body.
But the basal temperature will be within 37 degrees and below.
If the dead embryo is in the uterus for more than 3 to 4 weeks, then an intoxication syndrome occurs (fever, general weakness and malaise) due to the decomposition of the embryo and infection of the mother with decay products of fetal tissue and toxins.
If a frozen pregnancy occurs in the second trimester, then the first signal will be the cessation of fetal movement.
When a dead embryo remains in the uterus for more than 2–6 weeks, signs of spontaneous abortion that have begun (spotting dark discharge, aching pain in the lower abdomen and lower back) appear.
Plus, during a gynecological examination, it is determined that the uterus is lagging behind the approximate gestational age. That is why gynecologists perform bimanual palpation of the uterus (chair-based examination) in the first trimester during each woman’s appointment.

Case Study: In the antenatal clinic, a multipregnant woman was observed from 6 weeks of pregnancy. From the anamnesis it is known that there were 3 births, abortions and therapeutic and diagnostic curettages were not performed. The pregnant woman and her husband had no bad habits, and there were no chronic diseases. The only negative point was the woman's age (40 years) and work on night shifts (nurse). During her next appointment, the woman complained of nagging pain in the lower abdomen and periodic “spotting.” On vaginal examination, the uterus is soft, enlarged to 12 weeks, painless (the estimated period was 16 weeks). After confirming the diagnosis of frozen pregnancy by ultrasound, the woman underwent uterine curettage and was prescribed antibacterial therapy. Fortunately, there were no infectious or coagulopathic complications, and after 10 days the patient was discharged home. What was the cause of the frozen pregnancy was never established, since parts of the fetus sent for histological analysis were “lost” in the laboratory.

Treatment of failed miscarriage

A woman must be hospitalized immediately even if a frozen pregnancy is suspected.

After the examination (ultrasound, hCG in the early lines and AFP in the second trimester, coagulogram), careful evacuation of the fertilized egg is carried out.
Expectant management is possible if the embryo is dead for no more than 2 weeks (in the early stages of pregnancy) and there are no signs of an ongoing abortion or infection of the uterus. In this case, the level of hCG in the woman’s body decreases sharply, and the uterus begins to contract, pushing out the fertilized egg. But, as a rule, they resort to a surgical method, that is, to remove the fertilized egg and membranes by therapeutic curettage or vacuum aspiration.
It is possible to use medical abortion (up to 7 weeks) by prescribing Mifegin (progesterone blocker).

After surgical or medical release of the uterus from the embryo, it is necessary. In the postoperative period, antibiotics are prescribed to prevent endometritis and chorioamnionitis.

If fetal death occurs after 14–16 weeks of gestation, then its evacuation is carried out by transcervical amniocentesis of a hypertonic solution of sodium chloride and/or prostaglandins or intravenous administration of a solution of prostaglandins.

Frozen pregnancy: what then?

What to do after a frozen pregnancy? - all patients are puzzled by this question. The material obtained after curettage or induced labor is necessarily sent for histology. In some cases (if a chromosomal pathology is suspected), a genetic study of embryo tissue (the number and quality of chromosomes) is additionally prescribed.

A woman is advised to abstain from pregnancy for six months, and oral contraceptives are prescribed (Yarina, Zhanine). Screening for all genital TORCH infections is also indicated. The woman’s hormonal status must be examined and adjustments made if necessary. In addition, an ultrasound examination of the pelvic organs, the blood coagulation system and a blood test for antibodies to its own phospholipids are performed.

When planning the next pregnancy, spouses are advised to give up bad habits, lead a healthy lifestyle, treat infectious diseases and, if possible, eliminate the causes that led to a missed abortion. A woman is prescribed folic acid and vitamin E 3 months before pregnancy and during the first 12 weeks of gestation.

A frozen or non-developing pregnancy is the cessation of fetal development and its death. Most often, a pregnant woman encounters a similar problem in the first trimester of pregnancy (up to 14 weeks). Much less often, frozen pregnancy occurs at a later date.

A non-developing pregnancy is a type of miscarriage, just like a miscarriage.

How does pregnancy stop?

First, as in a normal pregnancy, the embryo is implanted into the uterus. But for some reason, the development of the fetus stops and the fetus dies. But, despite this, termination of pregnancy does not occur, as with a normal miscarriage, that is, the fertilized egg does not exfoliate and does not come out of the uterus. Therefore, the uterus continues to grow, the woman still feels “pregnant” and the level of hCG (human chorionic gonadotropin) - the pregnancy hormone - does not increase, but slowly decreases. But sooner or later, detachment of the placenta and ovum occurs, and only then do symptoms of a frozen pregnancy appear.

What can cause a non-developing pregnancy?

Firstly, due to hormonal imbalance, or more precisely, due to a lack of progesterone or due to an excess of androgens, in particular testosterone.

The second possible cause of missed abortion is genetic abnormalities of the fetus that are incompatible with life. According to most researchers, nature thus carries out natural selection, promptly eliminating the non-viable fetus.

The third, most common reason is infections. During pregnancy, the immune system weakens, which serves as a favorable background for the exacerbation of infectious diseases. The most dangerous are sexually transmitted infections (gonorrhea, chlamydia, ureaplasmosis and mycoplasmosis) and TORCH infections (toxoplasmosis, rubella, herpes, cytomegalovirus infection).

Increasingly, the cause of non-developing pregnancy and miscarriages is the presence of APS in a pregnant woman.

Other provoking factors include pregnancy after in vitro fertilization;
stress and sudden climate change - long-distance flights;
smoking and drinking alcohol,
The pregnant woman's age is over 35 years.

Symptoms of frozen pregnancy

The symptoms of a frozen pregnancy are almost no different from the symptoms of a miscarriage. When the ovum is detached, cramping pain in the lower abdomen and blood discharge from the genital tract appear.

A woman can pay attention to the disappearance of pregnancy symptoms: toxicosis (if, of course, there was one), soreness of the mammary glands, and so on.

If a frozen pregnancy occurs at a later stage, then one of the ominous signals about the occurrence of pathology will be the absence of fetal movement.

However, even if the indicated symptoms are present, it is quite difficult to say for sure whether there is a frozen pregnancy or not, therefore, for any symptoms described, a consultation with a gynecologist is necessary. If there is bleeding and there is no fetal movement, consultation with a doctor is necessary as an emergency.

Diagnosis of frozen pregnancy

The examination includes an examination by a gynecologist, an ultrasound of the pelvic organs and a dynamic blood test for hCG. Based on these studies, a frozen pregnancy can be reliably diagnosed.

When examined in a chair, all pregnant women with a non-developing pregnancy are revealed to have a discrepancy between the size of the uterus and the gestational age, that is, the uterus is smaller than it should be.

According to ultrasound data, the size of the embryo is less than the required gestational age. He has no heartbeat. Ultrasound can also reveal anembryony - a type of non-developing pregnancy, when the fertilized egg is empty, without an embryo.

The hCG level, as already mentioned, does not increase during a frozen pregnancy and significantly lags behind the hCG level during a normal pregnancy. To better assess the dynamics of hCG fluctuations in the blood, it is advisable to take the test twice with an interval of 48 hours.

Termination of a frozen pregnancy

In most cases, they start with expectant management. That is, after the fetus dies, the hCG level drops, the uterus contracts and spontaneous miscarriage occurs, i.e. the fertilized egg comes out of the uterus on its own.

The second method is termination of pregnancy with medications. This method is used if the pregnancy is less than 8 weeks. For medical termination, progesterone antagonists (Mifepristone or Mifegin) with prostaglandin E2 analogues (Misoprostol, Cytotec) are used. After a few hours, under the influence of the drugs, contractions occur and spontaneous miscarriage occurs.

Surgical treatment is also used, which consists of curettage of the uterine cavity with removal of the fertilized egg. The resulting scraping is sent for histological and cytogenetic examination of the tissues of the fetal egg. After curettage, a hormone that contracts the uterus (Oxytocin) is injected intravenously and antibiotics are prescribed to prevent infectious complications.

A week or two after curettage, a control ultrasound of the pelvic organs is done to see if there are any remnants of the fertilized egg in the uterus.

All women who have been diagnosed with a non-developing pregnancy, after treatment, that is, after a miscarriage or curettage, are recommended to be examined by a gynecologist to determine the cause of the missed abortion, otherwise the subsequent pregnancy may also turn out to be non-developing.

The examination package after a frozen pregnancy includes:

Cytogenetic and histological examination of fetal tissue, which is carried out after curettage and with this result the woman should contact her gynecologist;
- PCR diagnostics for urogenital infections;
- smear on flora;
- blood test for TORCH infections;
- blood test for hormones that affect conception and pregnancy (LH, FSH, prolactin, estradiol, progesterone; androgens - testosterone and DHEA; 17-hydroxyprogesterone, cortisol. If necessary, thyroid hormones are examined (TSH, T4, T3);
- Ultrasound of the pelvic organs;
- blood coagulogram;
- blood test for antibodies to phospholipids and human chorionic gonadotropin.

Based on the results obtained, the doctor prescribes treatment. After a non-developing pregnancy, it is recommended to protect yourself from pregnancy for 3-6 months for examination, treatment and restoration of the body. As a rule, oral contraceptives are prescribed for protection (Zanine, Jess, Yarina, etc.).

In most cases, a non-developing pregnancy is not a death sentence, and after this the woman can safely become pregnant and give birth.

Complications of frozen pregnancy

Possible complications of a non-developing pregnancy are associated with the prolonged presence of the dead fetus in the uterine cavity. This can lead to chorioamnionitis, that is, infection of the membranes and endometritis, inflammation of the uterine mucosa. If a frozen pregnancy occurs at a later stage, there is a risk of fetal maceration, that is, decomposition of the deceased fetus, which can lead to serious complications such as peritonitis or sepsis.

Prevention of frozen pregnancy:

A healthy lifestyle, giving up bad habits, regular exercise;
- examination by a gynecologist before planning pregnancy and timely treatment of all infections and hormonal disorders;
- taking folic acid and vitamin E during pregnancy planning and in the first trimester up to 12-14 weeks of pregnancy.

Questions and answers.

1. When will menstruation begin after curettage for a missed pregnancy?
Your period should come 25-60 days after curettage.

2. I had a curettage done a month ago. The gynecologist prescribed oral contraceptives for 6 months, but I don’t want to take them. What do you recommend?
Oral contraceutives have a therapeutic effect, which is why they are most often prescribed. You can temporarily use barrier contraception, but in any case, this is decided by your doctor based on tests.

3. How many days after curettage can there be bleeding?
Up to 10-14 days.

4. What are my chances of carrying my pregnancy to term normally if I had a frozen pregnancy before?
The same as in healthy women, if there was a frozen pregnancy only once.

5. I take oral contraceptives. Can I get tested for hormones?
It is forbidden. This doesn't make any sense.

6. At what stage of pregnancy is the fetal heartbeat accurately visible on ultrasound?
At 6 weeks pregnant.

7. Can a non-developing pregnancy develop if ultrasound is performed frequently?
No, he can not.

8. Which ultrasound is better to do at a short term if there is a suspicion of a frozen pregnancy?
In the early stages, ultrasound with a vaginal sensor is more informative.

9.My hCG corresponds to the due date, but the ultrasound says that the pregnancy is not developing. Who to believe?
It depends on the stage of pregnancy. Before 6 weeks of pregnancy, the heartbeat is not always visible on ultrasound. But it happens that the pregnancy “freezes,” which is clearly visible on an ultrasound after 6 weeks, and the hCG has not yet had time to decrease.

Obstetrician-gynecologist, Ph.D. Christina Frambos