Amniotic fluid is the fluid that surrounds the fetus, protecting it and providing it with nutrients. Normally, the water leaves (i.e., the fetal bladder opens) directly in childbirth or before the onset of labor at full term. If this happens ahead of schedule, then there is a serious threat to the life of the health of the mother and baby.

The head of the pregnancy pathology department of the OPC, an obstetrician-gynecologist of the highest qualification category 9 told the Ural-press-inform agency about how doctors help women with amniotic fluid rupture0016 Natalia Zhukova .

- Natalya Vladimirovna, how long can you prolong pregnancy after amniotic fluid discharge?

- Everything is individual. As much as possible last year, we were able to prolong the pregnancy by 86 days, this year - by 82 days so far. We have patients who are admitted with amniotic fluid leakage, we carry out the necessary treatment and let the woman go home. In due time, she safely comes to us to give birth.

- What is the treatment?

- The woman is in the hospital under the supervision of doctors, she is undergoing the necessary examinations. Antibacterial therapy is used to avoid infections, and tocolytics are administered to prevent preterm labor. Hormonal preparations are also used to accelerate the maturation of the baby's lungs, since most often such births are premature.

- How does a baby manage without amniotic fluid?

- The production of amniotic fluid continues throughout pregnancy, they are produced by the placenta and the kidneys of the child. If the patient has a tear of the fetal bladder, then this place “sticks” during treatment, and the water is restored in the required amount.

- Does this prolongation affect the health of babies?

- No. We aim to extend the pregnancy to at least 34 weeks. All over the world it is believed that from this period the child has every chance not only for life, but also for good health. Last year we prolonged pregnancy in 96 women. Most of them carried to term, and an absolutely healthy child was born. If the birth occurred prematurely, then we had time to prepare the baby, and he was born with minimal respiratory disorders. After all, this is the main problem in newborns at this time.

- Why does premature outflow of water occur and how can this be avoided?

- A common cause of premature rupture of water is infection. For example, if a woman suffers from chronic diseases of the pelvic organs, or during pregnancy she repeatedly suffered ARVI. This also happens when there are many abortions in the anamnesis. But sometimes it is difficult to name the exact reason. Therefore, the main advice to women: take care of yourself, take care of your women's health, avoid viral infections and contact with patients during pregnancy. nine0005

- How can a woman avoid contact with the sick, if before maternity leave she most often has to work, go shopping ...

- I agree, this is already a social problem. There are women who give birth for themselves and have to work hard. But in any case, a woman should love herself, try to relax more, treat herself during this period, like a crystal vase from the time of Louis IV. And her family should create such conditions. A husband should not transfer problems at work to the house, he may well go to the store himself, take his wife to the cinema for a good movie or give flowers. nine0005

Of course, you shouldn't go to extremes and create a vacuum around yourself. Pregnancy is not a disease. But it is also not recommended to work until the very birth, and then come to the hospital while driving a car. For social reasons, most women today can experience the happiness of pregnancy only once or twice in their lives. Therefore, you need to make sure that these wonderful sensations are remembered for a lifetime: the first feeling of the birth of life inside oneself, the first movements of the baby, communication with the “tummy”. A woman should enjoy her pregnancy. To do this, she needs to come to this stage of life as healthy as possible. And it should also lead to a doctor who will notice any deviation in time and help prevent the consequences. And, of course, the family should give a woman only positive emotions during this period. nine0005

Expectant mothers should remember that the suspicion of amniotic fluid leakage is not a reason for panic, but for an early visit to the gynecologist. Today, only specialists of the Regional Perinatal Center have such opportunities in the Chelyabinsk Region. Women from both the region and Chelyabinsk are admitted to the LCPC with this problem.

The original article is available at http://uralpress.ru/reviews/schet-na-nedeli-ili-chasy-chelyabinskie-vrachi-nauchilis-prodlevat-beremennost

Missed miscarriage. What is a Missed Miscarriage?

IMPORTANT
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

A failed miscarriage is the intrauterine death of an embryo or fetus, which is accompanied by myometrial unreactivity and retention of the fetal egg in the uterine cavity. At first, there are no signs of a threat of spontaneous miscarriage, but later spotting appears, the size of the uterus lags behind the gestational age. For diagnosis, ultrasound is performed, a blood test for hCG. Treatment depends on the duration of pregnancy. Up to 14 weeks, it is possible to carry out vacuum aspiration, curettage of the uterine cavity. In the 2nd trimester, intravenous oxytocin or prostaglandins are administered into the amnion cavity. nine0005

ICD-10

O02.1 Miscarriage

• Causes
• Pathogenesis
• Classification
• Symptoms of missed miscarriage
• Complications
• Diagnostics
• Treatment of miscarriage
• Prognosis and prevention
• Prices for treatment

General

Missed miscarriage, or non-developing pregnancy (from Latin missed abortion), is 45-90% of all cases of spontaneous interruptions of gestation. Pathology often occurs at the beginning of the gestation period, about 20% of cases are observed in the second trimester. The majority of patients are re-pregnant women, most of them did not plan to conceive. In half of the pregnant women, the emptying of the uterine cavity occurs spontaneously within 14 days, but in the third part, the remains of the embryo are delayed for a longer period, which is an indication for obstetric and gynecological care.

Missed miscarriage nine0005

Causes

A failed abortion is characterized by the fact that when the development of the embryo stops and its death does not occur, the expulsion of the fetal egg does not occur. This is possible in violation of the neurohumoral regulation of myometrial contractility. The development of pathology is influenced by several factors at the same time, the main reasons are:

• Chronic endometritis. It is diagnosed in most women with a failed miscarriage. Most often, microbial associations are determined from opportunistic microorganisms, the herpes virus, chlamydia, gonococci, Trichomonas, cytomegalovirus are detected. nine0080
• Dense attachment of the chorion. With structural inferiority of the endometrium caused by endometritis, frequent abortions and high proliferative activity of trophoblast villi, the forming placenta grows deep into the wall of the uterus and delays the miscarriage.
• Immune factors. Rejection of the dead embryo does not occur with a high immunological compatibility of the mother and fetus. In some cases, there is a pronounced immunosuppression under the influence of progesterone-induced blocking protein - a specific protein of pregnant women. nine0080
• Contractile hypofunction of the myometrium. Chronic inflammation reduces the number of receptors for endogenous uterotonics. If the metabolism is disturbed, there is a deficiency of enzymes and hormonal factors involved in the expulsion of the fetus.

Pathogenesis

A failed miscarriage is more often associated with chronic endometritis, other factors act as additional ones. Viruses or bacteria that persist in the genitals can damage the cells of the fetus. Under the influence of infectious factors, the immune system is activated, the synthesis of inflammatory cytokines increases, the production of growth factors decreases, invasion is disturbed, and trophoblast cells are damaged. nine0005

With a failed abortion up to 5 weeks, the fetal egg is preserved and continues to develop, but anembryony is diagnosed due to autolysis of its contents. If infection occurred after the laying of internal organs, fetal death may occur at a later date, so a fetus is found that does not correspond to the day of gestation. Rejection does not occur due to a decrease in endometrial reactivity.

The dead embryo can linger inside the uterine cavity for 20 days or more. Its tissues undergo destruction and necrosis, and later they are able to mummify or petrify. When embryonic remains are preserved for more than a month, blood clotting factors are released, coagulopathy develops, which can turn into DIC. nine0005

Classification

A failed miscarriage can develop in the 1st or 2nd trimester; this definition is not used for later terms. In the 3rd trimester, the condition is called antenatal death. In clinical gynecology, a classification is accepted depending on the gestational period in which the complication developed:

• Missed early miscarriage. Occurs before 12 weeks of gestation.
• Missed late miscarriage. The fetus dies between 12 weeks and 21 weeks of gestation. nine0080

Symptoms of missed miscarriage

With the death of the embryo, subjective sensations are absent for a long time. After 10-14 days, due to hormonal changes, non-specific signs of bearing a child decrease. The patient feels the disappearance of morning sickness, soreness of the mammary glands, fatigue and drowsiness. Appetite, mood gradually return to normal, but amenorrhea persists.

If the child dies at the end of the 2nd trimester, the pregnant woman stops feeling his movement, the size of the abdomen stops increasing, and body weight also does not grow. Pain over the bosom, which radiates to the sacrum, inguinal region or perineum, begins to disturb 14-30 days after a failed miscarriage. At the same time, spotting spotting from the genital tract may appear. nine0005

Sometimes the amniotic fluid is absorbed into the mother's bloodstream, the dead fetus is dehydrated and mummified. The deposition of calcium salts in the tissues of the child causes petrification. Such changes occur with prolonged retention of the fetus in the uterine cavity. A mummified and calcified fetus can be asymptomatic in the uterus for years.

Complications

With prolonged preservation of the remains of the embryo, concomitant colpitis, endometritis, an infected abortion occurs. In a pregnant woman, signs of intoxication become pronounced, body temperature rises, fetid discharges appear from the genital tract. If treatment is not started, dissemination of pathogens to the pelvic cavity occurs, pelvioperitonitis, peritonitis and sepsis develop. nine0005

With prolonged preservation of the dead embryo, the blood coagulation system is activated. This causes coagulopathy, impaired hemostasis. Therefore, a pregnant woman with a missed miscarriage has a high risk of severe uterine bleeding and DIC.

Diagnosis

An obstetrician-gynecologist of the antenatal clinic conducts an examination of a woman with a suspicion of a failed abortion. In the early period, dynamic observation is necessary to confirm the diagnosis. Consultation with an anesthesiologist is carried out only in the appointment of surgical treatment or the risk of severe complications. The following methods are used for diagnosis: nine0005

• Gynecological examination. The height of the uterine fundus is less than the gestation period; during vaginal examination, the cervix is ​​​​closed, and small bleeding may be observed.
• Ultrasound of the uterine cavity. The size of the uterus lags behind the gestation period by 2 weeks or more. In the 1st trimester, anembryony can be determined - an empty fetal egg. In other cases, there is no fetal heartbeat, and after 12 weeks there are no signs of movement.
• HCG assay. A failed interruption is accompanied by a discrepancy between the concentration of the hormone in the blood and the time of gestation. Upon re-examination, the level of hCG decreases rapidly, which confirms the death of the embryo. nine0080
• Coagulogram. A failed abortion is an indication for determining blood clotting time, aPTT, INR, prothrombin time and fibrinogen in order to anticipate hemostasis disorders and prevent them in time.

Treatment of miscarriage

After the death of the embryo, the preservation of pregnancy is impossible. Mandatory hospitalization in the gynecological department to remove the remnants of the fetus and monitor the patient. Outpatient rehabilitation and treatment of concomitant chronic endometritis can be carried out. With a failed miscarriage, the following methods of therapy are used: nine0005

• Vacuum suction. Can be used in pregnant women up to 14 weeks. This is a gentle treatment method that does not damage the uterine walls. The procedure is performed under general anesthesia.
• Curettage of the uterine cavity. Manipulation is carried out up to 12-14 weeks under anesthesia. Curettage requires dilation of the cervical canal. Special tools remove the mucous membrane, the remnants of the fetal egg.
• Administration of prostaglandins. After 14 weeks drugs are injected into the amniotic cavity in the form of a solution or into the vagina in the form of suppositories. The drug causes the opening of the cervical canal, contraction of the myometrium and rejection of the remnants of the fetal egg. nine0080
• Use of misoprostol. The drug is effective up to 24 weeks. The dosage is selected individually, in the first trimester it is 2 times more than in the second. A miscarriage occurs after 2-5 days.
• Oxytocin injections. The hormone causes uterine contractions, but sensitivity to it appears only from the 20th week of gestation. To cause a miscarriage, the drug is administered in a large dose intravenously.

Prognosis and prevention

For a woman diagnosed with miscarriage, the prognosis depends on the time of the visit to the doctor and the cause of the disease. In chronic endometritis, there is a possibility of recurrence of this condition, so testing for sexually transmitted infections and their treatment is necessary. After the addition of uterine bleeding, DIC, the risk of severe consequences or death increases. nine0005

To prevent pregnancy complications, it is necessary to plan conception, treat sexual infections and somatic pathologies. To protect against infection, casual sex should be avoided and a condom should be used. If a frozen pregnancy is repeated two or more times, an in-depth examination is required.

You can share your medical history, what helped you in the treatment of a missed miscarriage.

Sources

1. Miscarriage. Causes and possibilities of rehabilitation / Yu.E. Dobrokhotova, Zh.A. Mandrykina, M.R. Narimanov // Russian Bulletin of an obstetrician-gynecologist. - № 4 - 2016.
2. Spontaneous miscarriage. clinical protocol. Approved September 19, 2013.
3. Obstetrics / ed. Savelieva G.M. - 2000
4. Non-developing pregnancy. Guidelines for MARS (Interdisciplinary Association of Reproductive Medicine Specialists) / V.E. Radzinsky et al. - 2015.
5. This article was prepared based on the site: https://www.krasotaimedicina.ru/

IMPORTANT
Information from this section cannot be used for self-diagnosis and self-treatment.

---

Learn more

• 
  How long does child have to be in car seat
• 
  38 weeks pregnant severe leg pain
• 
  Importance of folic acid for pregnancy
• 
  Genetic birth defects
• 
  Fatigue during early pregnancy
• 
  Early pregnancy and sneezing
• 
  How long child in rear facing car seat
• 
  Upright birthing positions
• 
  Female anatomy bone
• 
  How do you dress a newborn in summer
• 
  First feed after birth