A miscarriage is considered to be the cessation of the development of the fetal egg and the death of the fetus, which occurred for various reasons, but the dead fetus does not leave the body on its own. An ultrasound test confirms an empty fetal egg or with a dead embryo. This type of miscarriage is diagnosed for a period of not more than 28 weeks.
A failed miscarriage code according to ICD 10 has O02.1.
Symptoms
Unfortunately, by definition, a missed miscarriage usually means there are no symptoms of a failed miscarriage before diagnosis. In some cases, pregnancy symptoms continue. Although pregnancy is not viable, the placenta can still produce hormones, and there may also be signs such as chest pain, morning sickness, and fatigue. But most often, signs of pregnancy disappear or become dull.
Signs of an undeveloped pregnancy in the early stages
The breast falls and becomes soft, the stomach does not increase, the woman ceases to feel the fetal movements. A failed miscarriage is characterized by symptoms such as chills, weakness, poor appetite, and an unpleasant aftertaste in the mouth. From time to time there are spotting in small quantities. This can be either a single manifestation or a repeated one. In this case, you need to visit a doctor.
How to recognize
A miscarriage (in ICD 10 under the code O02.1) is rather difficult to recognize, because most patients do not feel any changes in the state of the body. A dead fetal egg remains in the uterus, causing pain in the lower abdomen that is pulling or painful. But even these symptoms pass very quickly, and then nothing worries the woman.
If the fetal egg has been in the uterus for too long, it gradually breaks down and is saturated with blood secretions, a phenomenon called blood drift. If even after this a natural or artificial exit of a dead fetal egg does not occur, then it forms a fleshy skid.
In a short period, approximately about two months, the fetus can completely dissolve. The danger is a fetal egg that lingers in the uterus for a longer period. Under such conditions, the fetus begins to gradually decompose or rot. It is difficult not to notice the process of decay; secretions with a very unpleasant odor signal it. In medicine, cases of complete mummification of the fetus in the uterus are known. After a long stay in the body, it loses amniotic fluid and dries up.
Diagnostics
The correct diagnosis can only be made by a gynecologist after a thorough examination, collection of anamnesis and some tests. On examination in the gynecologist’s chair, special attention is paid to the size and condition of the uterus, the nature of the discharge, and the condition of the cervix. With a failed miscarriage, a mismatch in the size of the uterus with the gestational age will be clearly visible. A woman is prescribed blood and urine tests to determine the level of hCG, placental lactogen, hormones estradiol and progesterone.
The patient is usually referred for ultrasound examination of the uterus and fetal ECG. If the fetal heart sounds cannot be heard, then the diagnosis is confirmed even without additional examinations. If necessary, the patient donates blood for the Rh factor, group and other immunological studies.
Such a diagnosis as a failed miscarriage can not always be made immediately. This may take time to observe, especially in the early stages of pregnancy. After the 8th week, the diagnosis is made much faster, because the fetal heartbeat can already be heard.
Causes
The factors that contributed to the failed miscarriage may be different. Often, fetal death is provoked by bacterial infections (gonorrhea, streptococcus) and the viral type. Sometimes a miscarriage occurs due to the fault of ureaplasma, mycoplasma, chlamydia, toxoplasmosis. But despite the fact that medicine has stepped far forward, it is still impossible to say exactly what specific causes provoke a failed miscarriage.
Genetics
The fetus stops in development due to the genetic characteristics of the woman’s body or genetic abnormalities in the fetus. In the early stages of pregnancy, up to 8 weeks, it is already possible to detect some genetic mutations or malformations in the embryo that ultimately negatively affect its viability. In this case, nature takes care to give life to a better gene pool and eliminate the weak.
Thyroid
Endocrine causes always play an important role in the development of pregnancy, for example, progesterone deficiency most often causes a failed miscarriage. In more rare cases, the cause is a Rhesus conflict, the presence of antibodies to hCG.
Pathology of the cervix
Often a failed miscarriage provokes pathology of the cervix and isthmus of the uterus, in which these organs do not withstand the pressure exerted on them. Under the pressure of the fetus or amniotic fluid, the neck can simply open. Any uterine abnormalities will interfere with the normal attachment of the fetus and contribute to death, among them the syndrome of the infant uterus and the uterus, split into two cavities.
The same statement is true for uterine fibroids, the fetal egg does not have the opportunity for normal fixation, and its shape becomes deformed due to the myomatous node. Inflammatory processes that occur directly in the uterus or appendages can not only provoke a failed miscarriage, but also permanently impair the ability of the female body to conceive. The lack of necessary hormones or, conversely, an excess of certain types of hormones will contribute to the early death of the fetus, but without expelling it from the uterine cavity. An unstable hormonal background is very likely to cause a miscarriage.
Blood coagulation
If a woman has problems with blood coagulation, then she is threatened with complications during the formation and development of the placenta. The vessels of the placenta become clogged with too thick blood, and blood circulation between the placenta, the fetus and the expectant mother can stop, which in 100% of cases leads to fetal death.
Do not exclude as a reason the effect of stress on the body of the expectant mother. Stress equally with other factors becomes the reason why pregnancy does not continue to develop, but miscarriage as such does not occur.
A miscarriage in some cases occurs due to acute infectious diseases or intoxication suffered by the mother.
Due to a number of factors, the regulatory functions of the central nervous system change the neuromuscular sensitivity of the uterus. If for some reason the fetus dies in the uterine cavity, the body will perceive it as a foreign body and will try to tear it away. But for a failed miscarriage, the uterus is insensitive to this irritant. Its muscular walls, lining it from the inside, are in a passive state, so they do not push the dead embryo out.
Hormonal background with a failed miscarriage represents a high level of progesterone along with low levels of titer of estrogen hormones. These circumstances only exacerbate the inert state of the myometrium - the muscular walls of the uterus. If the gestational age was very short, this allows the embryo to quickly dissolve without causing harm to the woman's body.
Treatment
After the diagnosis is made, most likely, you will have to wait a while for the miscarriage to occur naturally. This can take from several days to several weeks. Active intervention is carried out only in urgent need, if there are symptoms that threaten the health of the woman. Bleeding, pain, fever - such indications will serve as a reason for speedy hospitalization and taking measures to cleanse the uterus. Depending on the duration and other important factors, curettage of the uterus or medical abortion is performed. In some cases, the doctor may prescribe antibiotics after cleansing the uterine cavity.
Possible complications
A dead embryo located in the fetal egg can become infected ascending from the vagina. This poses a great threat to women's health, so endometritis, chorioamnionitis, chorionepithelioma, metroendometritis can develop.
Even if a woman did not notice a miscarriage, then her condition due to complications will clearly make it clear what happened. The patient has pains in the lower abdomen, subfebrile or high fever, severe weakness, nausea, and heart rhythm disturbance. Sometimes the uterus independently gets rid of the fetus, and heavy bleeding begins.
After complications, the prognosis is often quite positive. But much depends on the degree of infection of the uterus, for example, with metroendometritis, the risk of repeated miscarriage increases.
Conclusion
Unfortunately, early miscarriage is common, and not all pregnancies end in the birth of a baby. After a missed miscarriage, couples have to wait one to three menstrual cycles before trying to conceive a baby again. The issue of conception must be approached carefully and all the measures prescribed by the doctor must be observed. Pregnancy planning should include a proper diet, sanitation of all known sexually transmitted infections, smoking cessation and alcohol. According to statistics, the majority of women who have had a miscarriage have subsequently been able to become pregnant and have healthy children.
In addition to gynecological care, a woman may also need the help of a psychologist. Since a failed miscarriage, especially if it occurs in the later stages, leaves a psychological trauma.