Pregnancy regresses. In medicine, this means that the fetal development stops. A pathological condition when the fetus dies inside the woman, but placental abruption does not occur, as does a miscarriage. This condition is extremely dangerous for the health of women. If such a situation has occurred, then the intervention of doctors is urgently required.
Medical terminology
Today, more and more often you can hear from the mouth of representatives of medicine or notice entries in the medical history of "regressing pregnancy." This is nothing but a non-developing or frozen pregnancy.
ICD-10 regressive pregnancy is indicated by the gynecologist in the patient’s medical history in connection with the accepted international classification of diseases of the 10th revision for coding diseases and pathological processes.
Another name for the pathology is a failed miscarriage, which reflects the picture most clearly.
The ICD-10 regression pregnancy code should be indicated as follows:
- O02.0 Fatal ovum and blistering skid.
- O02.1 Failed miscarriage. Early fetal death with a delay in the uterus.
Statistics
According to official statistics, the rate of regressive pregnancy is up to 20% of the total. In other words, every fifth pregnant woman experiences regression.
Of all the registered miscarriages in the early stages of up to 12 weeks, the number of regressions varies from 45 to 85%.
Regressive corpus luteum
Ovulation is a complex process. The eggs mature in the formations of the round body, they are called follicles. Their number is determined even with the intrauterine development of the girl.
Each month, up to 10 vesicles develop, among which only one reaches the desired size, it is called the dominant follicle. Regressive vesicles begin to decrease.
What happens after ovulation?
After completing ovulation, the follicle is converted into the corpus luteum. The released egg forms the corpus luteum in the ovary.
This formation develops in several stages, and the absence of pregnancy means that this corpus luteum, which regresses in the ovary, can no longer be determined.
Or vice versa, after conception, the corpus luteum persists for a long time. After all, his main task in the body of a woman is hormonal support for pregnancy. And then the function of the regressing corpus luteum ends. Nevertheless, it accompanies the formation of the fetus up to 12-14 weeks of development, while the placenta is formed. And only then, after this period, when the placenta will take over its functions, it will not be possible to determine the regressing corpus luteum by ultrasound.
In the case of a failed miscarriage, the fetus dies due to insufficient production of progesterone - the main hormone of pregnancy. In this case, the regressing corpus luteum is no longer able to support the current pregnancy.
Reasons for regressions
Unfortunately, it is not every time to find out the root cause of fetal death. Quite often, too many influential moments are to blame for the situation. It is possible to disclose the suspected cause, but only after a thorough gynecological examination and tests.
Listed below are the main prerequisites that can affect the arrest of the fetal life.
Genetic abnormalities
Genetic heredity is the most common cause of early regression. In the event of a breakdown of the genetic material, the embryo dies in the period up to eight weeks. By this time, the main organs of the embryo begin to form; soft tissues form. Changes in the chromosome set always negatively affect development, including the cause of fetal death. No matter how rude this may sound, regression in the early stages is a natural selection. Since abnormalities that develop up to eight weeks are usually incompatible with life. In this way, nature gets rid of the non-viable fetus.
Deviation in the genetic code of the embryo can be an accident, or it can be inherited from parents. The first option speaks of a failure unknown to science at the stage of cell division of the embryo, which provokes the development of defects. Factors that affect the occurrence of defects:
- contact of a pregnant woman with probably unsafe elements for the fetus;
- ionizing radiation;
- polluted environment;
- taking pharmaceutical preparations of a certain series (teratogens).
All of these factors affect only once, that is, the fetus dies only in the framework of the current pregnancy. A woman in the future has every chance to safely endure and give birth to a baby without complications and developmental disabilities.
The other side is taken if the genetic anomaly is inherited from mom or dad. This set of circumstances initially lays in the embryo a defective genetic code. In the presence of genetic pathologies, the threat of the resumption of regressions or a change in the number of chromosomes in a born child in the future increases. A recommended geneticist consultation.
Pathology of hemostasis
A system defect is more likely to occur after 12 weeks. A pathological defect in the blood coagulation system can be congenital and acquired. Carriage of thrombophilia genes provokes the formation of microthrombi in the area of attachment of the fetal egg to the uterine membrane. In this case, the embryo is not able to join, and its nutrition is disrupted, which, in turn, leads to the death of the fetus. You can identify violations in the work of hemostasis. To do this, you need to pass an analysis for a hemostasiogram in advance.
Fortunately, not all genetic abnormalities can cause fetal death. However, the likelihood of a missed pregnancy increases if:
- the patient has vascular diseases (if they are not diagnosed, this does not mean their absence);
- smoking expectant mother.
In some situations, women will never in their life learn about the presence of a pathology of hemostasis, because more than one pregnancy is easy to bear.
Infections
Affect the fetus for a period of six to nine weeks. The following infections pose the highest threat to embryo life:
- chlamydia
- rubella;
- toxoplasmosis;
- cytomegalovirus infection (CMV);
- herpes.
A number of infectious agents may be present in the body of the weaker sex for a long time before the onset of conception and even for life. In this case, the infection is not as serious as the viruses that first entered the body of the mother during the period of gestation. However, an exacerbation of a chronic disease can also cause a poor outcome.
Pelvic diseases
Also pose a threat to the life of the fetus and the expectant mother. Inflammation of the pelvic organs can provoke regression, for example, endometritis.
This pathological condition causes damage to the uterine endometrium. In the case of an extensive lesion, the fertilized egg is not able to find places for attachment, but still penetrates the inflamed mucosa. The lack of proper nutrition of the embryo leads to its explainable death. Interestingly, the risk of developing endometritis and the next regression increases due to abortion or miscarriage.
Hormonal disorders
It affects the fetus for the most part for up to 12 weeks. From statistics, it is confirmed that during a regressive pregnancy there is a violation of progesterone metabolism. A hormone deficiency leads to changes in the endometrium. As a result, the process of attachment of the egg to the uterine wall is disrupted and the fetus is malnourished. Such a combination of circumstances leads to the death of the fetus.
A significant role in the progression of pathology has a deficiency of thyroid hormones or their excess, which also leads to fetal death. Increased levels of male androgen hormones also provoke a disappointing end.
Autoimmune diseases
Become the root cause of a frozen pregnancy at any time. The condition when hostile antibodies are formed is called an autoimmune disease.
Antibodies act on a person’s own cells, destroying them and blocking the normal functioning of body functions. They are able to penetrate the placenta and affect the life of the fetus.
Anatomical anomalies
They provoke a halt in the development of pregnancy for a period of 6 to 12 weeks. An exceptional cause of regressive pregnancy is a malformation of the uterus, which provokes an arbitrary miscarriage.
Symptomatology
Fetal arrest can occur at any time. However, 85% of recorded regressions occur before 12 weeks. In the II and III trimester of pregnancy, the possibility of regression significantly decreases.
Symptoms or signs of a missed pregnancy have their own distinctive characteristics.
The first changes that happen to a woman during the onset of regression are the disappearance of absolutely all pregnancy indicators: nausea recedes, vomiting disappears, the chest decreases and becomes soft to the touch. However, emotional leaps and a breakdown accompany a woman for a long time.
In the later stages of gestation, when the baby is already actively moving, there is a lull. The fetus stops moving for a while. Unfortunately, in the period from the 16th to the 28th week, fetal movements are not so strong and distinct. For this reason, a woman is not always able to timely detect alarm signals and rush for help. When a dead fetus is in the uterus for more than four weeks, the woman has symptoms:
- dizziness;
- fever;
- prostration.
As described above, external changes in the mammary glands occur on the fourth day. Distinctive signs appear only in cases of regression in the early stages. A failed miscarriage after 24 weeks is characterized by colostrum.
Another characteristic feature indicating regression is spotting from the vagina, accompanied by pulling pain in the lower abdomen, as during menstruation.
Allocations begin 2-4 weeks after the actual regression, can be abundant or insignificant. The amount of blood loss depends on the process and duration of pregnancy. The body of a woman seeks to free herself from fragments of the deceased fetus. But the pathology of regression does not allow the body to completely detach the placenta. What is dangerous is heavy bleeding, which can only be stopped in a hospital. The most unfavorable outcome when ignoring medical care is infection and sepsis.
Diagnosis
If a woman has doubts and suspicions about a frozen pregnancy, you should immediately consult a gynecologist. After a thorough examination, the doctor will diagnose and explain the next steps to the patient.
A gynecologist, when examining a patient on a gynecological chair, focuses on the volume of the uterus. If it is reduced, then the body does not meet the expected gestational age.
Laboratory research
Laboratory tests are able to confirm or exclude the diagnosis of regressive pregnancy:
- HCG blood. Analysis for a hormone reflects the course of pregnancy. With regression, the hCG content is about five times underestimated. Normally, the hormone begins to be produced after a day after the fertilized egg is fixed to the walls of the uterus.
- Blood for progesterone. Determining the concentration of progesterone in the patient’s blood makes sense only if the study during pregnancy was carried out repeatedly. Since progesterone decreases slightly during regression, about 1.5 times, but still continues to remain at a high level.
- AFP. Diagnosis of AFP plays a significant role in the case of a missed pregnancy for periods after 12 weeks. After three days from the time of the death of the fetus, the highest level concentration in the blood is diagnosed.
- Ultrasound diagnosis (ultrasound). Today it is one of the most accurate methods for diagnosing a regressive pregnancy. An ultrasound performed in time allows you to fix a dead fetus long before the appearance of the clinical picture.
In the event of a recourse following an ultrasound scan, the following results are likely to last for up to 12 weeks:
- the embryo is not determined;
- the volume of the ovum does not correspond to the gestational age.
After 12 weeks of regression, the following features confirm:
- deviation from the norm of the size of the fetus in accordance with the term;
- deformation of the fetal head;
- lack of midbrain tissue structures of the brain;
- spinal distortion.
At any time, the absence of a heartbeat indicates the death of the fetus. This characteristic sign most accurately makes it possible to diagnose regression.
Complications
Frozen pregnancy can always provoke heavy bleeding that threatens the health and life of a woman. If you find any, even minor blood discharge from the vagina during pregnancy, it is advisable to seek medical help as soon as possible to identify the causes of this condition - visit a gynecologist or call an ambulance.
The prolonged presence of a dead fetus inside a woman causes the development of infection. In the future, the inflammatory process is able to go to the pelvic organs and peritoneum. A failed miscarriage, without timely medical assistance, can lead to sepsis and death.
Treatment
When pregnancy regresses, this means that the independent exit of the fetal egg is minimized. Despite the death of the fetus, the female body is in no hurry to get rid of it. In order to avoid consequences for health and life, in case of suspicion or diagnosis of fetal death, a woman needs to be hospitalized in a gynecological hospital. The task of doctors is to free a woman’s body from fragments of a dead fetal egg and reduce the risk of complications. The method of treatment always depends on the period at which the regression occurred.
I trimester
In the early stages, surgical intervention is always used. Constructive treatment with such a pathology is ineffective.
Until 16 weeks, the dead fetus is evacuated from the woman’s uterus. The operation is performed under general or local anesthesia.
After the removal of the ovum is completed, the uterine cavity is scraped. Material obtained during curettage is sent for histological examination. In certain cases, the operating doctor suggests conducting a genetic study of the material. In what cases is this study recommended:
- early regression;
- not the first case;
- hereditary genetic diseases of one or both parents.
Then, after finishing all the cleaning operations, the woman performs a control ultrasound to exclude fragments of the fetal egg in the uterine cavity.
II / III trimester
After 16 weeks, two methods of treatment are used to diagnose a missed pregnancy:
- intra-amniotic administration of substances (sodium chloride or prostaglandins);
- the use of prostaglandins in combination with antiprogestogens.
The selection of a method is made as a result of the characteristics of the process.
Effects
Having gone through a regressive pregnancy, it is rare when a woman does not face the consequences that affect her health. Problems that concern many:
- The main difficulty that awaits a woman after performing cleansing and treatment is the inflammatory process in the uterine cavity. Often, inflammation develops into chronic endometritis. The condition is characterized by spotting blood discharge, independent of the cycle. It is possible that the discharge is accompanied by pelvic pain. Such a condition greatly complicates life and becomes a prerequisite for poor health in the future.
- Malfunctions in the menstrual cycle and hormonal disorders are another unpleasant consequence of a postponed frozen pregnancy. Sudden jumps in hormone levels lead to the fact that the body is not able to recover on its own, and the defective work of the ovaries causes the development of infertility.
Rehabilitation
To reduce the likelihood of infection and endometritis after curettage or other methods of removing fetal residues, antibiotics are determined for a course of five to seven days, as antibiotic therapy.
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If the situation requires it, a woman and her partner are recommended professional advice from a geneticist and endocrinologist before planning a subsequent pregnancy.