Antenatalny death of a fruit
Antenatalny death of a fruit – fruit death during pregnancy. The Rhesus factor conflict, mnogoplodiy, heavy congenital defects of a fruit and other factors can be provoked by somatic diseases, diseases and anomalies of reproductive system, infections, intoxications, stomach injuries. Antenatalny death of a fruit is shown by the termination of growth of a uterus, lack of movements and heartbeat of a fruit, weakness, an indisposition, pains and weight in the lower part of a stomach. The diagnosis is established by results of survey and to data of tool researches. Treatment in the I trimester – a scraping, in II and the III trimester – an urgent rodorazresheniye.
Antenatalny death of a fruit
Antenatalny death of a fruit (pre-natal death of a fruit) – fruit death during pre-natal development (prior to childbirth). Is the reason of 39% of still births. Statistical data on prevalence of this pathology significantly vary that is caused by distinction of classifications of pre-natal death in the different countries. In Great Britain the level of perinatal mortality (includes antenatalny and intranatalny mortality) makes 0,58%, in the USA – 1% without abortions to 20-22 weeks of pregnancy. Antenatalny death of a fruit is provoked by various external and internal factors. Can pose a threat for life and health of the pregnant woman. In case of polycarpous pregnancy increases probability of an arrest of development and death of the second fruit. Diagnostics and treatment are performed by experts in the sphere of obstetrics and gynecology.
Reasons of antenatalny death of a fruit
This pathology can arise under the influence of various endogenous and exogenous factors. Carry infectious diseases (flu, pneumonia, measles, a rubella, hepatitis), hypovitaminoses, somatic diseases (congenital heart diseases, cardiovascular insufficiency, a serious illness of a liver and kidneys, anemia of various genesis), diabetes and other diseases of endocrine system of mother to number of the endogenous factors causing antenatalny death of a fruit.
Besides, include in group of the endogenous reasons of antenatalny death of a fruit gestoza (an eklampsiya, a nephropathy), heavy anomalies of development of a fruit, a Rhesus factor conflict, incompatibility of a blood type, abundance of water, lack of water, violations of placentary blood circulation (at anomalies of an attachment of a placenta, an otsloyka of a placenta, fetoplatsentarny insufficiency and arteriovenozny anastomoza of vessels of the general horion at twins), true knot of an umbilical cord, obvity umbilical cords around a neck of a fruit and inflammatory diseases of reproductive system of mother.
The exogenous factors provoking antenatalny death of a fruit are toxic influences (smoking, alcoholism, drug addiction, toxicomania, reception of some medicines, sharp and chronic poisonings with household and industrial poisons), ionizing radiation and injuries of a stomach. According to researches, the leading positions in the list of the causes of this pathology are taken by heavy malformations of a fruit, pathology of a placenta, an infection, a trauma and intoxication. Sometimes the reason of antenatalny death of a fruit remains obscure.
After death the fruit can remain in a uterus several days, months or even years. At the same time maceration, mummification or a petrifikation is possible. 90% of fruits are exposed to maceration – the damp necrosis resulting from contact with amniotic waters. In the beginning necrosis of fabrics has aseptic character. After a while after antenatalny death of a fruit nekrotizirovanny fabrics can be infected. Heavy infectious complications, including sepsis are possible.
The Matserirovanny fruit looks soft, flabby. At early stages of maceration skin reddish, covered with the bubbles alternating with sites of the exfoliated epidermis. At accession of an infection the fruit becomes greenish. The head and a trunk are deformed. For clarification of the reason of antenatalny death of a fruit autopsy is carried out. On opening treatment of fabrics liquid and lungs comes to light. Cartilages and bones brown or reddish, epifiza are separated from metafiz. At long stay in a uterus it is possible internals. Sometimes at a delay in a uterus the fruit becomes impregnated with blood, forming a blood drift which in the subsequent is transformed to a fleshy drift.
At a mnogoplodiya and an obvitiya of an umbilical cord the fruit is quite often mummified. It is squeezed by the living twin, decreases in a size, is wrinkled. Sometimes the mummified fruit in the subsequent is exposed to a petrifikation (to "petrifaction" as a result of adjournment of salts of calcium). Petrifikation is more often observed at extra-uterine pregnancy though can arise also at a normal gestation. The Petrifitsirovanny fruit can be for years in a uterus or in an abdominal cavity, without causing any pathological symptoms.
Symptoms and diagnostics of antenatalny death of a fruit
Pre-natal death of a fruit is followed by the termination of growth of a uterus. The movements of a fruit disappear, the tone of a uterus goes down or raises. Mammary glands become sluggish. Violation of the general health, inexplicable weakness, an indisposition, pains and weight in the lower part of a stomach are possible. The evidence of antenatalny death of a fruit is lack of heartbeat. About 9-10 weeks lack of warm reductions comes to light when performing ultrasonography, from 13-15 – when using a phonocardiography of a fruit or electrocardiography. After 18-20 weeks lack of heartbeat is defined at a usual auskultation. For confirmation of the diagnosis appoint additional researches: Ultrasonography, a kardiotokografiya, blood tests on hormones.
Characteristic signs of antenatalny death of a fruit are decrease in level of an estriol, progesterone and a placentary lactogene. At an amnioskopiya within the first days greenish amniotic waters are found (change of color of waters is caused by meconium availability). In the subsequent color of waters becomes less intensive, blood impurity sometimes comes to light. In some cases in the course of diagnostics of antenatalny death of a fruit use a X-ray analysis. On roentgenograms gas in hypodermic fatty cellulose, heart and large vessels of a fruit is defined.
The relative positioning of bones of a skeleton is broken. Edges of bones of a skull come at each other or disperse, forming "step". In the first case reduction of a head, in the second – flattening or a peculiar meshkovidny pulling of a skull is observed. The head of a fruit can be rejected aside. The backbone is also deformed. Are possible its straightening, or angular deformation. Extremities of a fruit settle down chaotically. At a petrifikation in the field of an amniotic cover, a trunk and extremities deposits of salts of calcium are looked through. At intravenous urography of the patient of a kidney of a fruit are not contrasted.
Treatment and prevention of antenatalny death of a fruit
At death of a fruit in the I trimester the abortion is possible. If the abortion does not occur, perform medical abortion. At deaths door in the II trimester the fruit usually independently is not expelled, the urgent rodorazresheniye is necessary. After comprehensive inspection and studying of a condition of the curtailing system of blood of the patient carry out a rodovozbuzhdeniye. In the beginning enter estrogen, glucose, vitamins and medicines of calcium, then appoint oxytocin and prostaglandins. For acceleration of the first period of childbirth carry out an amniotomiya.
At antenatalny death of a fruit in the III trimester independent childbirth is possible. In the absence of patrimonial activity appoint stimulation. According to indications perform plodorazrushayushchy operations. At hydrocephaly, frontal and pelvic prelying, threat of a rupture of a uterus and serious condition of the patient carry out a kraniotomiya. At the started cross prelying carry out a dekapitation or an evistseration, at a delay of a coat hanger in the patrimonial channel – a kleydotomiya.
Prevention of antenatalny death of a fruit includes timely detection of genetic anomalies, diagnostics and treatment of somatic diseases, sanitation of the chronic centers of an infection, refusal of addictions, the termination of contact with household toxic substances, elimination of professional vrednost, prevention of traumatism and the thought-over prescription of medicines during pregnancy.
Antenatalny death of a fruit at polycarpous pregnancy
Pre-natal death of a fruit comes to light in 6% of polycarpous pregnancies. The probability of development depends on quantity of fruits and horion. The more degree a mnogoplodiya, the is higher risk of death of one of twins. In the presence of the general horion the probability of death of one of fruits increases several times in comparison with dikhorialny twins. Become immediate causes of antenatalny death of a fruit a delay of pre-natal development, the otsloyka of a placenta, heavy gestoza, horioamnionit or formation of an arteriovenozny anastomoz at the general horion.
The form of pathology depends on time of death of a fruit. On early terms of pregnancy (up to 10 weeks) the phenomenon of "the gone twin" is observed. The died embryo is torn away or absorbed. In the presence of two horion the death of one twin does not influence development of another in any way. At the general horion at the second twin the probability of a cerebral palsy and a delay of pre-natal development increases. Antenatalny death of a fruit in similar cases often remains not distinguished and is regarded as threat of termination of pregnancy.
At deaths door at the end of the first or the beginning of the second trimester of pregnancy the died fruit does not disappear, and is mummified. It is squeezed by the increasing fetal bubble of the brother or sister, "dries" and decreases in a size. At the general horion the second twin quite often has congenital malformations caused by receipt in an organism of products of disintegration through the general blood circulatory system.
At a mnogoplodiya and suspicion on antenatalny death of a fruit immediate hospitalization for carrying out inspection and the solution of a question of tactics of conducting pregnancy is shown. In the course of inspection determine the term of a gestation and quantity of horion, estimate a condition of a live fruit, reveal somatic diseases and diseases of reproductive system of mother. At the general horion and the antenatalny death of a fruit diagnosed at the beginning of the second trimester, to parents recommend to consider a question of termination of pregnancy in connection with high risk of development of pre-natal pathology in the second twin.
On term 25-34 weeks of a gestation are necessary careful inspection of the survived fruit (ultrasonography, MRT). At satisfactory condition of a fruit pregnancy prolongation is shown. Need of an urgent rodorazresheniye at antenatalny death of a fruit is defined with a condition of mother and the survived child, probability of development of pre-natal violations and risk of the complications caused by prematurity. The somatic diseases and diseases of reproductive system interfering a pregnancy prolognirovaniye become indications to a rodorazresheniye from the pregnant woman. Relative indications from a fruit are anemia, a terminal blood-groove and threat of death of a fruit at arteriovenozny anastomoza. As the absolute indication to a rodorazresheniye antenatalny death of a fruit after 34 weeks of polycarpous pregnancy is considered.
In the presence of two horion the urgent rodorazresheniye usually is not required. The patient is placed under the constant observation including daily control of temperature, HELL, hypostases and allocations and also regular analyses for assessment of a condition of the curtailing system of blood. The condition of a live fruit is estimated by results of a dopplerometriya of a uterine and placentary blood-groove, biometrics and an ekhografiya of a brain. After the birth carry out opening of the died twin and studying of a placenta for identification of the reason of antenatalny death of a fruit.