Spontaneous termination of pregnancy
Spontaneous termination of pregnancy (spontaneous abortion, abortion) – the spontaneous completion of pregnancy on term up to 28 weeks of a gestation which is not allowing a fruit to reach a mature viable state. Spontaneous termination of pregnancy is shown by the aching or skhvatkoobrazny belly-aches, bloody allocations, exile of fetal egg from a uterus. Diagnostics of spontaneous termination of pregnancy is based on data of gynecologic survey and ultrasonography. The result of pregnancy depends on a stage of spontaneous interruption: at the menacing abortion – pregnancy can usually be kept, at begun – it is extremely rare.
Spontaneous termination of pregnancy
Spontaneous termination of pregnancy – obstetric pathology at which incubation of a fruit suddenly stops at a stage when the fruit is still undeveloped and impractical. Depending on the term of spontaneous termination of pregnancy allocate early (up to 12 weeks of a gestation) and late (from 12 to 28 week of a gestation) abortions. The majority of spontaneous abortions is done in the I trimester of pregnancy before end of the main stages of an embryogenesis and formation of a placenta. Spontaneous termination of pregnancy after 28 weeks of a gestation is considered premature birth.
Rank not developing pregnancy as spontaneous termination of pregnancy: an anembrioniya (empty fetal egg) and stood pregnancies (death of an embryo or fruit without its exile). The spontaneous termination of pregnancy which is done more than 2 a time in a row is called habitual abortion.
Reasons of spontaneous termination of pregnancy
Early spontaneous termination of pregnancy is most often connected with chromosomal pathology, a uterus is more rare with violation of implantation of the impregnated ovum in mucous. Endocrine violations (deficiency of progesterone, a hypothyroidism) can be the reasons of spontaneous termination of pregnancy; autoimmune diseases of mother (anti-phospholipidic syndrome); deformations of a cavity of a uterus (two-horned uterus, intrauterine partition, sinekhiya, solderings, myoma, polyps).
Negatively the previous abortions which are followed by development of the istmiko-tservikalny insufficiency (ITI), an inflammation of genitals (endometritises, endotservitsita, adneksita), infections (flu, toxoplasmosis, clamidiosis, a rubella, mycoplasmosis) transferred to pregnancy time are reflected in the result of pregnancy.
The risk of spontaneous termination of pregnancy increases at a habitual abortion, polycarpous pregnancy, the Rh-conflict, presence at mother of diabetes, hypertension, renal failure, deficiency of folic acid, at active physical activities, injuries, smoking, etc. As a result of EKO, existence of Naval Forces at the time of conception, holding procedures of invasive prenatal diagnostics (amniocentesis, a biopsy of a horion, a kordotsentez) risks of spontaneous termination of pregnancy can also increase pregnancy.
Symptoms of spontaneous termination of pregnancy
On clinical symptomatology of spontaneous termination of pregnancy distinguish the menacing abortion, the begun abortion and abortion in the course. At threat of spontaneous termination of pregnancy there are aching pains and weight in the bottom of a stomach and in a sacrum; on later terms of pain have skhvatkoobrazny character. Mucous and sanious or bloody allocations from a vagina can be observed. The tone of a uterus is raised, its size corresponds to gestation term; the uterus neck - is closed, normal length; growth and development of a fruit are most often not broken.
The begun abortion is characterized by more expressed pristupoobrazny pains and bloody allocations from a genital tract, slightly slightly opened uterus neck, but yet not a sawn-off fruit. At abortion in the course there are regular skhvatkoobrazny pains in the bottom of a stomach, is frequent - plentiful bloody allocations. An internal and external pharynx of a neck of a uterus are open, fetal egg can be in the channel of a neck of a uterus or in a vagina, the size of a uterus is estimated less than the term of pregnancy, dribble of amniotic waters is possible.
At full spontaneous termination of pregnancy fetal egg is expelled from a uterus completely, the uterus is reduced and bleeding stops. At incomplete abortion some elements of fetal egg are late in a uterus cavity, the uterus is reduced not completely, big blood loss and development of gipovolemichesky shock are possible.
The uncomplicated infected abortion is characterized by inflammatory process in endometrium (endometritis) and fruit covers (horionit, amnionit), temperature increase, tachycardia, morbidity of a uterus, bloody, sometimes purulent allocations from a genital tract. At the complicated infected abortion the condition of the pregnant woman worsens, there are fever, a fever, pains, the dispepsichesky and dizurichesky phenomena, purulent processes in a small basin (salpingit, the parametritis, pelvioperitonit). The septic form of spontaneous termination of pregnancy is followed by symptoms of a generalized septic infection and development of infectious and toxic shock.
Diagnostics of spontaneous termination of pregnancy
The obstetrician-gynecologist makes the diagnosis of spontaneous termination of pregnancy on the basis of clinical symptomatology, results of vaginal, bimanualny survey, ultrasonography. Careful gynecologic survey allows to estimate a uterus neck condition, to find allocations or bleeding from the channel of a neck of a uterus, exile of fetal egg and its remains. The Bimanualny research promotes determination of the sizes of a uterus, its consistence and tone.
Ultrasonography helps to establish signs of spontaneous termination of pregnancy: lack of an embryo in fetal egg, an otsloyka of fetal egg (placenta), discrepancy of the sizes of an embryo (fruit) to gestation term, lack of heartbeat at a fruit.
Spontaneous termination of pregnancy should be differentiated from anovulyatorny uterine bleedings, new growths of a uterus and vagina, a puzyrny drift and extra-uterine pregnancy. If necessary carry out a kolposkopiya, a biopsy, and a diagnostic laparoscopy.
At diagnostics the general blood test, determination of the HGCh level and progesterone in blood, a Rh-factor, quantity of platelets, fibrinogen level is made. At suspicion on the infected abortion bakposeva of blood, urine and the material received after a scraping are investigated. At habitual spontaneous termination of pregnancy the cytogenetic research of the remains of fetal egg is conducted.
Treatment of spontaneous termination of pregnancy
At threat of spontaneous termination of pregnancy in the I trimester appoint a bed rest, sexual rest, a diet, sedative and spazmolitichesky means, vitamin E, hormonal medicines (usually, gestagena). The threat of spontaneous termination of pregnancy in II and III trimesters demands hospitalization and constant control of a condition of a neck of a uterus and a fruit. Apply spazmolitichesky, tokolitichesky means, at ITsN - on 14–16 week of a gestation on a neck of a uterus impose a circular seam.
At the begun abortion urgent hospitalization, styptic means, in the I trimester of pregnancy - estrogensoderzhashchy medicines, progesterone are shown. At abortion in the course carry out surgical removal of the remains of fetal egg vacuum – aspiration or a scraping of a cavity of a uterus. In case of cancelled abortion in the I trimester of pregnancy the died fetal egg is deleted instrumentalno or medicamentally; carry out a rodovozbuzhdeniye to late terms of a gestation. After a scraping of a uterus appoint antibacterial therapy, oksitotsichesky means. To patients with Rh (-) blood enter antirezusny immunoglobulin.
The general principles of treatment of a septic form of spontaneous termination of pregnancy which are applied by clinical gynecology are: infusional and transfusion therapy, oxygen inhalations, antibacterial therapy, tool removal of the remains of fetal egg and nekrotizirovanny fabrics. At inefficiency of antimicrobic therapy the hysterectomy with adneksektomiya - removal of a uterus with appendages is possible. At spontaneous termination of pregnancy on the term of 22-28 weeks take measures for nursing of deeply premature child.
Prevention of spontaneous termination of pregnancy
Spouses need to undergo full inspection for identification of the reasons of spontaneous termination of pregnancy, to lead a healthy lifestyle and to plan the following pregnancy not earlier, than in 3 months after an abortion. Treatment of pregnant women with habitual abortion in the anamnesis needs to be begun before clinical manifestations of spontaneous termination of pregnancy. After single spontaneous abortion chances of incubation of future pregnancy remain high.