Fetus - says Doctor of Medical Sciences, Professor Igor Makarov.

In a non-developing pregnancy, which is also called a “frozen pregnancy,” the embryo/fetus dies, but there are no clinical signs of spontaneous miscarriage.

The reasons for a non-developing pregnancy are very diverse. Thus, stopping the development of the embryo/fetus can be caused by an inflammatory process as a result of the action of various microorganisms. Most often, the causative agents of inflammation are: streptococci, staphylococci, Escherichia coli, Klebsiella, virus, cytomegalovirus, herpes simplex virus, Coxsackie virus, mycoplasma, chlamydia, treponema, mycobacteria, toxoplasma, plasmodia, fungi ().

Chronic infectious diseases in women most often do not directly lead to intrauterine fetal death, but cause certain disorders that contribute to it. For example, as a result of direct exposure to an infectious factor, a heart defect is formed in the fetus, which prevents its further normal development. However, not always and not every infection leads to the death of the embryo. The impact of the infection depends on the route of its penetration, the involvement of the fetus and amniotic membranes in infection, the type and activity of the pathogen, the number of penetrating microorganisms, the duration of the mother’s illness, the activity of the body’s protective capabilities and other factors.

Microorganisms can penetrate the uterus from the underlying parts of the reproductive system, infecting the amniotic fluid, which is then swallowed by the fetus. The infection can spread through the amniotic membranes and further to the fetus, causing damage to its internal organs, which, in turn, is the cause of its death. The infection can reach the fetus from chronic foci of inflammation in the fallopian tubes and ovaries.

The death of the embryo/fetus may be due to a violation of the immune relationship, taking into account that the fertilized egg is half foreign to the mother's body. In this case, rejection reactions are activated, aimed at damaging the fertilized egg and removing it from the uterus. Failure to develop pregnancy may be due to various chromosomal disorders: in the first 6-7 weeks of pregnancy, chromosomal changes are present in 60-75% of cases of spontaneous abortion, in 12-17 weeks. - in 20-25%, in 17-28 weeks. - in 2-7%. With age, the likelihood of developing chromosomal disorders increases. The causes of the development of chromosomal disorders are also unfavorable external factors. Stopping the growth and development of the embryo/fetus can be caused by thrombotic complications caused by genetic defects in the blood coagulation system in a pregnant woman. The most common among them are: factor V Leiden mutation, prothrombin G202110A mutation, methyltetrahydrofolate reductase mutation, plasminogen activator gene polymorphism, platelet receptor polymorphism.

Blood coagulation disorders caused by also determine the unfavorable development of the embryo/fetus. In the early stages of pregnancy, the role of direct damaging effects of antiphospholipid antibodies on the structures of the fetal egg, followed by spontaneous termination of pregnancy, cannot be excluded. With this pathology, the process of implantation of the fertilized egg is disrupted. In addition, with antiphospholipid syndrome, there is a decrease in the formation of blood vessels in the placenta and a decrease in its function, which can cause a non-developing pregnancy. Another cause of impaired development of the embryo and placenta in antiphospholipid syndrome is thrombosis and damage to the uteroplacental vessels.

Among the causes of miscarriage, there are also hormonal changes. Impaired formation and decreased function of the corpus luteum in the ovary leads to a decrease in progesterone and inadequate preparation of the uterus for implantation of the fertilized egg. In this regard, the formation of the uteroplacental circulation is disrupted, which entails a decrease in the blood supply to the embryo/fetus and its death. Often, such disorders occur with excessive accumulation of male sex hormones in a woman’s body (Stein-Leventhal syndrome, adrenogenital syndrome), with decreased or increased thyroid function.

The shorter the gestation period, the higher the sensitivity of the embryo/fetus to the action of damaging factors. However, it decreases unevenly throughout intrauterine development. There are critical periods during pregnancy in which the fertilized egg, embryo, fetus are especially vulnerable to adverse effects: the period of implantation (7-12 days), the period of embryogenesis (3-8 weeks), the period of placenta formation (up to 12 weeks), the period of formation the most important functional systems of the fetus (20-24 weeks).

There are a number of sequential violations, characteristic of undeveloped pregnancy: reduction and cessation of uteroplacental circulation against the background of damage to placental structures; cessation of uteroplacental circulation; disruption of the structure of the inner layer of the uterus (endometrium), caused by the presence of dead elements of the fertilized egg in the uterine cavity.

Clinical signs of a non-developing pregnancy can be extremely scarce against the background of a cessation of increase in the size of the uterus and their discrepancy with the gestational age. However, the uterus can be of normal size, it can be reduced, and it can even be enlarged if it is filled with blood due to detachment of the fertilized egg.

For some time after the death of the embryo/fetus, the patient may feel pregnant. However, over time, subjective ones gradually disappear. Spotting bloody discharge from the genital tract and cramping abdominal pain are periodically noted. Chorionic gonadotropin in a woman’s blood, as a rule, is at an extremely low level or even completely absent.

Diagnosis of non-developing pregnancy

The most reliable way to identify a non-developing pregnancy is by the results ultrasound examination in the absence of fetal heartbeat. One of the most common variants of non-developing pregnancy is anembryonia, i.e. absence of an embryo in the cavity of the ovum after 5-6 weeks of pregnancy. In this case, the fertilized egg is smaller than expected, and the embryo is not visualized.

In other cases of non-developing pregnancy, according to ultrasound examination, the fetal egg is similar in size or lags behind in its development, the embryo can be visualized, but without a heartbeat. Often, a retrochorial hematoma can be detected, which is an accumulation of blood at the site of detachment of the fertilized egg from the uterine wall.

If the dead embryo remains in the uterus for a longer period, visualization of the embryo is impossible; there are no signs of its vital activity. The size of the uterus lags behind the gestational age, and there is a deformation of the fertilized egg with unclear contours.

Removal of a dead ovum

The death of the embryo/fetus is not always accompanied by its spontaneous expulsion from the uterus. There are often cases where a dead fertilized egg lingers in the uterus for an indefinitely long time. The reason for this delay may be: the primary tight attachment of the fertilized egg to the wall of the uterus during implantation, the inferiority of immune rejection reactions of the dead fertilized egg, and a decrease in the contractile activity of the uterus.

When a dead embryo remains in the uterus for more than 4 weeks, elements of the decomposition of the fertilized egg enter the maternal bloodstream, which can cause massive bleeding when attempting to terminate the pregnancy. Therefore, before curettage of the uterus, it is necessary to carry out studies of the state of the blood coagulation system and, if necessary, carry out appropriate treatment.

After a thorough examination and appropriate preparation of the woman (carrying out treatment and preventive measures aimed at reducing the risk of developing possible complications), it is necessary to interrupt. For this purpose, instrumental or medicinal dilatation of the cervix and instrumental removal of uterine contents are performed. It is also possible to use special medications for non-operative removal of the fertilized egg from the uterus. Immediately during the abortion or immediately after its completion, an ultrasound scan is necessary to ensure complete removal of parts of the fetus and placenta. After removal of the fertilized egg during a non-developing pregnancy, regardless of the chosen method of termination, it is advisable to carry out anti-inflammatory treatment.

In each case, when a pregnancy is not developing, an in-depth examination is required to identify possible causes of termination of pregnancy with their subsequent elimination or weakening of the effect.

How to reduce the likelihood of embryo death?

To reduce the likelihood of possible damaging factors affecting the course of pregnancy, it is necessary to carry out screening examination patients planning pregnancy, as well as women in early pregnancy for urogenital infection. It is also important to conduct medical genetic counseling in order to identify high-risk groups for congenital and hereditary pathologies. If there are endocrine causes of miscarriage, appropriate corrective hormonal therapy should be selected.

It is also important to identify various autoimmune disorders and correct them. Repeated pregnancy is possible if the identified causes of death of the embryo/fetus are eliminated and after the necessary treatment. When pregnancy occurs again, an ultrasound examination is performed to determine markers of possible fetal development disorders in the blood, including: α - fetoprotein, human chorionic gonadotropin, PAPP-A test at the most informative time. According to indications, invasive prenatal diagnostics are also performed, including chorionic villus biopsy, amniocentesis or cordocentesis to determine chromosomal and a number of monogenic diseases of the fetus. In addition, therapeutic and preventive measures are carried out aimed at eliminating the infectious process, specific anti-inflammatory therapy is carried out in combination with immunocorrectors, correction of blood coagulation disorders and prevention of placental insufficiency from 14-16 weeks of pregnancy.

Today the site for mothers will tell you about what a non-developing pregnancy is, what its causes and consequences are.

Any woman, having learned that she will soon become a mother, looks forward to her first trip to the ultrasound. But women's plans for a happy future can collapse in one short moment - if the device detects the absence of the child’s heartbeat. And one of the reasons for this phenomenon may be.

Most of these cases occur in early pregnancy, before 14 weeks, and involve the death of the baby. A pregnant woman may not know about this, because There are no obvious signs of fetal death, such as a miscarriage.

Causes of fetal freezing

There are no exact answers to the question of why pregnancy does not develop. Factors influencing the formation of the fetus in the first few weeks can be very different. Moreover, if the woman did not suspect that she was pregnant.

Most likely reasons:

• global hormonal changes throughout the body;
• predisposition to hereditary diseases that cause abnormalities in the development of the fertilized egg;
• infections, incl. including genital and TORCH infections;
• the presence of antiphospholipid syndrome (APS) in the pregnant woman;
• bad habits;
• too early or late pregnancy;
• nervous tension...

Signs of an undeveloped pregnancy in the early stages

Using hCG levels, you can determine the further development of pregnancy. A week after fertilization, this hormone begins to be produced by the cells surrounding the fetus. From this time until the tenth week of pregnancy, the level of hCG increases rapidly, doubling every day.

Each week of pregnancy has its own hCG level. If its indicators are lower than they should be in a given period, and a repeat analysis a day later shows a continued decline, then the doctor can diagnose a frozen pregnancy.

A decrease in human chorionic gonadotropin levels is one of the first signs of an undeveloped pregnancy.

Another reliable sign of fetal freezing is early ultrasound procedure. It will help determine if the baby has a heartbeat (cardiac activity begins at 5 weeks). But if the fetal features are clearly visible and there is no heart rhythm, this may mean intrauterine fetal death.

To accurately diagnose a “non-developing pregnancy”, it is necessary to undergo another ultrasound scan a week later.

Symptoms of a non-developing pregnancy

A woman may notice some signs of a frozen pregnancy:

• in the early stages, signs of pregnancy such as toxicosis, soreness and swelling of the mammary glands, changes in taste preferences, increased salivation, etc. disappear;
• normalization of basal temperature;
• during an external examination, the gynecologist may note that the size of the uterus lags behind the size corresponding to the probable stage of pregnancy;
• for periods of more than 16 weeks, absence of fetal movements;
• detachment of the fertilized egg due to its freezing causes pain in the lower abdomen with the release of blood contents from the genital tract. Your temperature may rise. This happens a couple of weeks after the death of the embryo.

The process of terminating a frozen pregnancy

Unfortunately, a “non-progressing pregnancy” must be terminated. To select the appropriate therapy, the doctor must proceed from each specific case.

Most of these pregnancies end spontaneous miscarriage. Sometimes, for periods up to 8 weeks, a medical termination of pregnancy is required. For this purpose, drugs that weaken the effect of progesterone and prostaglandin analogues are used.

After their introduction, the body starts a natural mechanism for expelling the fetus in the form of a miscarriage.

Late surgical intervention involves the process of curettage of the uterine cavity in order to remove the dead fertilized egg.

The scraped tissue is sent for laboratory testing for histology and cytogenesis. To contract the uterus, the woman is given oxytocin, and a course of antibiotics is also prescribed to prevent the development of infection. A couple of weeks after the procedure It is necessary to undergo another ultrasound to exclude the presence of residual fragments of the fertilized egg in the uterus.

Consequences of a non-developing pregnancy

A delay in terminating a frozen pregnancy can cause the development of an intrauterine infection, an inflammatory process in the tissues of the uterus and appendages.

The decomposition of the cells of a dead embryo saturates a woman’s blood with dangerous toxins. As a result, decreased blood clotting and the risk of severe bleeding.

During the curettage procedure, damage to organ tissue is possible. Along with the physical difficulties endured, the woman’s mental state also requires rehabilitation. After all, there is nothing worse than losing a very tiny, but already so dear and long-awaited creature.

All of these factors can reduce your likelihood of having children in the future. Therefore, if you notice the first alarming signs, you should immediately contact your gynecologist. Timely removal of a dead embryo can significantly reduce the risk of complications.

So that the next pregnancy after a non-developing one is not terminated in the same way, It is better not to plan to conceive for another six months after the rehabilitation course. Before this, both partners should undergo a full examination in order to identify the causes of previous fetal freezing.

Gynecologists say that during each month a woman experiences all four seasons. After all, the level of hormones in her body fluctuates all the time, which affects both our well-being and mood. All these processes are aimed at ovulation and further fertilization of the egg. And if this happens, then hormonal activity will be aimed at preserving the fertilized egg and its successful development.

Not all, but the vast majority of women certainly feel these changes on a physical and emotional level. Often, even intuitively, a woman feels that she is pregnant. We listen to our body from the first weeks, trying to determine what is happening to us. And sudden changes or disappearance of certain signs and sensations can frighten us greatly. Most often this happens at the stage when the body is already getting used to functioning in a new mode, that is, closer to the second trimester. But still, if your intuition tells you that something is wrong, then it is better to play it safe and go to the gynecologist. Unfortunately, it is not so rare that a pregnancy stops developing due to the death of the embryo. And this can happen at any time.

A pregnancy that is not developing is also called a frozen pregnancy. Its outcome is always the same: interruption by natural, medicinal or surgical means. Such a pregnancy has no chance of developing, because there is either no embryo or it died.

In the first case, obstetricians talk about anembryonia- this is one of the types of non-developing pregnancy, in which the fertilized egg turns out to be empty, without an embryo inside. This pathology is detected at the earliest stages, usually during the first ultrasound.

But it also often happens that an embryo that has begun its development turns out to be non-viable or dies under the influence of certain pathological factors. The first signs of an undeveloped pregnancy may appear after a certain time, because at first there are no signals about the tragedy from within.

Most often, pregnancy stalls in the first trimester. It is not always possible to determine this on your own, but sometimes a woman can still suspect something is wrong based on changes in her condition.

Breasts during frozen pregnancy

The breast is one of the first to react to the new condition of a pregnant woman. It becomes heavier, fills up, increases in size, the sensitivity of the nipples increases, they darken, and a painful sensation may occur. These changes, like all others, occur under the influence of hormones. If pregnancy stops developing, then the level of these hormones will begin to decrease, and its early symptoms will begin to disappear.

So, if in the first weeks, in the early stages, the chest suddenly stopped hurting, toxicosis and other early signs (irritability, drowsiness, etc.) disappeared, and the woman no longer feels what she used to, then it is better to consult a doctor for consultation and examination . It is likely that early toxicosis has ended - and the most pleasant period in terms of well-being is beginning. However, if you are tormented by any doubts, it is better to dispel them.

Temperature during non-developing pregnancy

If a woman kept a chart of basal temperatures before conception and continues to do so in the first weeks after, then when the embryo freezes, she may notice some changes in the chart. In particular, BT, which was fixed at elevated levels, will begin to decline. However, very often it remains elevated for a long time after the death of the fetal egg, and in general, BT can behave differently in each individual case, and very often errors and errors are made when measuring BT. Therefore, doctors do not recommend using this method to assess the well-being of embryo development.

As for general health, then, of course, when a miscarriage begins due to a non-developing pregnancy, the body temperature may rise - as a reaction to the pathological process. But this is not a prerequisite and does not always indicate an ST.

The developing fertilized egg actively produces the hormone human chorionic gonadotropin, so pregnancy can be diagnosed at the earliest stages. A blood test for hCG is perhaps the earliest reliable method of determining it.

The level of hCG in the blood and urine of a pregnant woman doubles every two days in the first days and weeks. If there is a suspicion of pathological development of pregnancy or its fading, a woman is often prescribed this test to monitor the level of hCG over time. That is, if several studies conducted in a row (usually at intervals of a day) show that the hCG level does not increase or even decreases, then they come to a disappointing conclusion.

What will the test show during a frozen pregnancy?

For the same reason, a test performed during a frozen pregnancy may show a pale second line or even give a negative result if enough time has passed since the death of the embryo and the level of human chorionic gonadotropin has significantly decreased.

However, you should never trust this method alone. Remember: tests quite often produce false positive and false negative results, for which there can be many different reasons.

By and large, none of the signs described above should lead a woman to think that the embryo has frozen. And only if these signs are combined with each other, you can start to worry. And if, in addition, bloody discharge from the vagina appears, then you should definitely consult a doctor, even if there are no other reasons for concern. Bleeding, brown discharge or even spotting indicate that the ovum has begun to detach, and it is very likely that the pregnancy can still be saved.

If the fetus has frozen for quite some time, then the woman will certainly notice that for a long period of time no movements are noted. However, even such a very eloquent sign cannot accurately indicate fetal freezing.

A woman’s own feelings cannot be any reliable signs of an undeveloped pregnancy. In combination with various circumstances and accompanying symptoms, they can only lead to the idea that perhaps not all is well. But in general, gynecologists say that a non-developing pregnancy is often not accompanied by any specific characteristic clinical manifestations. The diagnosis of ST can only be made on the basis of laboratory tests.

Among the signs already mentioned, only the hCG level has an important diagnostic value. But even if its concentration is low, a woman who is suspected of fetal failure will definitely be sent for an ultrasound.

Even during a personal examination in the office, the gynecologist is able to predict a delay in the development of pregnancy if the size of the uterus, which he palpates with his hands, does not correspond to the expected gestation period. Ultrasound examination can more accurately determine this discrepancy. In addition, it will evaluate the signs of embryonic life: the presence of heartbeats and motor activity. In case of a non-developing pregnancy, the uzist will see damage to the structures of the placenta, deterioration or complete cessation of uteroplacental blood flow, damage to the endometrium of the uterus due to the decomposition of dead tissue, and a hematoma at the site of detachment of the fertilized egg.

If the pregnancy has stopped and a spontaneous miscarriage begins (the woman’s immune system rejects foreign cells), then the ultrasound will also show detachment of the fertilized egg or placenta.

In the short term, the doctor can take a wait-and-see approach: that is, wait until the fertilized egg leaves the woman’s body on its own. And very often this is exactly what happens.

However, it is also not uncommon for a dead embryo to remain inside the womb for a long period of time, soon beginning to decompose. This outcome is very undesirable and is fraught with serious consequences, and therefore doctors are forced to intervene in this process: they resort to medical abortion (interrupting pregnancy with hormonal medications) or perform curettage during a frozen pregnancy. A non-developing fetus is disposed of only when the absence of a heartbeat is confirmed by at least 2 ultrasound examinations.

I would like to note that, despite the prevalence of this problem, the majority of women who have had an undeveloped pregnancy successfully carry and give birth to healthy children in the future. In Western countries, even after three cases of fetal death in a row, 75% of women still get pregnant and give birth.

Therefore, you should not be overly upset and upset: the best is yet to come! However, doctors advise women who are at risk for miscarriage to prepare and plan their next conception:

• suffering from sexually transmitted infections;
• those who have had infectious diseases during pregnancy;
• suffering from endocrine disorders;
• those giving birth for the first time over the age of 30 or becoming pregnant after 40 years;
• have had abortions in the past;
• alcohol abusers, drug users, heavy smokers;
• taking antidepressants or suffering from nervous disorders;
• in whom the fetus has repeatedly died (especially in the later stages);
• having a uterus with developmental pathologies (small, bicornuate, etc.) or uterine fibroids.

Especially for - Larisa Nezabudkina

The concept of a non-developing pregnancy is relatively unfamiliar to a wide range of women, although such a pathology is not so rare in real practice. This does not mean that information about the disease is artificially hidden by doctors. It’s just that the peculiarities of its development and course do not ultimately present a clear clinical picture, characteristic, for example, of spontaneous abortion in the early stages. The disease occurs relatively latently, and at the time of detection is usually irreversible.

In fact, a non-developing pregnancy in the early stages is a “hidden” analogue of an abortion. But at the same time, the appearance of vivid symptoms is not observed - pain, deterioration of the condition, discharge of blood from the genital tract. For certain reasons, the development of the embryo stops and its intrauterine death occurs. But expulsion of the fertilized egg from the uterine cavity is not observed, as a result of which the pregnancy takes on a non-developing character.

Like spontaneous abortion, this pathology has a fairly rapid and rapid course, making it difficult to prevent its occurrence. Therefore, the embryo dies long before a clinical diagnosis is made. Moreover, during the diagnostic search, special attention is paid to identifying concomitant conditions that most often underlie the arrest of growth and development of the fertilized egg and lead to its death.

Reasons

A non-developing pregnancy is always secondary, occurring against the background of any diseases or conditions affecting the mother or fetus. Moreover, most of them come from the female body, which leads to disruption of the normal processes of growth and development of the embryo:

1. If such an effect occurs acutely, it usually ends with a similar mechanism in termination of pregnancy. There is widespread thrombosis of the vessels of the fetal membranes, and their parallel detachment from the uterine wall. The simultaneous contraction of muscle fibers leads to their expulsion from the organ cavity - spontaneous abortion occurs.
2. If the effect is continuous, existing even before conception, or gradually increases during the first weeks, then the growth of the embryo is inhibited in the same way. At a certain point, compensation mechanisms are exhausted, which makes further development of pregnancy impossible. At the same time, it seems to freeze - the fertilized egg dies and begins to gradually collapse in the uterine cavity without expulsion.

The underlying causes of non-developing pregnancy are currently combined into two groups - according to the general mechanism of the changes that occur.

Endocrine disorders

Hormonal regulation in humans is characterized by good compensatory abilities. Chronic pathology of the endocrine system can occur for quite a long time without any clinical manifestations. Therefore, most often the basis for a non-developing pregnancy is precisely the following disorders:

• The main share among the entire group is occupied by subclinical hypothyroidism - reduced production of thyroid hormones by the thyroid gland. The timely and correct development of all structures and membranes of the embryo depends on a sufficient level of these biologically active substances. Accordingly, their initial deficiency during pregnancy increases even more, which ultimately causes first growth retardation and then the death of the fetal egg.
• The next most common is diabetes mellitus, but it does not occur during pregnancy in the later stages (gestational), but is present in a woman before its development. When it is insufficient or incorrectly controlled, an insulin deficiency is created, which also plays an important role in the processes of growth and development of the embryo.
• Disturbances in the regulation of sex hormones that have some organic nature are less common - most often a tumor. In this case, a competing effect is created on the level of progesterone in the blood, which inhibits the progression of pregnancy.

The problem is that even a conception planning system does not always allow for effective and timely identification of these conditions. The situation is also aggravated by the fact that in most cases they are asymptomatic.

Immunological disorders

Another group of disorders underlying frozen pregnancy includes some autoimmune processes that occur only in certain situations. But the most common in practice is Rh incompatibility between mother and child:

• This situation occurs only in women who do not have a specific antigen in their blood - the Rh factor.
• Their first pregnancy usually proceeds normally and ends with natural birth or cesarean section.
• But if the fetus was Rh-positive, then its red blood cells can enter the mother’s bloodstream directly during birth or subsequent manipulations.
• As a result, immunological mechanisms are triggered that recognize the red blood cells of the fetus as foreign. Then they are destroyed, followed by the formation of a kind of “immunity” to them.
• In subsequent pregnancies, if the embryo also has Rh-positive blood, a similar mechanism is implemented, only on a larger scale. Depending on the speed of exposure, fetal death is possible even without expulsion from the uterine cavity.

When planning a pregnancy, the Rh factor of the mother's blood must be tested. In this way, it is possible to carry out preventive measures in a timely manner to prevent the development of complications in the future.

Manifestations

A negative feature of the pathology is its relatively hidden course - as a result, diagnosis is almost always delayed. The disease is detected “after the fact”, when intrauterine death of the embryo has occurred. And since the first screening is carried out between 11 and 13 weeks, clinical data are only compared with the results of ultrasound and analysis of the level of hCG in the blood.

But often women turn much earlier, having felt some changes in their own well-being. But in such a situation, it is even more difficult to suspect the correct diagnosis - at a period of about 8 weeks, the size of the fertilized egg may still only slightly lag behind its age norms. Therefore, observation continues for some time to accurately determine whether the growth and development of the embryo has stopped, as well as changes in hormone levels.

Symptoms

In the early stages, it is almost impossible to assess objective signs of pregnancy, so complaints and doubtful manifestations are mainly assessed. With the following combination, the diagnosis of a non-developing pregnancy becomes most likely:

1. Symptoms characteristic of the first trimester of pregnancy disappear - mood swings, drowsiness or insomnia, transient nausea, intolerance to certain odors.
2. Changes in food preferences and appetite also disappear. Moreover, this happens quite suddenly, in contrast to normal and physiological reactions.
3. Increased pigmentation of the skin in the midline of the abdomen, genitals, and nipple areolas gradually disappears. The process also proceeds quite quickly, which makes it different from natural adaptation reactions.
4. Transient engorgement of the mammary glands, accompanied by an increase in their density and soreness, completely disappears.

Normally, for many women, some signs may disappear or be initially absent even during a normal pregnancy. Therefore, assessment of such complaints and symptoms should be carried out only in conjunction with additional examination.

Confirmation

Establishing a clinical diagnosis of a frozen pregnancy requires the same diagnostic procedures that include the first screening. Therefore, its actual implementation is an excluding or confirming factor for this pathology:

• An ultrasound examination reveals a fertilized egg in the uterine cavity, which in size significantly lags behind the terms of normal development. Sometimes there is even no actually formed embryo in it - the image shows only empty shells.
• For additional confirmation, the level of human chorionic gonadotropin (hCG) in the blood is assessed in parallel. This active substance, within certain limits, characterizes the normal development and course of pregnancy. When its progression is stopped, a significantly reduced level of hCG is observed, lagging behind weekly norms.

Receiving confirmation of the diagnosis serves as a reason for performing an induced abortion. This procedure will allow you to completely remove the dead embryo from the uterine cavity.

Consequences

If the fact of a non-developing pregnancy is confirmed, then its further preservation is no longer possible. Many women think that with the help of some medications they can stimulate the growth of the embryo so that it has time to reach normal size. But this opinion is fundamentally wrong, and contradicts the very mechanisms of development and course of the disease. Like spontaneous abortion, progression stops suddenly and is accompanied by fetal death.

Therefore, the only method of help in this case is to artificially complete the process - medicinal or surgical interruption. It is necessary for the complete removal of the dead embryo with its surrounding membranes. Otherwise, they become a substrate for the development of another pathology, which can become destructive for the entire reproductive system of a woman.

Early

Despite the fact that the death of the embryo occurs in the sterile conditions of the uterine cavity, the immune system still triggers the mechanisms of its destruction. Depending on the period at which the progression stopped, the following outcomes are possible:

• If regression developed during the first weeks after conception, then by the time of detection, autolysis of the embryo occurs. At the same time, under the influence of immune cells and the enzymes they secrete, the tissue is completely destroyed.
• If the fertilized egg has already reached a significant size, then its immediate destruction becomes impossible. Therefore, destruction occurs gradually, accompanied by the processes of necrosis and maceration. The outcome is the formation of a focus of chronic inflammation in the uterine cavity, delimited by a capsule.
• A rather rare consequence is spontaneous abortion, which occurs under the influence of embryo destruction. In this case, incomplete expulsion of the fertilized egg from the uterine cavity is more often observed.

After confirmation of the diagnosis, expectant management is usually replaced by an active one - in the near future the woman will undergo an artificial termination of pregnancy.

Remote

Unlike spontaneous abortions, even with a single development of regression, a thorough search for its causes is carried out. This is necessary in order to prevent the occurrence of a similar pathology during the next conception:

1. Timely and complete artificial interruption is the main way to prevent long-term consequences. Removing the fertilized egg along with the membranes will ensure the reverse development of changes in the reproductive system and restoration of the menstrual cycle.
2. Given the prevalence of the causes, an examination is carried out to identify endocrine or immunological disorders.
3. Active identification of other concomitant diseases that can affect the course of pregnancy is also carried out.
4. If necessary, a woman is prescribed long-term maintenance or replacement therapy to normalize hormonal levels.
5. If the Rh factor is negative, immunological prophylaxis is carried out using a special serum.

In general, if a woman is responsible for planning a subsequent pregnancy, then she usually does not have long-term problems with identified disorders in the future. Thanks to continuous monitoring and correction of existing diseases and conditions, doctors are able to ensure successful pregnancy.

Symptoms of a non-developing pregnancy

Signs of a non-developing pregnancy are varied. Conventionally, they can be divided into subjective and obvious (proven through medical examinations). Let's consider both.

Possible symptoms

1. Disappearance of toxicosis. Of course, it should not last throughout pregnancy, but unpleasant symptoms in the form of nausea and vomiting usually disappear gradually, over several days or even weeks. If there was severe toxicosis, which suddenly stopped, this should alert you.

2. Disappearance of breast tenderness- these are the symptoms a frozen pregnancy can have. Moreover, not only breast tension may disappear, but its size may even decrease somewhat. The chest seems to fall. This symptom is especially noticeable in the case of pregnancy of 8-10 weeks or more.

3. Bloody, beige, brown vaginal discharge, abdominal pain- usually such signs of a non-developing pregnancy in the early stages indicate the onset of a miscarriage. But such a natural termination of a frozen pregnancy is not possible in all cases. Often a miscarriage does not occur for 1-2-3 weeks, and then curettage of the uterine cavity is necessary. In addition, we should not forget that these signs can occur both in the event of a threat in the case of a normal developing intrauterine pregnancy, and an ectopic one - which is especially dangerous.

4. Decrease in basal temperature. Many women know that in the second phase of the menstrual cycle and during pregnancy, the temperature in the rectum should be elevated - above 37 degrees. A decrease in temperature may be due to a lack of the hormone progesterone or the death of the embryo.

5. The first signs of an undeveloped pregnancy can be determined by a doctor during a gynecological examination., when he notices a discrepancy between the size of the uterus and the gestational age (calculated according to the first day of the last menstruation). Or if since the last gynecological examination, carried out 1-2 weeks before, the uterus has not grown at all.

Absolute signs

1. Absence of heartbeat in the embryo(determined from the fifth week of pregnancy during ultrasound examination). If the heartbeat is not detected, the woman is advised to repeat the examination in a few days. If a heartbeat does not appear, it is recommended to remove the non-developing fetus and its membranes by curettage of the uterine cavity.

2. Lack of growth, low levels of human chorionic gonadotropin- this is how a frozen pregnancy always manifests itself in the early stages - the first weeks. Human chorionic gonadotropin is a hormone produced by the chorion (future placenta) that rises rapidly in the first trimester. There are its norms, departure from which indicates pathologies. For women at risk of miscarriage, doctors prescribe periodic blood tests for hCG. And if there is no growth of the hormone, they are sent for an ultrasound.

At the end of the article, it is worth saying that a non-developing pregnancy is a very common occurrence. According to statistics, approximately every 8th pregnancy ends in the death of the embryo. In most cases, the cause is chromosomal abnormalities, but there are frequent cases of the harmful effects of infections, toxic substances and medications. To minimize the likelihood of this unpleasant pathology, plan your pregnancy, take all the necessary tests, undergo examinations, listen to the doctor’s recommendations and do not self-medicate.