Intrauterine fetal death symptoms. Antenatal fetal death. Antenatal fetal death in multiple pregnancies

The biggest tragedy for a pregnant woman is the antenatal death of the fetus. It occurs during the child’s intrauterine development and is a great shock not only for parents, but also for all relatives.

Pathologies of the placenta, fetus and umbilical cord

Many people want to figure out why this happened, to find out for themselves what caused the death of the unborn baby. But it is very difficult for doctors to answer this difficult question unambiguously. This is due to the large number of possible causes of antenatal death, as well as their complex nature.

Very rarely, the umbilical cord becomes entangled around the neck, which prevents nutrients from entering the body. If this process continues for a long time, suffocation occurs. Another danger associated with the umbilical cord is its location above the front of the fetus.

An equally rare cause of antenatal death is severe congenital pathology of the placenta. The presence of premature crusts, incorrect positioning, maternal falls, hematomas and other abnormalities negatively affect the transport of nutrients and oxygen. This provokes growth disturbances and intrauterine death. Premature aging of the placenta reduces its conductive functions. This contributes to the occurrence of morphological changes, which pose a great threat to the life and development of the unborn child.

Diseases of the pregnant woman and intrauterine death of the child

Possible causes of fetal death often include:

• the appearance of severe late toxicosis;
• various pathologies of the placenta (previa, premature detachment, malformations);
• diagnosing multiple pregnancy or oligohydramnios;
• incompatibility of Rh factors in the blood of mother and baby.

Not the last place in this list belongs to inflammatory processes in the genital organs, syphilis, hepatitis, and eczema.

For a more accurate determination, numerous specialized studies are required, which include an autopsy of a stillborn child, genetic testing, etc.

Factors leading to fetal death

Since the causes of fetal death have not yet been sufficiently studied, experts identify several factors:

• Hormonal disruption of a pregnant woman. This provokes progesterone deficiency, and the fetus does not receive enough nutrients. As a result, antenatal fetal death occurs. This condition is typical for the first trimester of pregnancy. In addition, early fetal death can be caused by thyroid disease and ovarian dysfunction (for example, polycystic disease).
• Stressful situations, abuse of various medications.
• Having bad habits.
• A variety of external influences (air travel, heavy lifting, radiation, prolonged exposure to the sun) and exposure to chemicals.

Immune and autoimmune factors

Recently, the immunological factor has become increasingly common. Since the fertilized egg consists half of the father’s genetic information, the expectant mother’s body can perceive it as a foreign body. This provokes the production of antibodies that interfere with the development of the fetus. In other words, the embryo is rejected by the woman’s immune system.

A large number of antibodies to phospholipids found in the blood plasma causes the appearance of autoimmune disorders. The first place among them belongs to antiphospholipid syndrome. Almost 5% of cases of fetal freezing occur due to the presence of this pathology. With subsequent pregnancies, this figure increases to 42%. The main reason for the appearance of this syndrome is heredity. The pathology provokes the formation of blood clots and significantly complicates the situation during pregnancy.

Impact of infectious diseases

Acute and chronic forms of infectious diseases are also a great threat to the life of the fetus. The most common cases of fetal death are in the presence of herpes, mycoplasmosis, chlamydia, etc. They may appear earlier. But during this period there is a significant decrease in the woman’s immunity, and because of this, any illness during pregnancy manifests itself more intensely.

In the first trimester, cytomegalovirus poses a great threat, which very often causes pregnancy to fail. But in later stages it provokes the appearance of various developmental defects.

But, unfortunately, it is not always possible to determine why antenatal fetal death occurred. The reasons for it often remain unknown.

The first signs of antenatal death

It is very difficult to independently determine intrauterine fetal death in the early stages. This is due to the individuality of each pregnancy. Some people suffer from toxicosis, while others do not have it. Therefore, in the first trimester, the first symptom of intrauterine death of a child is the cessation of signs of pregnancy. This applies to those cases where they were present. If the woman initially feels well, antenatal fetal death is determined only during a visit to the doctor or an ultrasound scan.

Somewhat later, the main indicator of freezing is the lack of movement. Fetal death in the later stages is most often accompanied by spontaneous miscarriage. But there are also cases when a pregnant woman walks with the baby frozen inside for some time. The death of the fetus and the beginning of its decomposition process may be indicated by nagging pain in the abdomen and the presence of bloody discharge.

Maceration

The fetus can remain in a woman’s uterus from 1-2 days to several months, even years. In this case, maceration, mummification or petrification occurs in the uterine cavity. Approximately 90% of all cases are maceration - a putrefactive, wet process of tissue death. Very often it is accompanied by autolysis of the internal organs of a frozen child, their resorption.

The first time after death, maceration is aseptic in nature. And only after this does an infection appear, which very often provokes the development of sepsis in women.

Macerated fruit is characterized by flabby, soft, wrinkled skin with epidermis exfoliated in the form of bubbles. This explains the reddish coloration of the fetus's skin, which turns green when infected.

The head, like the chest and abdomen, has a flattened shape, soft, the bones of the skull are separated. The soft tissues are impregnated with liquid, separating the epophyses from the diaphyses. Bones and cartilage have a dirty red or brown tint.

Mummification and petrification of the fetus

Dry necrosis of the fetus is called mummification. Most often it is recorded during multiple pregnancies. In this case, intrauterine death of one of the children occurs. Mummification is also observed when the umbilical cord is entwined around the fetal neck. As a result of this process, the fetus shrinks and amniotic fluid is absorbed.

A rarer case is petrification. Most often, it is characteristic of an ectopic pregnancy, when calcium salts are deposited in the tissues of the mummified fetus. That is, the formation of the so-called lithopedion, or fossilized fruit, takes place. Its presence in a woman’s body can continue for many years. In this case, there are no symptoms of intrauterine fetal death.

Studies confirming the diagnosis

If there is a suspicion of intrauterine fetal death, the pregnant woman must be urgently hospitalized. To reliably confirm the diagnosis, FCG and ECG are used. Their results can confirm or deny the presence of heartbeats. An ultrasound examination of the fetus, which is also mandatory in this situation, in the early stages of pregnancy will help to see the absence of breathing and heartbeat, as well as blurry contours of the body. A little later, it can be used to detect the decomposition of the body.

Amnioscopy is one of the methods by which the condition of the waters and fetus is diagnosed. During this procedure, on the first day after the death of the fetus, a green tint of amniotic fluid can be detected. Later they acquire a less intense color and a blood admixture appears. The skin of the fetus has the same color. By pressing the amnioscope on the part of the fetus that is presenting, you can see the depression. This is explained by the lack of tissue turgor.

Quite rarely, X-ray examinations are used, during which it is possible to observe disturbances in the condition of the fetus:

• its size does not correspond to the period of pregnancy;
• flattened arch and blurred contours of the skull;
• the arrangement of the bones is imbricated;
• drooping lower jaw;
• curved spine;
• atypical nature of the arrangement of body members;
• decalcified skeleton.

Removing a dead fetus from the uterine cavity

If a suddenly terminated pregnancy (fetal death) was diagnosed in the first trimester of pregnancy, surgical intervention (curettage) is performed. Arbitrary miscarriages also occur.

If this problem arose in the second trimester and the placenta separated prematurely, an emergency delivery is performed. Determining its method depends on the degree of readiness of the birth canal. The likelihood of spontaneous expulsion of the fetus at this period is reduced to zero.

At the end of pregnancy, with intrauterine death of the fetus, spontaneous birth most often occurs. Otherwise, doctors stimulate labor.

Sometimes, if indicated, fetal-destroying operations take place. In the postpartum period, it is imperative to prevent endometritis and uterine bleeding.

Death of one fetus during multiple pregnancy

The incidence of death of one fetus during twin pregnancy is 1:1000. The causes of death in this case are different:

• pathology of the fetus during pregnancy;
• improper blood circulation;
• impaired development of the placenta or umbilical cord;
• the influence of mechanical factors (critical lack of oxygen in the common placenta or fetal sac).

This greatly affects the health of the second child, even leading to death. If one of the children dies in the first trimester of pregnancy, the probability that the second will survive is 90%. If fetal development stops before the third week, the frozen embryo resolves or softens. This is followed by drying. In this case, the woman may not feel absolutely any symptoms. And only ultrasound helps to identify pathology.

In later lines, the death of one of the twins can be provoked by fetal pathology during pregnancy associated with the development of severe damage to the central nervous system of the second. As a result, various pathologies of internal organs, and even death, can also occur.

Actions of medical workers

What the doctor will do when this problem is detected depends on the period of pregnancy. At a later date, he may decide to perform an emergency delivery, without taking into account the unpreparedness of the second fetus for birth. This happens when it would be safer for a living baby to be born than to be left with a dead fetus. And the sooner a living baby is removed from the uterine cavity, the less harm it will receive.

In the second trimester, if delivery is not possible, any relationship between the babies’ bodies can be stopped and blood transfused into a living fetus.

If this problem occurred in the last trimester, artificial birth is performed. Because the harm from having a dead child inside is caused not only to the healthy baby’s body, but also to the woman’s. This condition can provoke the appearance of coagulation disorders.

Ways to prevent intrauterine fetal death

It is very difficult to predict in advance whether intrauterine fetal death will occur. Therefore, before pregnancy, doctors recommend that absolutely all women, regardless of age, undergo a full examination. It consists of carrying out the following activities:

• Ultrasound of the pelvis;
• taking smears;
• carrying out urine and blood tests;
• thyroid examination;
• tests for the presence of infections and hormonal levels.

Additional studies may also be prescribed based on the individual characteristics of the female body.

Antenatal fetal death is not a death sentence. To prevent problems, future parents should lead a healthy lifestyle, follow the doctor’s recommendations, conduct a full examination before planning a pregnancy, and cure absolutely all existing diseases.

The influence of childbirth on the condition of the fetus: the fetus experiences increasing hypoxia, hypercapnia, and acidosis. Scrum accompanied. decreased uterine hemodynamics. Complicated labor aggravates intrauterine hypoxia. During childbirth, the condition of the fetus worsens in parallel with the increase in pharmacological load, and some problems appear. not directly toxic. e-e, but indirect. The meaning of the body position of a woman in labor: the position of pregnant women. presented on the back additional load on the cardiovascular system and breathing. woman's system. For the outcome of labor and fetal condition, and then for n/r. The mother's position is of no small importance. The most physiological at time pushing - a semi-sitting or sitting position, as well as a position on the side. Childbirth in horizontal positive and more often accompanied. traumatization of the fetus and greater physiological blood loss Surgical delivery: All operations are characterized by t traumatic for the fetus. At the same time, they help reduce perinatal mortality. Application of A. forceps - can lead to birth trauma n/r. Caesarean section - allows noun. reduce perinatal mortality. The timeliness of the operation is of decisive importance when it is possible to avoid protracted labor, a long anhydrous interval and the onset of fetal hypoxia. Incorrectly chosen anesthesia and technical errors can have a negative impact on the fetus. Peculiarities of care: after removal from the uterus, the child is given the usual range of resuscitation measures, aerosol therapy is prescribed, and often breathing stimulants are prescribed. and heart activities The frequency of complications reaches 10.9% (surgery during childbirth) and 1.7% (planned). The prognosis depends on the nature of A. pathology. The prognosis improves if the operation was performed as planned. Birth trauma: a distinction is made between birth trauma, birth injuries and obstetric trauma. The first ones arose. under the doctor of physics. loads, properties, complications. giving birth The latter often more easily arose where there is an unfavorable background in the womb. development, aggravated by hypoxia during childbirth. For acute or chronic woman's illnesses, poisoning, pathological. during pregnancy, polyhydramnios, multiple pregnancy, post-term/premature pregnancy, rapid/prolonged labor, conditions are created for the occurrence of birth trauma. CAUSES of intrauterine hypoxia and fetal death during childbirth: There are acute and chronic. fetal hypoxia: Chronic - 1. Maternal obstetrics (decompensated heart defects, diabetes, anemia, bronchopulmonary pathology, intoxication, infections). 2. Complications of pregnancy: late gestosis, postmaturity, polyhydramnios. 3. Fetal obstetrics: hemolytic. illness, generalization. IUI, developmental defects. Acute - 1. Inadequate blood perfusion to the fetus from the maternal part of the placenta. 2. Placental abruption. 3. Clamping of the umbilical cord. 4. Inability to tolerate changes in oxygenation, connection. with contraction of the uterus. Causes of fetal death during childbirth: 1. Fetal asphyxia. 2. Hemolytic. disease. 2. Birth injuries. 3. Intrauterine infections. 4. Malformations of the fetus.

22. Antenatal fetal protection. The influence of occupational hazards and alcoholism on fetal development. Embryo- and fetopathies.

ANTENATAL FETAL PROTECTION (lat. ante before + natus birth) is a set of diagnostic, therapeutic and preventive measures carried out to ensure normal intrauterine development of the body from conception to birth. A. o. p. is aimed at eliminating factors that negatively affect the formation and development of the embryo and fetus, preventing congenital pathology, reducing perinatal mortality (mortality of fetuses and newborns in the period from the 28th week of pregnancy to the 7th day of life).

A. o. includes early monitoring of a pregnant woman, early detection, treatment and prevention of infectious, cardiovascular and other diseases, toxicosis of pregnancy, balanced nutrition, prohibition of taking medications and X-ray exposure without a doctor’s prescription, prohibition of alcohol and tobacco consumption, sufficient oxygen saturation of the mother’s body , her stay in a special sanatorium or rest home for pregnant women, the correct work and rest schedule, physical therapy, psychoprophylactic preparation for childbirth, and the expectant mother’s attendance at a maternity school. Qualified assistance during childbirth, etc. is of great importance. A pregnant woman’s blood type is tested in advance, the Rh factor is identified, etc.

A. o. is carried out by the entire healthcare system, maternal and child health care with its preventive focus. A. o. p. is also due to special legislation on the protection of women's labor in general and pregnant women in particular - leave and maternity benefits and other measures. Monitoring the implementation of all activities and their direct implementation is provided by antenatal clinics, social and legal offices attached to them, maternity hospitals and medical and genetic consultations that provide prevention and treatment of hereditary diseases.

Embryo- and fetopathies are abnormalities in the development of the embryo and fetus. Periods: Up to 12 weeks - embryonic. From 12 to 40 weeks - fetal. According to the timing of embryo development, the following periods are distinguished: - blastogenesis - from 1 to 15 days. -embryogenesis 16 - 75 days (embryo). -fetogenesis 76 - 280 days (fetus).

Fetal alcohol syndrome (60-80 g/day). - microcephaly, microphthalmia, ptosis of the eyelids, dysplasia of the ears, nose, jaws, clitoral hypertrophy, developmental delay of the cervix; diaphragmatic hernia, hydronephrosis, age spots and hemangiomas. In the postpartum period: - neuroses, epilepsy, mental retardation.

Smoking - chronic lung diseases, drugs - the fetus does not gain weight well; poor protein nutrition, etc.

Medical genetic consultation: 1st half of pregnancy - once a month 2nd half of pregnancy - once every 2 weeks 37-38 weeks - once a week. Amnioscopy - if fetal hypoxia - meconium (green), Rh conflict - bilirubin / yellow /. Amniocentesis - determine protein, sugar, bilirubin, Ig. Chorion biopsy in the early stages. Chordocentesis (puncture of umbilical cord vessels) - gr. blood, Rh, HbF, sugar, bilirubin, creatinine, protein fractions. Social protection factors: in the early stages of pregnancy, women are exempted from harmful production, a ban on certain things. professions for women.

Pregnant women may be exposed to many chemicals in the workplace. Of these, lead, mercury, phosphorus, benzene and its derivatives, carbon oxides, phenol, chloroprene, formaldehyde, carbon disulfides, nicotine, etc. have the most pronounced embryotoxicity.

When exposed to ionizing radiation, the disruption of embryogenesis depends on the stage of intrauterine development and the radiation dose. Exposure to radiation in the early stages of pregnancy causes intrauterine death of the embryo (embryotoxic effect) and often causes spontaneous abortion (60-70%). Ionizing radiation during the period of organogenesis and placentation can cause fetal development abnormalities. In the fetus, the central nervous system, visual organs and hematopoietic system are the most radiosensitive. With radiation exposure during fetogenesis (after 12 weeks of pregnancy), a general delay in fetal development and typical symptoms of radiation sickness inherent in an adult body are usually observed.

chemical agents have a damaging effect:

oIndirectly - causing damage in the mother’s body

oDirectly - upon penetration through the placenta

Most expressed embryotoxicity: lead, mercury, phosphorus, benzene, carbon oxides, phenol, chloroprene, formaldehyde, carbon disulfides, nicotine.

Ionizing radiation causes problems depending on the dose and stage of internal development:

· In the early stages - fetal death (embryotoxicity)

· In the area of ​​organogenesis and placentation – developmental anomalies (CNS, organ of vision, hematopoiesis)

· In the period of fetogenesis (after 12 weeks) - general developmental delay and general symptoms of radiation sickness

Pesticides- can cause hereditary and non-hereditary changes. Inheritances of betrayal manifest themselves in the second and third generations.

Alcohol- has a pronounced teratogenic and embryotoxic effect. There is no alcohol dehydrogenase in the fetal body. Arises fetal alcohol syndrome- impaired physical and mental development, many congenital defects (microcephaly, anomalies of the facial skull, heart defects, kidney defects, undeveloped limbs, hemangiomas)

18. Fetoplacental complex. Methods for determining its functional state.

The main components of F. s. are the circulatory systems of the mother and fetus and the Placenta that unites them . + adrenal glands of the mother and fetus, in which precursors of placental steroid hormones are synthesized, fetal liver and maternal liver, which are involved in the metabolism of placental hormones; the mother's kidneys, which excrete the products of placental metabolism. One of the main factors determining the function of F. is the permeability of the placenta, which ensures all types of exchange between mother and fetus. Impaired placental permeability is the main cause of fetal damage during pregnancy complications. The permeability of the placenta depends on the structure of its villi, the chemical properties of the substances and the amount of placental perfusion. Permeability is facilitated by the presence of special syncytiocapillary membranes devoid of microvilli at the locations of the trophoblast above the capillaries of the fetal part of the placenta. Substances with a molecular weight of less than 100 easily penetrate the placenta, while the passage of substances with a molecular weight of more than 1000 through it is difficult. Fat-soluble substances (such as steroids) cross the placenta more easily than water-soluble substances of the same molecular weight. In the last trimester of pregnancy, blood flow in the uterus increases to 750 ml/min, blood pressure in the spiral arteries of the uterus is 80 mmHg st., in veins - 10 mmHg st., perfusion pressure (the difference between the pressure in the arteries and veins of the uterus), ensuring the exchange of blood between mother and fetus in the intervillous space, reaches 70 mmHg st., i.e. approximately the same as in the capillaries of the uterine organs. Molecules of water, oxygen and carbon dioxide pass freely through the placenta. The transfer of oxygen through the placenta to the fetus is ensured by a higher concentration of hemoglobin in the fetal blood and the greater ability of fetal hemoglobin to absorb oxygen. The oxygen concentration in the fetal blood is higher than that of the mother. Its pressure in the fetal tissues is 7.6 mmHg st., in extracellular fluid - 2.3 mmHg st . Carbon dioxide in the blood of mother and fetus dissociates equally. Glucose easily penetrates the placenta due to the formation of a complex with protein that is easily soluble in fats. The placenta absorbs a lot of glucose; in the early stages of pregnancy it is used for the synthesis of glycogen; in the later stages, the main amount of glucose goes to the processes of glycolysis and energy production. Protein metabolism in the fetus is 10 times more active than in the mother, and the placenta removes amino acids much faster than the mother's liver. A high level of free amino acids in the fetus is evidence of anabolic metabolism; the concentration of amino acids in the fetal blood is approximately 5 times higher than in the maternal blood. Free fatty acids easily cross the placenta, and their levels in the fetus and mother are approximately the same. The permeability of the placenta to iron is high, so the hemoglobin level in the fetus can be normal even with iron deficiency anemia in the mother. Calcium and iodine also easily pass through the placenta. The endocrine function of F. is important. The main hormones of this system are estrogens, progesterone, placental lactogen and α-fetoprotein. Among them, the leading role belongs to steroid hormones - estrogens and progesterone. The intensity of blood flow in the fetus, the growth of the uterus, the accumulation of glycogen and DTP in the myometrium, which are necessary for the activation of anabolic processes in the fetus, its growth and development, and the loosening of the tissues of the vagina and pubic symphysis, depend on them; hyperplasia of the secretory tissue of the mammary glands and their preparation for lactation; suppression of contractile activity of the uterine muscles; certain metabolic changes and immunosuppression necessary for normal fetal development. The source of the formation of estrogen and progesterone is pregnenolone, which is synthesized from cholesterol in the mother’s liver and enters the placenta through the bloodstream. Most of the pregnenolone passes through the placenta into the adrenal glands of the fetus, where it is converted into dehydroepiandrosterone sulfate: a smaller part of pregnenolone, under the influence of certain enzymes, is converted into progesterone, which enters the mother's body. Dehydroepiandrosterone sulfate from the fetal adrenal glands enters its liver, where it is converted into 16 α-dehydroepiandrosterone sulfate. This substance enters the placenta through the bloodstream and is converted into estriol. Then estriol passes into the mother’s blood, is inactivated in her liver, combining with glucuronic and sulfuric acids, and is excreted in the urine in the form of esters of these acids. 90% of estriol synthesized in the placenta is formed from precursors entering it from the adrenal glands of the fetus, only 10% of this hormone is of maternal origin, therefore the content of estriol in the blood and urine of a pregnant woman, starting from the second trimester of pregnancy (when the maturation of the placenta ends) is one from indicators of fetal condition. Part of the dehydroepiandrosterone sulfate comes from the fetal adrenal glands back to the placenta and is converted under the influence of its enzyme systems into estradiol and estrone, which pass into the mother’s blood. The content of estrogen in the blood and urine of a pregnant woman increases sharply as the duration of pregnancy increases. Thus, the amount of free (not bound to blood plasma proteins) estriol increases from 2.5 ng/ml in the 10th week of pregnancy to 15 ng/ml at the 38th week, daily excretion of estriol in urine - from 1 mg in the 10th week of pregnancy to 45 mg to 39 - 40th week. In the urine, pregnant women excrete 1000 times more estriol, hundreds of times more estradiol and estrone than outside pregnancy. The formation of a significant amount of estrogens, which are protectors of pregnancy and ensure the preparation of the body for childbirth, is possible only due to the participation in their synthesis of the fetal adrenal glands and the enzyme systems of the placenta. Progesterone is secreted by the placenta in significant quantities (by the end of pregnancy up to 250 mg per day). At the 6th week of pregnancy, the level of progesterone in the blood of a pregnant woman is approximately 25 ng/ml, at the 38th week reaches 250 ng/ml. The protein hormone placental lactogen formed in the placenta is similar in its properties to somatotropin (growth hormone) and prolactin. Its content increases in the second trimester of pregnancy, reaches a maximum by the 36th week and decreases towards childbirth. The level of placental lactogen in the blood of a pregnant woman clearly correlates with the weight of the fetus and placenta, and the number of fetuses. This hormone helps provide the fetus with glucose (the so-called diabetogenic effect of pregnancy), increases the content of cholesterol in the blood of a pregnant woman - the main precursor of progesterone and estrogens secreted by the placenta. Placental lactogen is excreted by the kidneys of a pregnant woman; disruption of their function can lead to a decrease in its level in the urine. The waste product of the fetus is α-fetoprotein, which is synthesized up to 12 weeks. pregnancy in the yolk sac of the fetus, and after 12 weeks. in his liver. It is believed that α-fetoprotein is a protein carrier of steroid hormones in the blood of the fetus. Its content in the fetal blood reaches a maximum at 14-16 weeks. pregnancy, after which it gradually decreases. As the duration of pregnancy increases, the transplacental transfer of α-fetoprotein into the blood of the pregnant woman increases; its highest level in the blood of the pregnant woman is determined at 32-34 weeks. pregnancy. An increase in the level of α-fetoprotein in the blood of a pregnant woman and amniotic fluid is observed with malformations of the fetus, especially often with disorders of the development of the central nervous system. From the first weeks of pregnancy, human chorionic gonadotropin begins to be synthesized in the chorionic villi. Its secretion increases rapidly, reaching a maximum at 12 weeks. pregnancy, and then decreases and remains at a low level until its end. Methods for studying the functional state of the fetoplacental system in a modern obstetric clinic are diverse. The most informative is a comprehensive examination and comparison of indicators obtained by different methods. Determination of the concentration of F. hormones is important. in the blood and urine of a pregnant woman. The levels of estriol and α-fetoprotein are regarded as indicators of the state of the fetus, placental lactogen and progesterone - as indicators of placental function. The most widespread is the determination of the amount of estriol in the blood and urine of a pregnant woman; its decrease is an early indicator of a disturbance in the condition of the fetus, detected within 2-3 weeks. before clinical manifestations. The content of human chorionic gonadotropin, strictly speaking, is not an indicator of F.'s function, since by the time the placenta is formed (12-14 weeks of pregnancy), its secretion decreases sharply. The level of this hormone in the blood and urine allows us to judge the development of the placenta in the early stages of pregnancy. In modern obstetrics, the immunological method for determining human chorionic gonadotropin is used for early diagnosis of pregnancy, as well as for dynamic monitoring of the results of therapy for trophoblastic disease. To study uteroplacental blood flow after 32 weeks. During pregnancy, dynamic scintigraphy of the placenta can be performed using short-lived radionuclides. At the same time, the time it takes for the vessels of the uterus and the intervillous space to fill with radionuclide, the volumetric velocity of blood flow in the intervillous space and the uteroplacental basin, and the capacity of the various sections of this basin are assessed. Dopplerography allows one to study the blood flow in the vessels of the fetus, umbilical cord and uterine arteries. Important information about the condition of the placenta and The fetus can be obtained using ultrasound. Based on a study of the size and structure of the placenta, its hypo- and hyperplasia, discrepancy between the degree of maturity of the placenta and the gestational age, cysts, fibrin and calcium deposits, and inflammatory changes can be identified. Determining the size of the fetus using ultrasound is the basis for diagnosing fetal malnutrition. Studying the motor activity and respiratory movements of the fetus helps to judge its functional state. In addition, an ultrasound examination can detect fetal malformations, assess the amount of amniotic fluid, etc. Ultrasound examinations are recommended to be carried out at least three times during pregnancy (in the first, second and third trimesters) with its results entered into the exchange card . After 32 weeks pregnancy is a necessary element of the study of F. s. is the assessment of fetal cardiac activity using electrocardiography, phonocardiography and cardiotocography . A stress-free test and functional tests - stress tests - are of great importance for identifying chronic fetal hypoxia.

Antenatal fetal death is the death of a fetus during intrauterine development. It is extremely difficult for specialists to determine the etiology of fetal freezing. But the following factors are distinguished: a malfunction in the genetic code of the embryo (freezing occurs up to 8 weeks); diseases of the maternal reproductive system, intoxication, abdominal damage, different Rh factors of mother and child, multiple pregnancy.

Intrauterine (antenatal) fetal death is manifested by the absence of fetal movement and heartbeat (audible from 6-7 weeks), cessation of fetal growth and enlargement of the uterus, the woman feels unwell, painful sensations and heaviness in the lower abdomen. The diagnosis is made as a result of a doctor's examination and ultrasound. As a treatment for antenatal fetal death up to 12 weeks - curettage, later stages - artificial birth.

Antenatal fetal death does not always manifest itself immediately. A pregnant woman, unaware of what has happened, can carry a dead fetus from a couple of weeks to several months. Only a doctor can identify this, so regular monitoring by a specialist is very important.

So, let's look at the symptoms that may lead a pregnant woman to believe that she has experienced antenatal (intrauterine) fetal death:

• An abrupt cessation of signs of toxicosis (of course, this is not a 100% sign of a frozen pregnancy, since in many women the nausea is temporary and tends to end);
• decrease in basal temperature (up to twenty weeks it fluctuates between 37.1-37.3 degrees and this is considered normal);
• the swelling of the mammary glands and their painful sensations stop;
• in the later stages, milk is released from the mammary glands (when the fetus is alive, colostrum is released);
• spotting and bloody discharge;
• no fetal movement is felt (in later stages this is one of the most important indicators of fetal death (antenatal death), therefore, if the baby has not been felt to move for seven hours, you should start sounding the alarm);
• painful, cramping sensations and heaviness in the lower abdomen.

Even the presence of some of the above symptoms does not mean that antenatal fetal death has occurred. Therefore, the recommendation for a pregnant woman is not to self-diagnose, but to go for an examination to a doctor as soon as possible and tell him all the disturbing points. Only a doctor, having examined the patient, also based on instrumental and biochemical diagnostics, is able to determine an accurate diagnosis.

The doctor can conclude antenatal fetal death based on the following indicators:

• changes in the tone of the uterus and the constancy of its size (does not increase);
• absence of signs of intrauterine tremors and fetal heartbeat (after 6 weeks determined by ultrasound, in later stages - by auscultation);
• results of tests, ultrasound and other studies (decrease in the level of certain hormones (in particular hCG), greenish tint of amniotic fluid (relevant during the first day after fetal death, caused by the presence of meconium in them; sometimes traces of blood are found), the presence of gas in the cardiovascular cells, disturbance of the arrangement of bones, deformation of the spine and shape of the skull, the presence of salts in the amniotic sac and in the embryo itself).

Antenatal fetal death in the early stages (up to 12 weeks) is determined directly when the patient is examined by a doctor and monitored by test results and ultrasound:

• determination and correspondence of uterine size to gestational age;
• low levels of the hCG hormone, determined by blood and urine tests;
• absence of heartbeat on ultrasound examination (after 6 weeks);
• small size of the fetus, not at term (determined by ultrasound).

The above indicates that pregnancy is not developing.

Starting from 12 weeks (the most important period for research), the first ultrasound is performed (if there were no indications before) and biochemical screening. These two studies are carried out in combination, based on the results of which a frozen pregnancy can be detected ( antenatal fetal death) or genetic abnormalities of the fetus. It is worth noting that biochemistry is carried out after an ultrasound of the fetus, the main indicators of which are cardiac activity and the condition of the internal organs of the fetus. If the heartbeat cannot be heard, the structures of the heart, brain, skull bones, spine are changed, there are signs of self-destruction (autolysis) of the internal organs of the embryo (due to prolonged intrauterine position after death).

And if an ultrasound examination has diagnosed fetal death, then biochemistry is no longer necessary. Otherwise, blood is taken for biochemistry (it is important to do both studies on the same day, for the accuracy of the calculations) and calculations are made for various indices of proper fetal development.

To clarify the diagnosis of intrauterine (antenatal) fetal death in the later stages, an additional method such as cardiotocography is used (CTG reveals the correct functioning of the heart and the activity of the baby).

For up to 12 weeks, antenatal fetal death can manifest itself as a miscarriage. If this does not happen, curettage is performed (medical abortion). Curettage during a frozen pregnancy is the removal of the embryo and its membranes from the uterine cavity. The procedure itself lasts between 15-25 minutes and is performed under general anesthesia. Since this is an operation, preparation is required before it is performed: general blood and urine tests are taken, and a blood clotting test is taken. The patient is advised to refuse food 8-12 hours before and water 3 hours before. After curettage, the contents extracted from the uterus are sent for histology, which may indicate the cause of the incident. But you should not count on this analysis, since it cannot always show what was the true cause of death (antenatal death) of the fetus.

If fading (antenatal fetal death) occurs after 12 weeks, an artificial birth is called. The procedure is implemented only when the pregnant woman has been examined. This is done to prevent negative consequences. All necessary medications are introduced into the woman’s body (including hormones that stimulate labor). To speed up the initial stage of labor, the amniotic sac is opened.

There are cases when the process of artificial childbirth cannot proceed normally, so manipulations have to be carried out to destroy the fetus:

• incorrect presentation of the fetus (frontal, pelvic, neglected transverse);
• retention of the shoulders in the birth canal;
• there is a risk of uterine rupture;
• the patient's extremely serious condition.

It is extremely important to carry out proper treatment and recovery. It is necessary to strictly follow the doctor’s recommendations, refuse intimate relationships and not become pregnant for six months.

Prevention of antenatal fetal death

Antenatal fetal death can be prevented by following these recommendations:

• maintain personal hygiene;
• regular observation and implementation of all recommendations of the local doctor, especially if the course of pregnancy is complicated (if there is a threat of intrauterine (antenatal) fetal death);
• early examination and cessation of bad habits of both parents;
• comfortable home and work environment (no stress);
• prevention of traumatic situations;
• careful use of medications during pregnancy.

Antenatal fetal death most often does not occur when the above recommendations are followed.

Results

Intrauterine death (antenatal death) of the fetus is a tragic event in the life of most women. It is impossible to completely exclude the possibility of this event occurring. But this probability can be minimized through a healthy lifestyle, avoiding stressful situations, regularly visiting a doctor, diagnosing diseases, and treating them in a timely and correct manner. But, if antenatal fetal death does occur, it is necessary to consistently and fully go through the rehabilitation process (without haste) and prepare your body for a new pregnancy.

Antenatal fetal death is one of the most terrible verdicts for a woman expecting the birth of a baby. What causes this pathology, how to recognize it and avoid it, is described in detail in this article.

Antenatal death is the death of the fetus in the womb from 9 to 42 weeks of gestation. This is a fairly common occurrence. According to statistics, there is one such case for every 200 pregnancies.

The death of an unborn child is very difficult news for a woman, and many who have experienced this misfortune are afraid to become pregnant again. Fortunately, according to the same statistics, this is extremely rare in healthy women.

Antenatal death of the fetus before 28 weeks is also called frozen pregnancy. It implies the cessation of development and death of the embryo in the earliest stages (up to 9 weeks).

Causes of pathology

Sometimes antenatal fetal death can occur in healthy women, even if the pregnancy was normal.

But in most cases the causes of pathology are:

• infectious diseases of pregnant women (ARVI, rubella, pneumonia, measles, hepatitis);
• vitamin deficiency;
• congenital heart disease, heart failure, serious liver and kidney dysfunction, low hemoglobin levels in the blood of the expectant mother;
• diabetes mellitus and other endocrine disorders;
• infections of the pelvic organs in a pregnant woman;
• Rhesus conflict, incompatibility of blood groups of mother and fetus;
• gestosis is a pathology of the second half of pregnancy, which is often manifested by edema, increased blood pressure, convulsions, and the presence of a significant amount of protein in the urine;
• congenital pathologies of the fetus;
• various disorders in the placenta;
• high or low water levels;
• umbilical cord entanglement, true umbilical cord knot;
• abdominal injuries of a pregnant woman;
• alcohol abuse, smoking, drug use;
• taking pharmaceuticals contraindicated for pregnant women;
• ionizing radiation;
• various intoxications.

Development during multiple pregnancy

The death of one of the fetuses is recorded in 6% of cases of multiple pregnancies. The frequency of this phenomenon is determined by the degree of multiple pregnancy and chorionicity (correspondence between the number of placentas and the number of embryos). Thus, the risk of intrauterine death of one of the fetuses is higher in triplets than in twins. Also, antenatal death is more common in monochorionic twins (when two fetuses have one placenta) than in dichorionic twins (when each fetus has its own placenta).

Features of the pathology depend on the stage of pregnancy:

1. In the first trimester of a multiple pregnancy (up to 10 weeks), the “missing twin” phenomenon occurs when a dead embryo is rejected or absorbed. In the case of dichorionic twins, the death of one embryo does not affect the health of the second. If there is only one chorion, there is a high risk of cerebral palsy and intrauterine development disorders in the surviving twin.
2. The end of the first - the beginning of the second trimester. At this stage, the dead fetus mummifies, becomes smaller and is compressed by the living one. With common chorion, the surviving twin often experiences serious congenital developmental disorders caused by exposure to the decomposition products of the deceased, so the mother is usually offered to terminate the pregnancy.
3. From 25 to 34 weeks of pregnancy, with a common chorion, the surviving fetus is examined using ultrasound and MRI. Based on the results, a decision is made on urgent delivery or further management of the pregnancy.
4. Antenatal fetal death in late stages with multiple pregnancy (more than 34 weeks) requires urgent delivery.

In case of multiple pregnancy and expected death of the fetus, the woman is hospitalized, the gestational age, the number of chorions are determined, the presence of concomitant diseases is determined and a decision is made on further actions.

If one fetus dies in dichorionic twins, emergency delivery is usually not required. The pregnant woman is observed, body temperature and blood pressure are monitored, and regular blood tests are performed. The condition of the living fetus is assessed using Doppler ultrasound and other research methods. After birth, an autopsy is performed on the deceased twin to determine the reasons for his death.

Symptoms and signs

The main sign of pathology is the prolonged absence of signs of fetal movement. If the expectant mother has already felt the daily periodic tremors of the baby, she should be alarmed by their absence during the day. In this case, there is no need to panic, because the woman simply could not notice the child’s movements. To make sure that everything is fine with the baby and to get him to move a little, you can eat something sweet or lie on his back.

If after taking the measures the child still does not move for a long time, you should consult a doctor as soon as possible. This phenomenon may also indicate acute fetal hypoxia.

There are also other signs of the death of a child in the womb:

• general malaise;
• sagging mammary glands;
• pain and heaviness in the lower abdomen;
• lack of fetal heartbeat;
• decreased tone and cessation of uterine growth.

If the dead fetus is in the womb for more than two weeks, the following symptoms occur:

• high body temperature (up to 39 degrees);
• dizziness and headaches;
• drowsiness;
• stomach ache;
• confusion.

Diagnostic measures

Having discovered symptoms of antenatal fetal death, a woman should immediately visit a doctor managing the pregnancy. The specialist will conduct an examination and prescribe an appropriate examination.

Pathology is confirmed by the following hardware and laboratory methods:

1. Ultrasound. The study reveals the absence of heartbeat from 9-10 weeks of pregnancy.
2. Phonocardiography is a method for determining sound waves resulting from the fetal heartbeat in order to assess the activity of this organ. Used from 13-15 weeks of pregnancy.
3. Auscultation is listening to the heartbeat using a stethoscope. Used from 20 weeks of pregnancy.
4. Cardiotocography (CTG) is a method for analyzing uterine contractions and fetal cardiac activity over time using Doppler and phonocardiography.
5. Determination of hormone levels in the blood. With intrauterine fetal death, the concentration of progesterone, estriol and placental lactogen decreases.
6. Amnioscopy is an examination of the fetal bladder through the birth canal or abdominal wall. On the first day after the death of an unborn baby, greenish amniotic fluid is observed. Later, blood impurities appear.
7. Radiography. The method is used in some cases of diagnosing pathology.

Medical intervention for this diagnosis

The purpose of medical intervention for such a pathology is to remove the dead fetus from the uterus. The type of measures taken depends on the gestational age.

1. First trimester. After fetal death at less than 10 weeks, miscarriage often occurs. If this does not happen, curettage of the uterine cavity is performed (medical abortion).
2. In the second trimester, drugs that stimulate labor (oxytocin) are used with the aim of natural delivery of the dead fetus.
3. In the third trimester, labor begins spontaneously or is stimulated.

In some situations, in the later stages, a caesarean section is indicated. When a dead fetus for some reason does not pass through the birth canal, fetal-destroying operations are performed.

After removing the dead fetus, the woman is prescribed a course of antibiotic therapy to prevent complications. Next, the causes of antenatal fetal death are determined, and measures are taken to eliminate them. Patients also often need consultation with a psychologist.

Possible consequences

If you consult a doctor in a timely manner, intrauterine fetal death will not lead to complications. As a rule, 6-12 months after treatment, the next pregnancy may occur, which will end successfully.

If the patient consults doctors later than two weeks after the death of the fetus, serious bacterial complications are likely to develop, including sepsis, which can be fatal.
There are also rare cases where a dead fetus remained asymptomatically in the womb for years. This is possible during mummification (occurs when the umbilical cord is entangled, multiple pregnancy) or petrification (petrification, calcification). The latter involves the accumulation of calcium compounds in the tissues of the dead fetus, which is most common in ectopic pregnancy.

How to prevent intrauterine fetal death

Certain measures to prevent such a pathology must be taken at the stage of pregnancy planning. Before conception, a woman should undergo an examination in order to detect and subsequently treat somatic diseases, infections and other pathologies that may affect the intrauterine development of the unborn child.

At the stage of pregnancy planning, it is imperative to be tested for so-called TORCH infections (herpes, rubella, toxoplasmosis, chlamydia). Diseases of this group can cause not only intrauterine death, but also serious deviations in fetal development.

Measures to prevent intrauterine fetal death during pregnancy:

• eliminating bad habits;
• balanced diet, taking special vitamin complexes;
• optimal working conditions for a pregnant woman (absence of heavy physical activity, ionizing radiation, contact with toxic substances, prolonged sitting and other negative factors);
• regular visits to a gynecologist during pregnancy;
• monthly urine test;
• preventing abdominal injuries;
• prevention and timely treatment of influenza and other infections;
• taking medications only as prescribed by a doctor.

The death of a child in the womb is a tragic and, unfortunately, not uncommon pathology. To significantly reduce the risk of its occurrence, you need to carefully monitor your health and follow the recommendations of a specialist.

– fetal death during pregnancy. It can be provoked by somatic diseases, diseases and abnormalities of the reproductive system, infections, intoxications, abdominal injuries, Rh conflict, multiple births, severe congenital defects of the fetus and other factors. Antenatal fetal death is manifested by cessation of uterine growth, lack of fetal movements and heartbeat, weakness, malaise, pain and heaviness in the lower abdomen. The diagnosis is established based on the results of examination and instrumental studies. Treatment in the first trimester is curettage, in the second and third trimesters - urgent delivery.

General information

Antenatal fetal death (intrauterine fetal death) is the death of the fetus during intrauterine development (before the onset of labor). Causes 39% of stillbirths. Statistical data on the prevalence of this pathology varies significantly, which is due to differences in the classification of fetal deaths in different countries. In the UK, the perinatal mortality rate (including antenatal and intrapartum mortality) is 0.58%, in the USA - 1%, excluding miscarriages before 20-22 weeks of pregnancy. Antenatal fetal death is provoked by various external and internal factors. May pose a threat to the life and health of a pregnant woman. In case of multiple pregnancy, it increases the likelihood of developmental delay and death of the second fetus. Diagnosis and treatment are carried out by specialists in the field of obstetrics and gynecology.

Causes of antenatal fetal death

This pathology can occur under the influence of various endogenous and exogenous factors. Endogenous factors causing antenatal fetal death include infectious diseases (influenza, pneumonia, measles, rubella, hepatitis), hypovitaminosis, somatic diseases (congenital heart defects, cardiovascular failure, severe liver and kidney diseases, anemia of various origins), diabetes mellitus and other diseases of the maternal endocrine system.

In addition, the group of endogenous causes of antenatal fetal death includes gestosis (eclampsia, nephropathy), severe fetal development anomalies, Rh conflict, blood group incompatibility, polyhydramnios, oligohydramnios, placental circulatory disorders (with anomalies of placental attachment, placental abruption, fetoplacental insufficiency and arteriovenous anastomoses of the vessels of the common chorion in twins), a true umbilical cord knot, entanglement of the umbilical cord around the fetal neck and inflammatory diseases of the maternal reproductive system.

Exogenous factors that provoke antenatal fetal death are toxic effects (smoking, alcoholism, drug addiction, substance abuse, taking certain medications, acute and chronic poisoning with household and industrial poisons), ionizing radiation and abdominal trauma. According to research, the leading positions in the list of causes of this pathology are occupied by severe fetal malformations, pathology of the placenta, infections, trauma and intoxication. Sometimes the cause of antenatal fetal death remains unclear.

Pathological anatomy

After death, the fetus may remain in the uterus for several days, months or even years. In this case, maceration, mummification or petrification is possible. 90% of fruits undergo maceration - wet necrosis resulting from contact with amniotic fluid. Initially, tissue necrosis is aseptic in nature. Some time after antenatal fetal death, necrotic tissue can become infected. Severe infectious complications, including sepsis, are possible.

The macerated fruit looks soft and flabby. In the early stages of maceration, the skin is reddish, covered with blisters, alternating with areas of exfoliated epidermis. When infection occurs, the fruit turns greenish. The head and body are deformed. An autopsy is performed to determine the cause of antenatal fetal death. An autopsy reveals tissue permeation with fluid and pulmonary atelectasis. The cartilage and bones are brown or reddish, the epiphyses are separated from the metaphyses. With a long stay in the uterus, autolysis of internal organs is possible. Sometimes, when retained in the uterus, the fetus becomes saturated with blood, forming a bloody mole, which subsequently transforms into a fleshy mole.

In case of antenatal fetal death in the third trimester, spontaneous childbirth is possible. In the absence of labor, stimulation is prescribed. According to indications, fruit-destroying operations are performed. In case of hydrocephalus, frontal and pelvic presentation, threat of uterine rupture and serious condition of the patient, a craniotomy is performed. If the transverse presentation is advanced, decapitation or evisceration is performed; if the shoulders are retained in the birth canal, cleidotomy is performed.

Prevention of antenatal fetal death includes timely detection of genetic abnormalities, diagnosis and treatment of somatic diseases, sanitation of chronic foci of infection, giving up bad habits, stopping contact with household toxic substances, eliminating occupational hazards, preventing injuries and thoughtful prescription of medications during pregnancy.

Fetal death during multiple pregnancy

Intrauterine fetal death is detected in 6% of multiple pregnancies. The likelihood of development depends on the number of fetuses and chorions. The greater the degree of multiple pregnancy, the higher the risk of death of one of the twins. In the presence of a common chorion, the probability of death of one of the fetuses increases several times compared to dichorionic twins. The immediate causes of antenatal fetal death are intrauterine growth retardation, placental abruption, severe gestosis, chorioamnionitis or the formation of an arteriovenous anastomosis with a common chorion.

The form of the pathology depends on the time of fetal death. In the early stages of pregnancy (up to 10 weeks), the “missing twin” phenomenon is observed. The dead embryo is rejected or absorbed. If there are two chorions, the death of one twin does not affect the development of the other. With a common chorion, the second twin increases the likelihood of cerebral palsy and intrauterine growth retardation. Antenatal fetal death in such cases often remains unrecognized and is regarded as a threat of termination of pregnancy.

If you die at the end of the first or beginning of the second trimester of pregnancy, the dead fetus does not disappear, but is mummified. It is compressed by the enlarging amniotic sac of a brother or sister, “dries out” and decreases in size. With a common chorion, the second twin often experiences congenital malformations caused by the entry of decay products into the body through the common circulatory system.

In case of multiple pregnancy and suspected antenatal fetal death, immediate hospitalization is indicated for examination and decision on pregnancy management tactics. During the examination, the gestational age and the number of chorions are determined, the condition of the living fetus is assessed, and somatic diseases and diseases of the mother’s reproductive system are identified. In case of general chorion and antenatal fetal death, diagnosed at the beginning of the second trimester, parents are advised to consider terminating the pregnancy due to the high risk of developing intrauterine pathology in the second twin.

At 25-34 weeks of gestation, a thorough examination of the surviving fetus (ultrasound, MRI) is necessary. If the condition of the fetus is satisfactory, prolongation of pregnancy is indicated. The need for urgent delivery in case of antenatal fetal death is determined taking into account the condition of the mother and surviving child, the likelihood of developing intrauterine disorders and the risk of complications caused by prematurity. Indications for delivery on the part of a pregnant woman include somatic diseases and diseases of the reproductive system that prevent the prolongation of pregnancy. Relative indications from the fetus are anemia, terminal blood flow and the threat of fetal death with arteriovenous anastomoses. Antenatal fetal death after 34 weeks of multiple pregnancy is considered as an absolute indication for delivery.

If there are two chorions, urgent delivery is usually not required. The patient is placed under constant monitoring, which includes daily monitoring of temperature, blood pressure, swelling and discharge, as well as regular tests to assess the condition of the blood coagulation system. The condition of a living fetus is assessed based on the results of Doppler measurements of uteroplacental blood flow, biometry and echography of the brain. After birth, an autopsy of the deceased twin is performed and the placenta is examined to identify the cause of antenatal fetal death.