Under the miscarriage spontaneous miscarriage understand it in different terms from conception to 37 weeks. The frequency of this complication varies from 10 to 25% and has no tendency to decrease.
Miscarriage before 28 weeks. referred to as spontaneous abortions (abortions). Termination of pregnancy in terms of more than 28 weeks - to premature birth (premature birth of pregnancy).
Spontaneous abortions are divided into early (up to 16 weeks) and late (more than 16 weeks) due to their different clinical course.
There are also habitual miscarriage in cases of abortion - in a row 2 times or more.
The etiology of miscarriage is diverse and depends on many factors - acting simultaneously or sequentially. Hormonal disorders in women play a major role especially in a trimester. The most common are hypothyroidism, and ovarian hyperandrogenism of various origins. Changes in ovarian function due to a violation of puberty, including genital and general infantilism, abortion (especially in the first pregnancy), inflammatory diseases of the genital organs. In this cup there is a relative (due to lack of progesterone) hyperestrogenia, less a small production of estrogen and progesterone. The latter is accompanied by the development of primary placental insufficiency. Thyroid disease (hypo-and hyperthyroidism), disrupt the development of the pregnancy - as well as the defeat of insular apparatus of pancreas (diabetes).
Mechanisms of termination of pregnancy when hormonal disorders are:
insufficient training of the endometrium for pregnancy
defective implantation of the ovum
increased excitability of the myometrium
primary placental insufficiency in the 11 trimester and fetal malformations.
Genetic causes play an important role in miscarriage. About 50% of reproductive losses, and belongs to chromosomal genomic mutations and chromosomal abnormalities in embryos up to 73% of abortions earlier deadlines. As a rule, gross chromosomal abnormalities (three-and tetraplodiya) was suspended in the very early pregnancy and the early period (3-4 weeks). Thus, natural selection, more than 95% of all mutations arising from termination of pregnancy ends. The older couple, the weaker the selection.
Infectious diseases are one of the first among the causes of miscarriage. These are latent and chronically occurring infectious diseases (chronic tonsillitis, inflammation of the genital organs, urinary tract infections, chlamydia and mycoplasma infection, listeriosis, toxoplasmosis), acute infectious diseases, including viral (influenza and paragripoznye disease, cytomegalovirus infection, rubella, herpes simplex herpes), etc. It is possible the direct loss of the ovum (placenta, fetal membranes and) transplacental or ascending through the impact of hyperthermia mother and intoxication, followed by the death of the embryo, teratogenic (9-12 weeks) or in early fetal psevdoteratogennoe period) the impact of .
By the miscarriage cause malformations of the uterus (intrauterine septum, two-horned, saddle, or a double-horned uterus), cancer of the uterus and appendages (uterine fibroids, cysts, ovarian cystoma), postoperative scar on the uterus.
In the problem of miscarriage is the role of a violation of the immune system. Maturation of the embryo occurs with the full heterozygosity for maternal and fetal histocompatibility antigens. In pregnancy, the mother may develop sensitization to tissue antigens of the fetus. Spontaneous miscarriage and habitual miscarriage may be associated with the reactions of erythrocyte and leukocyte sensitization, and decreased immunity is an additional element contributing to the miscarriage.
Contributing causes of miscarriage are extragenital diseases and pregnancy complications that lead to changes in the placenta, disrupting its function.
A role played by socio-economic factors, among which first place is occupied by manufacturing (vibration, humidity, hard physical labor, infection, allergy, etc.) and harmful environmental factors (radiation, gas content, the presence of high concentrations of chemicals, etc. ), habits (smoking, alcoholism), influencing the formation and development of the ovum.
The clinical picture of a premature termination of pregnancy depends on the stage of pregnancy and miscarriage. With the threat of abortion complain of pain in the abdomen and lower back: periodic voltage of the uterus. There are five stages of the early abortion:
abortion in progress
For early abortion is typical of the birth of the ovum.
Proper treatment and treatment for the first two stages allow abortion to save the pregnancy. At later stages require the removal of the gestational sac or delayed parts.
Symptoms of threatened abortion, and began to distinguish between the cervix (unaltered in threatened abortion and a few shorter closed or slightly open channel - which began with abortion) and the intensity of pain, tension of the uterus and / or the presence of blood discharge.
Late miscarriage occurs in the type of delivery:
disclosure of the cervix, rupture of membranes
the birth of the fetus
the birth of the placenta.
Clinically cramping or aching pain in the abdomen, a periodic voltage of the uterus and less bleeding.
Treatment of threatened abortion should be comprehensive. Of drugs, especially hormones, should be administered on strict indications, and in minimal doses, combining them with a drug-free control (acupuncture, Endonasal galvanizing, elektroanalgeziya, elektrorelaksatsiya uterus). The consequences of hormonal treatment on the fetus and the unborn child may occur many years later; virilizing effect of progestogens (progesterone, progestins) on the formation of reproductive organs in women whose mothers took during pregnancy, diethylstilbestrol. Hormone therapy in women with recurrent miscarriages can take up to 15 - 16 weeks, has not yet completed the formation of the placenta, which completely takes over the function of hormonal regulation in mother - fetus.
Prevention of miscarriage include a system of activities undertaken by a physician prenatal, obstetric and gynecological hospital. Prevention activities carried out during pregnancy. All women after spontaneous abortion and preterm delivery charge for outpatient observation, which includes a special survey (focused history taking, finding characteristics of menstrual function tests for functional diagnosis, hysterosalpingography, ultrasound scan, on the testimony of bacteriological, virological, immunological, and genetic testing) and treatment of identified abnormalities.
During pregnancy, allocate risk of preterm birth, scheduled dates and methods of treatment and prevention of infection rehabilitation centers, employment, creation of optimum conditions for the development of pregnancy. All pregnant women with a history of spontaneous abortions are hospitalized for examination and treatment before the manifestation of clinical signs of threats to interrupt (for 2 weeks before the dates of previous miscarriages).