miscarriage

Miscarriage - spontaneous termination of pregnancy in terms of up to 37 completed weeks, counting from the first day of the last menstrual period. Spontaneous abortion in terms of up to 28 weeks is called spontaneous abortion, from 28 to 37 completed weeks - premature birth. Nevynashivaemoeti frequency ranges from 10 to 25%, in the first trimester is 50%, in the second - 20% and in the third - 30%. Called habitual miscarriage abortion consecutive two or more times. On the miscarriage rate is influenced by such factors as maternal age (younger than 20 and older than 35 years), the interval between pregnancies (at least 2 years), and others.

Among the many causes of miscarriage are the following groups:

I. Genetic - disorders in the chromosomes that occur during grinding of a fertilized egg or inheritable in gene structures. These disorders result in the death of the embryo, since, as a rule, are not compatible with its development. abortion takes place at the earliest stages - up to 3 - 4 weeks.

II. Hormonal factors: hypovarianism, often combined with infantilism (hypoplasia) of the uterus, a violation of ovarian and / or adrenal glands, in which they promoted the formation of androgens (male sex hormones), thyroid dysfunction. When hormonal disorders caused by the termination of pregnancy occurs during the second trimester - 13-14 weeks.

III. Pathological conditions of the mother - the largest group of causes of miscarriage. These include:

1) malformations (horned, two-horned, saddle) uterine tumors (uterine fibroids, ovarian cysts);

2) traumatic endometrial damage due to repeated interventions (abortion, diagnostic and / or postpartum curettage).

The so-called cervical incompetence (damage to the circular muscles of the uterus in the internal os) occurs when trauma Isthmus region during the expansion of the cervix during a medical abortion and operational delivery. If the reasons for the termination of pregnancy of the above occurs in the second trimester of pregnancy up to 24 - 26 weeks.

IV. Extragenital diseases pregnant:

1) heart disease , anemia, hypertension , pyelonephritis ;

2) viral infections: rubella , cytomegalovirus infection , herpes infection , mumps , influenza ; Latent infection: toxoplasmosis , chlamydia and others.

V. Complications of pregnancy: polyhydramnios, severe toxicosis, presentation and / or placental abruption, malposition - cause abortion in the third trimester to 37 weeks.

The adverse effect on the course of pregnancy and its interruption cause a so-called environmental factors: mechanical, physical, chemical, 'often associated with occupational hazards.

Prevention is the careful examination of women in order to identify the causes of miscarriage and of rehabilitation therapy in preparation for a subsequent pregnancy. A survey in antenatal consultation involves the therapist to detect extragenital diseases in which pregnancy is contraindicated; metrosalpingography and / or hysteroscopy to rule out uterine malformation, intrauterine adhesions, cervical incompetence; Testing of functional diagnostics for evaluating hormonal balance; bacteriological examination of cervical canal content, testing for toxoplasmosis , cytomegalovirus, etc., blood group and Rh factor. Compulsory component of the survey women with a history of miscarriage is to assess the state of health of her husband, including a study of his sperm. If the first stage of the survey are not the causes of miscarriage, a woman sent to a women's clinic specialized classrooms or clinics, where they spend hormonal, medical and genetic research. If the causes of miscarriage still remain unclear, it is necessary to survey the specialized institutions or hospitals, which perform more in-depth study of the endocrine system, immune system and other special studies.

Preventing miscarriage is conducted taking into account the identified causes, such as hormonal disorders hormonal correction is needed, in the presence of foci of chronic infection - their rehabilitation.

The need to address the factors that contribute to spontaneous abortion. During pregnancy, the prevention and treatment of miscarriage are also conducted taking into account the reasons and timing of interruption of previous pregnancies. For women with recurrent pregnancy loss shown early hospitalization (no later than 2 weeks prior to the timing interrupt a previous pregnancy). The complex of therapeutic measures include bed rest, therapy, the use of sedatives (valerian, Leonurus), antispasmodics (No-Spa, papaverine, metatsina, magnesium sulfate and others.). In the I trimester of pregnancy is carried out according to indications hormone therapy (the corpus luteum drugs, human chorionic gonadotropin, mikrofollin, dexamethasone, and others.). In the II trimester when threatened abortion appoint tocolytic drugs (partusisten, brikanil et al.). non-pharmacological agents may be used: electroanalgesia, acupuncture and others.