INTRAUTROBIAL DEATH OF FRUIT

INTRAUTROBIAL DEATH OF FRUIT - fetal death during pregnancy (antenatal death) or during labor (intrapartum death). The main causes of intrauterine fetal death are infectious diseases of the pregnant woman, in which pathogens and toxins are transmitted through the placenta (eg, influenza, typhoid , sepsis), and toxicoses of pregnant women (especially nephropathy and eclampsia) causing fetal hypoxia. Fetal diseases such as decompensated heart disease, hypertension , nephritis , anemia, hypovitaminosis, as well as acute and chronic poisoning (eg, lead, phosphorus, mercury, alcohol), trauma can lead to fetal death. Often, the cause of death of the fetus is the incompatibility of blood of the mother and fetus according to the Rh factor, the ABO system or other blood factors (see Hemolytic disease of the fetus and newborn). The death of the fetus also occurs in the case of severe, incompatible with life vices of its development. During labor, fetal death can occur due to acute hypoxia-fetus due to premature detachment of the placenta, cordation around the neck of the umbilical cord, a true node of the umbilical cord, weakness of labor, etc. Predisposing factors include uterine diseases (eg, endometritis, tumors), incorrect position Uterus, placenta previa , short or long umbilical cord, polyhydramnios or hypochondria, multiple fetuses.

Symptoms of intrauterine fetal death in the first half of pregnancy are cessation of growth of the uterus, inconsistency of its size with the duration of pregnancy, reducing engorgement of the mammary glands. Sometimes there is malaise, a feeling of fatigue, a feeling of heaviness in the stomach. In the second half of pregnancy, in addition to these symptoms, the disappearance of the heartbeat and movement of the fetus in the ultrasound study is characteristic. A sign of the death of the fetus during labor is the cessation of his heartbeat.

If a fetus is suspected of fetal death during pregnancy, the woman should be urgently sent to a hospital. The diagnosis is based on ultrasound and auscultation data, fetal ECG and cardiac monitoring (absence of cardiac complexes). Other methods: X-ray examination of the fetus (characteristic changes in the fetal skeleton), the results of determining the content of hormones in the blood of a pregnant woman (decrease in the concentration of estriol and progesterone) are of subsidiary importance. In the hospital, when the diagnosis is confirmed, the induction is performed with the opening of the fetal bladder, and in the early stages of pregnancy (up to 12 weeks) - instrumental removal of the fetal egg. In connection with the fact that abortion and childbirth with intrauterine fetal death can be accompanied by uterine bleeding caused by a violation of the blood coagulation system, it is necessary to be ready for transfusion of blood products, blood substitutes.

With unrecognized intrauterine fetal death, it is usually spontaneously expelled from the uterine cavity by type of abortion (at the gestational age of up to 28 weeks) or premature delivery (at a period of more than 28 weeks). Fetus, who died and was born after the 28th week of pregnancy, is considered stillborn. The expulsion of the deceased fetus from the uterine cavity usually occurs soon after its death or 2 to 3 weeks later, less often at a later date. In case of delay of the deceased fetus in the uterus, it undergoes a wet decomposition (maceration) or drying (mummification). It is extremely rare in the tissue of a mummified fetus to deposit calcium salts and form a fossilized fruit. With the penetration of pathogens, putrefactive decomposition of the deceased fetus is possible, which in some cases leads to the development of sepsis in a woman.

Prevention includes the timely detection and treatment of complications of pregnancy (toxicosis of pregnant women, rhesus or AVO sensitization due to incompatibility of blood of the mother and fetus according to the Rhesus factor and the ABO system, etc.), adequate nutrition with sufficient vitamins and the correct organization of labor of the pregnant woman. Prevention of intrapartum fetal death is the proper management of labor, prevention of fetal hypoxia, constant monitoring of the fetal heartbeat during labor. If hypoxia occurs in childbirth, it is necessary to urgently carry out medical measures to eliminate it, and in case of their ineffectiveness, timely resolve the issue of operative delivery.