MISBIRTH (abortus spontaneus; synonym spontaneous abortion) — spontaneous abortion in the first 28 weeks. The fruit which is given rise in this time in most cases is impractical. Abortion after 28 weeks call premature childbirth (see).
Page and. treats main types of obstetric pathology. S.'s reasons and. are genital infantility (see), dysfunction of ovaries, bark of adrenal glands, inflammatory diseases of genitalias, the previous artificial abortions, especially artificial interruption of the first pregnancy, etc. (see. Nevynashivany pregnancies ).
Mechanism C. and. can be various. In some cases at first there are reductions of a uterus, to-rye cause amotio of fetal egg. In other cases reductions of a uterus are preceded by death of fetal egg (at toxicoses pregnant, acute and chronic inf. diseases, etc.) - Sometimes amotio of fetal egg and reduction of a uterus occur at the same time. Occasionally, at so-called cancelled abortion, after death of fetal egg of reduction of a uterus do not arise, the died fetal egg is not expelled from a uterus and is exposed to secondary changes, and amniotic liquid gradually resolves. If the reductions of a uterus arising after death of fetal egg are insufficient for its exile, there is slow amotio of fetal egg, edges can be followed by the long, not plentiful bleeding leading to development of anemia. Such abortion call long. At early durations of gestation cervical abortion is possible. In this case outside pharynx (ostium of the uterus, T.) does not reveal, and completely exfoliated fetal egg falls as a result of reductions of a uterus to the canal of a neck of uterus. Walls of the channel stretch, and the neck of uterus gets a barrel-shaped form. Page and., repeating at the pregnancies (more than 2 times) following one by one, call a usual abortion.
Distinguish early (before the 16th week) and late S. and. Depending on development and expressiveness of symptoms allocate the following stages: the menacing, begun abortion, abortion in the course, incomplete and complete abortion.
At the menacing abortion the heavy feeling or small nagging pains in the bottom of a stomach and in the field of a sacrum (at late abortion there can be pains of skhvatkoobrazny character) is noted. Bloody allocations insignificant or are absent. The neck of uterus is not shortened, the outside pharynx is closed, the tone of a uterus is raised. The size of a uterus corresponds to term pregnancies (see) since amotio of fetal egg happens on the insignificant site.
At the begun abortion colicy pains and bloody allocations are more expressed, than at menacing. Fetal egg exfoliates on the small site therefore the size of a uterus corresponds to duration of gestation. The neck of uterus is kept, its channel is closed or slightly slightly opened. At istmiko-cervical insufficiency (see) the channel of a neck of uterus it is a little expanded therefore pain is less expressed or are absent.
Abortion in the course is characterized by colicy pains in the bottom of a stomach, the expressed bleeding (see. Uterine bleedings ). The channel of a neck of uterus is revealed. Fetal egg is in the channel of a neck of uterus, its lower pole can act in a vagina. Abortion in the course can come to the end with incomplete or complete abortion.
At incomplete abortion when fetal egg is partially expelled from a cavity of the uterus, colicy pains in the bottom of a stomach and bleeding of different intensity are observed. The channel of a neck of uterus passes one finger. Uterus of a softish consistence. Its size is less, than shall be at estimated duration of gestation. In a uterus usually are late fetal membranes (see) and placenta (see).
At complete abortion, to-ry a thicket it is observed in late durations of gestation, fetal egg leaves a cavity of the uterus. The uterus is reduced, bleeding stops.
At a long current of S. and. (beginning, incomplete) penetration of microflora from a vagina in a cavity of the uterus with posleduyu-Shch1Sh development of a horioamnionit, an endometritis is possible (see. Metroendometritis ). The infected (feverish) abortion can become the reason of generalized septic diseases (see. Puerperal diseases ). Depending on extent of distribution inf. process allocate the uncomplicated infected abortion (inf. process is localized in a uterus) complicated infected (inf. process does not go beyond a small pelvis) and septic abortion (process accepts generalized character). Wedge, course of the infected abortion is defined generally by extent of spread of an infection.
S.'s diagnosis and. put on the basis a wedge, pictures, results of ultrasonic investigation, and also hormonal research — determination of levels of excretion chorionic gonadotrophin (see) and estrogen (see).
Treatment of the pregnant women who had in S.'s anamnesis and., it is necessary to begin before emergence klpn. symptoms of abortion. Early hospitalization on a long term is necessary. Treatment shall be pathogenetic. At the expressed hypofunction ovaries (see) since 5 — purpose of Microfollinum is reasonable 6th week of pregnancy, from 8th week add a gestagena (turinal or Gestanonum) to Krom. At low excretion of a chorionic gonadotrophin intramusculary 2 times a week enter 750 — 1000 PIECES of a horiogonin. Hormonal treatment is stopped to 15 — 16th week of pregnancy or after elimination of signs of threat of its interruption.
At dysfunction of bark adrenal glands (see) it is recommended dexamethasone or Prednisolonum, a dose to-rykh select individually depending on the level of excretion of 17 ketosteroids in daily urine.
At istmiko-tservikaljny insufficiency (see) its surgical correction is shown. In the II trimester of pregnancy at a hyperexcitability of a uterus use tokologichesky drugs: Partusistenum, Pre-Par (Ritodrinum), brikanit, etc. In an initiation of treatment appoint intravenous drop administration of drug, and then a tablet or candle before elimination of threat of abortion. Physiotherapeutic methods are effective: electrorelaxation of a uterus, electrophoresis of magnesium, endonasal galvanization, and also acupuncture and psychotherapy.
The issue of therapy of the begun abortion is resolved strictly individually, depending on clinical manifestations. So, at not plentiful bloody allocations treatment is carried out in the same volume, as at the menacing abortion. Appoint also an epsilon - aminocaproic to - that, etamsylate (Dicynonum), Ascorutinum. If the begun abortion is followed by plentiful bloody allocations, then preservation of pregnancy is, as a rule, not reasonable. In such cases the scraping of a uterus is shown.
At the uncomplicated infected abortion removal of the remains of fetal egg against the background of antibacterial therapy is reasonable. The principle of treatment at the complicated infected and septic abortion same, as well as at a puerperal septic infection (see. Puerperal diseases , Sepsis ).
At cancelled abortion long waiting is inexpedient in connection with a possibility of development of dangerous complications (disturbance of system of a hemostasis, infection, development of a horionepitelioma). In the I trimester of pregnancy the died fetal egg is deleted instrumentalno. In later terms use the means stimulating a sokratitelny uterine activity (oxytocin, prostaglandins) according to the schemes applied to initiation of childbirth (see. Childbirth ). After exile of fetal egg make tool inspection of walls of a uterus.
The forecast and Prevention
the Forecast concerning preservation of pregnancy depends on a stage of process. It is more favorable at the menacing abortion.
S.'s prevention and. consists in careful inspection of women out of the period of pregnancy and treatment of the revealed pathology.
Bibliography: Bodyazhina V. I., JI of Gobi of m about in and A. I. and P about z about in with to and y I. S. Usual abortion, M., 1973; To about in t at - N about in and L. G. and B of l at sh t e y N of JI. Ya. Organization of the specialized help at not incubation of pregnancy, Akush. and ginek., No. 5, page 13, 1980; To Osh e l e in and N. G. Prevention of perinatal incidence and mortality, M., 1979, bibliogr.; it, Modern ideas of the reasons of not wearing out of pregnancy, Vopr. okhr. mat. also it is put., t. 24, No. 1, page 65, 1979, bibliogr.; Exchange and endocrine functions of mother and child, under the editorship of V. K. Rymashevsky, etc., M., 1977; Glass R. H. a. G about 1-b u s M. S. Habitual abortion, Fertil. and Steril., v. 29, p. 257, 1978, bibliogr.; Hassold T. J. A cytogenetic study of repeated spontaneous abortions, Amer. J. hum. Genet., v. 32, p. 723, 1980, bibliogr.; Jouppila P. Ultrasonic, clinical, hormonal and histopathological aspects of threatened abortion, in book: Recent advances, in ultrasound diagnosis, ed. by A. Kurjak, p. 175, Amsterdam — Oxford, 1978, bibliogr.
V. M. Sidelnikova.