Regressive pregnancy: definition, symptoms, causes, complications, consequences and treatment

2024 Author: Priscilla Miln | [email protected]. Last modified: 2023-12-16 00:21

Pregnancy regresses. In medicine, this means that the intrauterine development of the fetus stops. A pathological condition when the fetus dies inside the woman, but placental abruption does not occur, as well as miscarriage. This condition is extremely dangerous for a woman's he alth. If such a situation occurs, then medical intervention is urgently required.

Medical terminology

Today, more and more often you can hear from the lips of representatives of medicine or notice entries in the case history of "regressive pregnancy." This is nothing more than an undeveloped or missed pregnancy.

Regressive pregnancy according to ICD-10 is indicated by the gynecologist in the patient's medical history, in connection with the accepted international classification of diseases of the 10th revision for coding diseases and pathological processes.

Another name for the pathology is a missed miscarriage, which reflects the picture most clearly.

Regressive codepregnancies according to ICD-10 should be indicated as follows:

• O02.0 Dead gestational sac and non-blistering mole.
• O02.1 Missed miscarriage. Early fetal death with uterine retention.

Statistics

According to official statistics, the frequency of regressive pregnancy is up to 20% of the total. In other words, one in five pregnant women experience regression.

Out of all reported early miscarriages up to 12 weeks, the number of regressions varies from 45 to 85%.

Regressive corpus luteum

Ovulation is a complex process. The eggs mature in round body formations, they are called follicles. Their number was determined during the prenatal development of the girl.

Each month, up to 10 bubbles develop, among which only one reaches the desired size, it is called the dominant follicle. Regressing bubbles begin to shrink.

What happens after ovulation?

After ovulation is complete, the follicle transforms into a corpus luteum. The released egg forms the corpus luteum in the ovary.

This formation develops in several stages, and the absence of pregnancy means that this corpus luteum regressing in the ovary can no longer be determined.

Or vice versa, after conception, the corpus luteum persists for a long time. After all, its main task in the body of a woman is hormonal support for pregnancy. And then the function of regressing yellowbody ends. However, it accompanies the formation of the fetus until 12-14 weeks of development, while the placenta is being formed. And only then, after this period, when the placenta takes over its functions, it will no longer be possible to determine the regressing corpus luteum on ultrasound.

In the case of a failed miscarriage, the fetus dies due to insufficient production of progesterone, the main hormone of pregnancy. In this case, the regressing corpus luteum is no longer able to support the current pregnancy.

Reason for regressions

Unfortunately, it is not possible to find out the root cause of intrauterine death of the fetus every time. Quite often, too many influencing factors are to blame for the current situation. It is possible to announce the suggestive cause, but only after a thorough gynecological examination and tests.

The following are the main prerequisites that can affect the cessation of fetal development.

Genetic anomalies

Genetic inheritance is the most common cause that provokes regression in the early stages. In the event of a breakdown of the genetic material, the embryo dies within a period of up to eight weeks. By this time, the main organs of the embryo begin to form, soft tissues are formed. Changes in the chromosome set always have a negative impact on development, including the cause of fetal death. As crude as it may sound, early regression is natural selection. Since anomalies that develop up to eight weeks are usually incompatible with life. In this way, nature gets rid ofnon-viable fetus.

Deviation in the genetic code of the embryo can be an accident, or it can be inherited from parents. The first option speaks of a failure so far unknown to science at the stage of embryonic cell division, which provokes the development of defects. Factors that influence the occurrence of defects:

• contact of a pregnant woman with probably unsafe elements for the fetus;
• ionizing radiation;
• polluted environment;
• taking certain types of pharmaceutical drugs (teratogens).

All of these factors affect only once, that is, the fetus dies only within the current pregnancy. A woman in the future has every chance to safely endure and give birth to a baby without complications and developmental disabilities.

The other side is taken by the situation if the genetic anomaly is inherited from mom or dad. Such a combination of circumstances initially lays an inferior genetic code in the embryo. In the presence of genetic pathologies, the threat of resumption of regressions or changes in the number of chromosomes in a born child increases in the future. The couple is recommended genetic counseling.

Pathology of hemostasis

System defect is more common after 12 weeks. Pathological defect of the blood coagulation system can be congenital and acquired. The carriage of thrombophilia genes provokes the formation of microthrombi in the area of attachment of the fetal egg to the uterine membrane. In this case, the embryo is not able to join, and theits nutrition, which, in turn, leads to the death of the fetus. It is possible to determine violations in the work of hemostasis. To do this, you need to pass an analysis for a hemostasiogram in advance.

Fortunately, not all genetic abnormalities can cause fetal death. However, the chance of miscarriage increases if:

• the patient has vascular diseases (if they are not diagnosed, this does not mean they are absent);
• future mother smoking.

In some situations, women will never know about the presence of hemostasis pathology in their lives, because they easily carry more than one pregnancy.

Infections

Affect the fetus for a period of six to nine weeks. The following infections pose the highest threat to the life of the embryo:

• chlamydia;
• rubella;
• toxoplasmosis;
• cytomegalovirus infection (CMV);
• herpes.

Some number of infectious agents may be present in the body of the fairer sex for a long time before conception and even throughout life. In this case, the infection is not as serious as the viruses that first entered the mother's body during the period of bearing a child. However, exacerbation of a chronic disease can also lead to poor outcomes.

Diseases of the pelvic organs

They also pose a danger to the life of the fetus and the expectant mother. Inflammatory processes of the pelvic organs can provoke regression, for example, endometritis.

Thisthe pathological condition causes damage to the endometrium of the uterus. In the case of an extensive lesion, the fertilized egg is not able to find a place for attachment, but still penetrates into the inflamed mucosa. Lack of proper nutrition of the embryo leads to its understandable death. Interestingly, the risk of developing endometritis and subsequent regression is increased by abortion or miscarriage.

Hormonal disorders

Affects the fetus for the most part for up to 12 weeks. From the statistical data, it was confirmed that during a regressing pregnancy, a violation of progesterone metabolism occurs. Lack of the hormone leads to changes in the endometrium. As a result, the process of attaching the egg to the wall of the uterus is disrupted and the embryo receives less nutrition. Such a combination of circumstances leads to the death of the fetus.

A significant role in the progression of pathology has a deficiency of thyroid hormones or their excess, which also leads to the death of the fetus. Elevated levels of male androgen hormones also provoke a disappointing end.

Autoimmune diseases

Become the root cause of missed pregnancy at any time. The condition in which hostile antibodies form is called an autoimmune disease.

Antibodies act on a person's own cells, destroying them and blocking the normal functioning of body functions. They are able to cross the placenta and affect the life of the fetus.

Anatomical anomalies

Provoke a stop in the development of pregnancyfor a period of 6 to 12 weeks. The exclusive cause of a regressive pregnancy is a malformation of the uterus, which provokes an arbitrary miscarriage.

Symptomatics

Stopping fetal development can happen at any time. However, 85% of reported regressions occur before 12 weeks. In the second and third trimesters of pregnancy, the possibility of regression drops significantly.

Symptoms or signs of miscarriage have their own distinctive characteristics.

The first changes that happen to a woman when regression occurs is the disappearance of absolutely all indicators of pregnancy: nausea subsides, vomiting disappears, breasts shrink and become soft to the touch. However, emotional surges and a breakdown accompany a woman for a long time.

In the later stages of gestation, when the baby is already actively moving, there is a lull. The fetus stops moving for a while. Unfortunately, in the period from the 16th to the 28th week, the movements of the fetus are not so strong and distinct. For this reason, a woman is not always able to detect alarming signals in a timely manner and rush for help. When a dead fetus is in the uterus for more than four weeks, the woman experiences symptoms:

• dizziness;
• fever;
• failure.

As described above, external changes in the mammary glands occur on the fourth day. Distinctive signs appear only in cases of regression in the early stages. A failed miscarriageperiod after 24 weeks is characterized by the release of colostrum.

Another characteristic feature that indicates regression is bloody discharge from the vagina, accompanied by pulling pain in the lower abdomen, as during menstruation.

Discharge starts 2-4 weeks after the actual regression, may be heavy or slight. The volume of blood loss depends on the process and duration of pregnancy. The woman's body seeks to independently free itself from the fragments of the deceased fetus. But the pathology of regression does not allow the body to produce a complete detachment of the placenta. What is dangerous is heavy bleeding, which can only be stopped in the hospital. The most unfavorable outcome of ignoring medical care is infection and sepsis.

Diagnosis

If a woman has doubts and suspicions of a missed pregnancy, you should immediately contact a gynecologist. After a thorough examination, the doctor will make a diagnosis and explain further actions to the patient.

A gynecologist, when examining a patient on a gynecological chair, focuses on the volume of the uterus. If it is reduced, then the organ does not correspond to the expected gestational age.

Laboratory studies

Laboratory tests are able to confirm or exclude the diagnosis of regressing pregnancy:

• Blood for HCG. Hormone analysis reflects the course of pregnancy. With regression, the content of hCG is approximately five times underestimated. Normally, the hormone begins to be produced already bythe expiration of a day after the fixation of the fertilized egg to the walls of the uterus.
• Blood for progesterone. Determining the concentration of progesterone in the patient's blood makes sense only if the study during pregnancy was performed repeatedly. Since progesterone during regression falls slightly, by about 1.5 times, but still continues to remain at a high level.

• AFP. Diagnosis of AFP plays a significant role in the case of missed pregnancy after 12 weeks. Three days after the death of the fetus, the highest concentration of blood levels is diagnosed.
• Ultrasound diagnostics (ultrasound). Today it is one of the high-precision methods for diagnosing regressive pregnancy. Timely ultrasound allows you to fix the dead fetus long before the appearance of the clinical picture.

In case of regression based on the results of ultrasound, the following results are likely for up to 12 weeks:

• germ not defined;
• The volume of the ovum does not correspond to the gestational age.

After 12 weeks of regression, the following features are confirmed:

• deviation from the norm of the size of the fetus in accordance with the term;
• deformation of the fetal head;
• absence of middle structures of brain tissue;
• distortion of the spine.

At any time, the death of the fetus is indicated by the absence of a heartbeat. This characteristic feature most accurately makes it possible to diagnose regression.

Complications

Missed pregnancy can always provoke heavy bleeding, threatening the he alth and life of a woman. If you find any, even minor bloody discharge from the vagina during pregnancy, it is advisable to seek medical help as soon as possible to identify the cause of this condition - visit a gynecologist or call an ambulance.

Prolonged presence of a dead fetus inside a woman causes infection. In the future, the inflammatory process is able to move to the organs of the small pelvis and peritoneum. A failed miscarriage, without prompt medical attention, can lead to sepsis and death.

Treatment

When pregnancy regresses, it means that the independent exit of the ovum is minimized. Despite the death of the fetus, the female body is in no hurry to get rid of it. To avoid consequences for he alth and life, if the death of the fetus is suspected or diagnosed, a woman must be hospitalized in a gynecological hospital. The task of physicians is to free the woman's body from fragments of the dead fetal egg and reduce the risk of complications. The method of treatment always depends on the period at which the regression occurred.

I trimester

In the early stages, surgery is always used. Constructive treatment for this pathology is ineffective.

Until 16 weeks, the dead fetus is evacuated from the woman's uterus. The operation is performed under general or local anesthesia.

After the removal is completedof the fetal egg, the uterine cavity is scraped. The material obtained during curettage is sent for histological examination. In certain cases, the operating doctor offers to conduct a genetic study of the material. When is this study recommended:

• regress early;
• not the first time;
• hereditary genetic disorders of one or both parents.

Then, having completed all the cleaning manipulations, the woman is given a control ultrasound to exclude fragments of the fetal egg in the uterine cavity.

II/III trimester

After 16 weeks, when diagnosing a missed pregnancy, two methods of treatment are used:

• intra-amniotic administration of substances (sodium chloride or prostaglandins);
• use of prostaglandins in conjunction with antiprogestogens.

The selection of one or another method is made as a result of the peculiarities of the process.

Consequences

After going through a regressive pregnancy, it is rare for a woman not to experience he alth consequences. Problems that bother many:

• The main difficulty that awaits a woman after cleansing and treatment is an inflammatory process in the uterine cavity. Often, inflammation develops into chronic endometritis. The condition is characterized by spotting bleeding independent of the cycle. It is possible that the discharge is accompanied by pelvic pain. This condition greatly complicates life and becomes a prerequisite for poor he alth.in the future.
• Irregularities in the menstrual cycle and hormonal disorders are another unpleasant consequence of a miscarriage. Sudden jumps in hormone levels lead to the fact that the body is not able to recover on its own, and defective ovarian function causes infertility.

Rehab

To reduce the likelihood of infection and endometritis after curettage or other methods of removing fetal debris, antibiotics are prescribed for a course of five to seven days, as antibacterial therapy.

Immediately after a regression, a woman needs to start using COCs (combined oral contraceptives) for a period of at least three months to restore the undermined hormonal levels and exclude early, undesirable for a depleted body, pregnancy.

General tips for a speedy recovery:

• Good rest and he althy sleep.
• Food containing fruits and vegetables.
• Rejection of bad habits.
• Moderate activity such as walking.
• Current intake of vitamin-mineral complexes.

If the situation requires it, the woman and her partner are advised to seek professional advice from a geneticist and endocrinologist before planning a subsequent pregnancy.