Premature termination of pregnancy. Diagnostics.

The method of examination of women suffering from miscarriage is complex and depends on a number of circumstances: a woman is examined during pregnancy or before her, first-pregnancy in case of threat of abortion or women with habitual miscarriage. The scope of the examination also depends on the nature of the underlying disease, against which the pregnancy is interrupted.

Carefully collected anamnesis suggests the cause of miscarriage. Clarifying the complaints of patients, it turns out the presence of occupational hazards, household factors, diseases in childhood, adolescence and adulthood, extragenital and gynecological pathology complicating hereditary factors. Obvious violations of the ovarian-menstrual function.

With an external examination pay attention to the physique of a woman, height, determine the weight. It is believed that miscarriage occurs more often in women with a disbalance in the structure of the body (infantile, asthenic, intersexual body type), obese, with a male type of hair.


Study of the endocrine function of the yellow body and placenta



The severity of the clinical symptoms of miscarriage in the course of a complete and incomplete spontaneous abortion excludes the need for an additional laboratory examination. Diagnosis of reverse development (in the case of rational treatment) of the condition requires mandatory hormonal studies: determination in the body of the hormones content of the fetoplacental complex, as well as some hormones, to be produced by the endocrine organs of a woman. More predictive value is the definition of chorionic gonadotropin, progesterone, estrogens, namely estradiol and estriol, placental lactogen, level 17-CS.

More stable and less informative is the use of functional diagnostic tests for examining women with miscarriage. A stable or periodic reduction in basal temperature to 37 ° C or lower is an objective symptom of a threatening miscarriage. Important in the problem of spontaneous abortion is also the definition of the cellular composition of the vaginal swab, the change in the pattern of which is most often associated with a decrease in the production of progesterone or with a change in the ratio between progesterone and estrogens. The normal course of pregnancy is characterized by: "gestagenic" type of smear, which is characterized by the predominance of the vaginal epithelial cells, which have the form of the umboscapodus and are located in layers; low values ​​of karyopicnotic and eosinophilic indices.


Definition of contractile activity of the uterus



Increase in contractile activity of the uterus - a characteristic symptom of threatening premature birth. It is determined by palpation of the uterus, tomography, hysterography and tonicity. In each case separately, it is important to establish excessive generic activities.

Due to the fact that the hardware registration of uterine contractions makes it possible to identify early stages of the threat of abortion much earlier than the subjective sensations of a pregnant woman, women with a high risk of miscarriage should record the contractile activity of the uterus in a woman's consultation. If there are 4 or more uterine contractions lasting 40-50 s or more for 1 hour, the hospitalization of the pregnant woman in the hospital is indicated, which allows, due to timely treatment, 85% of women to prevent premature birth. The presence of 3-5 or more fights in 10 minutes, with a smoothed neck, opening at 2-3 cm indicates a rapid flow of premature birth.

Fetal status is studied by listening to his heartbeat, Ultrasound with biophysical profile estimation, dopplerometry, determination of the content of hormones in the serum of the fetoplacental complex.

When performing CTG, abstain from stress tests (oxytocin, cold, "step-test", etc.). Usually CTG is performed once a week, with combined pathology more often. During delivery, KTG indicators are monitored continuously. Symptoms of hypoxia according to CTG data are the same, for both premature and full term fetuses.

Determination of the maturity of the lungs of the premature fetus is indicated in cases of resolution of the issue of delivery by Caesarean section in case of premature pregnancy, or prolongation of pregnancy with premature discharge of water in its III trimester and the need for prevention of the syndrome of respiratory distress of the fetus. The simplest and most widely used method for determining the degree of maturity of the fetal lungs is Clemence's foam ethanol test.

With ultrasound, the signs of a threat of termination of pregnancy are: a decrease in the ratio of the length of the cervix to its diameter at the level of the internal pharynx, an increase in the size of the cervical canal in the region of the internal pharynx, thinning of the anterior wall of the uterus in its lower segment, wedging of the fetal bladder in the cervical canal, and determination of the increased tone of the myometrium. Ultrasound can also assess the degree of maturity of the fetal lung tissue.