No heartbeat at 7 weeks but still feel pregnant: What are the reasons for a late fetal heartbeat?

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The chest is naughty😤😥

Complain Either it hurts or not ((the 7th obstetric week is already underway, the chest stopped hurting today, but it didn’t blow away … there was nausea for a week, it’s gone today .. but the stomach doesn’t hurt and didn’t hurt and there is no discharge, it pleases .. I’m very afraid what zb 😥 listen to the heartbeat on ultrasound tomorrow.I know that everyone most likely had such a question and there are a lot of posts on this topic.0003 3 14213

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signs, symptoms and causes. How to determine a frozen pregnancy. Clinic Ak. Grishchenko

03/15/2021

Not always long-awaited and such a desired pregnancy ends with the birth of a baby. Sometimes women find out that the pregnancy has stopped. Unfortunately, this problem is not rare. According to statistics, in about 15% of cases, the planned babies “freeze” in the womb for one reason or another.

CONTENT:

• What is it?
• Dangerous timing: when can it happen?
• Why is this happening?
• How do doctors determine missed pregnancy?
• Signs and symptoms
• How to recover from a frozen pregnancy?
• What tests to pass after?
• Answers from experts on whether ST cleanup is required.
• Frequently asked questions for which go to the forum.

What is it?

A dead pregnancy is a pregnancy that initially met all medical standards, but suddenly stopped developing in a certain period. The cessation of progress in the development of the fetus leads to its death, but it remains in the uterine cavity. For this reason, such a pathology is called a failed miscarriage.

In fact, at the very beginning, everything happens, as in a normal pregnancy – the egg is fertilized, enters the uterus and is implanted for further development, but it stops at one moment. This pathology also includes the syndrome of “empty fetal egg”. It is the development of fetal membranes in which there is no embryo. With this syndrome, a pregnancy test is positive, as well as an analysis for hCG.

Dangerous timing: when can it happen?

The development of the fetus can stop at any time up to 28 weeks (in rare cases, the cessation of development can occur later), but the greatest likelihood of such a pathology occurs in the first trimester. There are also several periods with the highest risk of miscarriage, these include the following periods:

• 3-4 weeks;
• 8-10 weeks;
• 16-18 weeks.

It is these terms that most often become critical for pregnancy.

Causes of miscarriage?

Even doctors are not always able to find out exactly why a miscarriage happened. In modern medicine, there are a number of reasons that can cause such a pathology. All of them are divided into several large groups:

• Genetic pathologies . It is these reasons that most often provoke a halt in fetal development. Pathological genes or the presence of an extra chromosome in the embryo can cause the development of many defects that are incompatible with life, leading to termination of pregnancy. Often, genetic pathologies cause a stop in the development of pregnancy in the eighth to tenth week.
• Infections . A missed pregnancy can also often happen due to the presence of infectious diseases, since during the period of bearing a child, a woman experiences a rather serious decline in immune defenses. Especially dangerous for this period are TORCH infections, which include rubella, cytomegalovirus, herpes and toxoplasmosis. The greatest danger to the fetus is the first “meeting” of the mother with the infection in an already pregnant state. Therefore, when registering, pregnant women are strongly recommended to be screened for these types of infections. Even seemingly simple and familiar diseases such as influenza or SARS can cause pathology, especially in the early stages, when vital organs are formed in the fetus. The infection can affect the fetus directly, causing various types of anomalies, or on the membranes, resulting in a significant lack of oxygen or nutrients to the fetus.
• Hormonal disorders . Hormonal balance is extremely important for the normal bearing of a child. Therefore, with a lack of progesterone or an excess of male hormones (androgens), the likelihood of miscarriage significantly increases. Any hormonal disruptions are recommended to be treated before pregnancy.
• Antiphospholipid syndrome . Because of them, the formation of placental vessels or their blockage may also decrease, which leads to a violation of the fetus receiving the necessary nutrition.
• Teratozoospermia . This cause of a missed pregnancy is associated with pathologies in the seminal fluid of a man. With teratozoospermia, spermatozoa have an irregular structure, so fertilization with such a cell leads to abnormalities in the development of the embryo.
• Lifestyle . The presence of bad habits, as well as lifestyle during childbearing (and the planning period) can also adversely affect the development of the embryo, causing it to freeze. The use of alcoholic beverages, smoking, stress, occupational hazards, daily routine, sedentary lifestyle, unbalanced diet – all this is considered negative factors for pregnancy.
• Other factors. Pregnancy fading can also occur due to a sharp change in climate, a history of abortions (especially if there were several).

In some cases, several causes may be found at once, which could lead to a pregnancy fading.

How do doctors determine missed pregnancy?

At each examination of a pregnant woman, the gynecologist determines the size of the uterus, so if they do not correspond to the current period, the specialist may suspect the fetal fading. But such a diagnosis is made only after an ultrasound examination. In rare cases, ultrasound is not performed – if the woman turned to the doctor late and intoxication of the body has already occurred due to the death of the fetus.

Signs and symptoms

The symptoms of miscarriage in any trimester are the same. The main signs that may indicate such a pathology are:

• vaginal discharge with blood impurities;
• general weakness, chills, fever;
• drawing pains in the lower part of the abdomen;
• cessation of swelling and soreness of the mammary glands;
• abrupt disappearance of manifestations of toxicosis;
• absence of fetal movements (with pathology in the second trimester).

Despite the presence of characteristic symptoms of pathology, often the cessation of fetal development goes unnoticed, since the basal temperature can remain within 37 degrees, and the hCG level remains high for several more weeks. In this case, the woman learns about the problem only at the next appointment with the doctor or a planned ultrasound.

How to recover from a missed pregnancy?

If such a pathology occurs, it is imperative to remove the dead embryo from the uterine cavity, if this did not happen naturally. For this, a cleaning is carried out, with the help of which all particles of the fetal membranes are removed from the uterus. Both scraping and vacuum can be used. If the fading occurred at a very early date, doctors may suggest a medical abortion, which is somewhat more gentle for the woman, including psychologically.

Doctors recommend to refrain from the next pregnancy for six months (according to the recommendation of the World Health Organization). This time is enough for the body to recover after what happened. Therefore, during this time, women are advised to take oral contraceptives, which minimize the likelihood of conception, and also allow you to normalize hormonal levels.

During recovery, it is also recommended to lead the most healthy and active lifestyle, take care of a balanced diet and take vitamin complexes. A woman definitely needs psychological support, and if she endured the incident especially hard, she may need the help of specialists – a psychologist or psychiatrist. This will help you get back to normal and prepare for your next pregnancy.

What tests to take after?

Before becoming pregnant after a missed pregnancy, it is necessary to exclude the possibility of a recurrence of what happened. Treatment should be appropriate to the problem that caused the pathology. Therefore, it is extremely important to undergo a complete examination, which will help determine the cause of the fetal development fading. According to the results of the examination, doctors prescribe treatment in accordance with the detected diseases.

It is recommended to undergo an examination after the restoration of the woman’s menstrual cycle (usually it takes about 30 days after cleaning). But both spouses should be tested. The full examination includes:

• genetic testing of spouses;
• tests for TORCH infections;
• hormonal study;
• blood coagulogram;
• Gynecological ultrasound;
• spermogram;
• immunogram.

This examination is usually sufficient to determine the causes of miscarriage, both early and late. The attending physician may prescribe additional studies if necessary. All these examinations can be done at the IVF and infertility treatment clinic of Academician V.I. Grishchenko.

Frozen pregnancy is not a verdict – in 90% of cases, after the occurrence of such a pathology, spouses become happy parents of healthy babies in the near future. The main thing is to undergo a complete examination and eliminate the cause of the pathology. And if necessary, you can go through the procedure of artificial insemination (IVF).

Answers from specialists in the field of reproduction, fertility, women’s health about whether cleaning is mandatory during a missed pregnancy.

On the Internet, the question is often asked: “Is it necessary to do curettage during a missed pregnancy (ZB)?”

We asked this question to our doctors:

Parashchuk Valentin Yuryevich

Head Physician of Academician Grishchenko Clinic, obstetrician-gynecologist, reproductologist.

Good afternoon. If the pregnancy froze at an early stage and there are no signs that it is going to resolve itself, that is, there is no bleeding, then it is advisable to evacuate the contents of the uterine cavity, that is, to do curettage. If the pregnancy seeks to resolve itself, then it can come out on its own. And then curettage is not required, you can just look at the ultrasound as soon as the discharge ends, that there are no inclusions in the uterine cavity, that there are no elements of the fetal egg in the uterine cavity.

Another situation is when the pregnancy has stalled and you really need to evacuate the contents, and then there are alternative methods, sometimes they offer the so-called “medical abortion”, this is the term. And it is more correct to do a scraping, or a vacuum, if the time permits. Because, sometimes, after these very medical abortions, you have to do scraping, but already in fact of complications. Because the entire contents of the uterine cavity does not always come out completely, and then inflammation joins, this is a big trauma for the uterus, this is already a conditionally urgent condition, and it is better not to allow it. Therefore, it is better to do a moderate, without severe injury and without complications, curettage on time than to do it as a necessary measure. When it is already clear that this is a frozen pregnancy, tactics can be discussed, but it is important to really understand when it is, which are such dangerous or alarming calls.

The main complaint is that if the uterus is already frozen and the uterus is trying to get rid of the pregnancy, then this is bloody discharge, that is, the pregnancy is already rejected. But it happens that she freezes and the patient knows absolutely nothing about it, and they become a godsend at a later date, when she is told that the fetal egg does not match in size, that she stopped earlier, and this cannot be suspected in any way. Therefore, if there are pains, pulling pains in the lower abdomen, spotting, you should definitely consult a doctor. Firstly, because it is not a fact that it is frozen. Or maybe it’s a threat of pregnancy fading, and you can turn in time, respond in time, stop the process and save the pregnancy. And if she really froze, then react in time and get rid of the fetal egg that has already stopped in development, without allowing any complications. In any case, if pain or spotting occurs during pregnancy, at any time, this is an indication to consult a doctor. There should be no pain, there should be no blood.

Alipova Elena Konstantinovna

Obstetrician-gynecologist, reproductologist, ultrasound specialist.

The question is unconditional that the miscarriage must be removed from the uterus. That is, non-developing tissues, they are the source of the inflammatory process in the first place, and these tissues should be removed as soon as possible. The best method is still scraping.

As for not deleting at all, this is not even discussed. You can talk a little about medical abortion, but in my opinion, he also has no right to exist with a missed pregnancy. First, because everything needs to be done:

• fast;
• as carefully as possible.

And most the main thing is that scraping products, concept products, as they say now, can be sent in this case for genetic testing . And this, with a frozen pregnancy, is very important because, well, what happened, it happened, and everyone is interested in the question of why it happened. A genetic study of abortive material helps in about 80% of cases to answer the question of what happened after all. If genetics is to blame, this is one conversation, if everything is in order from a genetic point of view, additional examinations will be directed in another direction.

Lutsky Andrey Sergeevich

Obstetrician-gynecologist, reproductologist.

Hello. Today we will talk about missed pregnancy. There are surgical methods, such as curettage, vacuum aspiration and hysteroscopic removal of the ovum, and medical methods, the so-called “medical abortion” . Medical methods of abortion are indicated for women who have already had pregnancies in the past and had natural childbirth. This is due to the fact that the cervix of the uterus in such women is ajar and during induction, artificial induction of uterine contractions, a complete spontaneous abortion occurs, no residues remain in the uterine cavity. If the girl is nulliparous, then medical abortion often gives complications. Not everything comes out of the uterine cavity. Parts of the membranes remain, clots, and, let’s say, a delay of these parts occurs and there may be an inflammatory process, as a result of which, subsequently, surgical intervention is required – curettage or vacuum aspiration. The method of terminating a missed pregnancy is chosen by the attending physician based on these data. In our clinic, we often encounter missed pregnancy in those women who want to give birth to their child. And to understand the genetics of the fetus, we often recommend hysteroscopic removal or vacuum aspiration of the ovum.

Yuliya Vladimirovna Labuznaya

Obstetrician-gynecologist of the department of operative gynecology, doctor of the cervical pathology office

Hello. Today I will try to answer the most frequently asked questions regarding non-developing pregnancy. Perhaps I’ll start with such a rink: “Is it necessary to do vacuum aspiration of the contents of the uterine cavity, that is, the evacuation of a missed pregnancy, if a non-developing pregnancy is diagnosed?” And so let’s deal with the concept. Non-developing pregnancy is such a pathological condition in which pregnancy fades, but spontaneous expulsion from the uterine cavity does not occur. At the same time, the woman herself does not immediately understand what happened to her. The first signs of a missed pregnancy can appear 2-3 weeks after the incident. The fetal egg, which is located in the uterine cavity, undergoes various pathological changes, adversely affecting the endometrium, thereby causing an inflammatory process called “endometritis”.

If a woman decides to wait for the spontaneous expulsion of a missed pregnancy from the uterine cavity, what happens? The endometrium tries to reject the frozen fetal egg, but the inflammatory processes taking place in this endometrium slow down this process, and the process can last from several days to several weeks. Which absolutely negatively affects the endometrium and contributes to the development of the inflammatory process further. There is an act that the fetal egg from the uterine cavity, as it were, came out, but not completely. There is a part of him left. From this part, often, a placental polyp is formed. The presence of a placental polyp in the uterine cavity contributes to the prevention of a subsequent pregnancy. Before the onset, planning a subsequent pregnancy, such a pali must be removed. In addition, the presence of a fetal egg in the uterine cavity for four weeks or more significantly increases the risk of bleeding. Therefore, the best solution to such an issue, in the presence of a missed pregnancy in a patient, is vacuum aspiration of the contents of the uterine cavity with the appointment of subsequent anti-inflammatory therapy.

The second issue is errors in the diagnosis of non-developing pregnancy. For example, at 5-6 weeks, an ultrasound examination, in order to avoid such errors, is carried out by at least two specialists. If there are no clear criteria for non-developing pregnancy, it is recommended for the patient to repeat this study after 3-7 days. Again, to avoid mistakes. In addition, in parallel, the task of such an analysis as an analysis of human chorionic gonadotropin in the blood is mandatory. If the pregnancy develops, the hCG will increase accordingly, if the pregnancy is still frozen, then the hCG will either fall or not grow at all. If the gestational age is 7-8 weeks, then according to the ultrasound examination, the heart rate of the embryo will be absent. In addition, there will be a discrepancy between the size of the fetal egg and the gestational age. At gestational age 9-12 weeks, in addition to the lack of heart rate and the discrepancy between the gestational age and the size of the fetal egg, there will also be no movement of the embryo. It should always be remembered that every woman has the right to take a closer look at the ultrasound in a few days for an accurate diagnosis, to control the human chorionic gonadotropin, in fact, in order to avoid errors in the diagnosis of “non-developing pregnancy”.

Answers to frequently asked and discussed questions on the forums:

✅ Can an ultrasound erroneously show a miscarriage?

Misdiagnosis of “non-developing pregnancy” occurs in the early stages. In our clinic, in order to avoid such errors, ultrasound at 5-6 weeks is performed by at least two specialists. If there are no clear criteria for non-developing pregnancy, then the patient is recommended to do a second study after 3-7 days. And on re-examination, it may turn out that the frozen pregnancy turned out to be normal.

✅ With a missed pregnancy, is it possible to do without cleaning?

If a frozen pregnancy tends to resolve itself, then it can come out on its own, and then curettage (cleansing) is not required. As soon as the discharge ends, it is necessary to check on an ultrasound scan that there are no elements of the ovum left in the uterine cavity. If the pregnancy froze at an early stage and there are no signs that it is going to resolve itself, that is, there is no bleeding, then it is advisable to do a curettage.

✅ Frozen pregnancy – cleaning or pills?

Medical abortions are indicated for women who have had previous pregnancies and vaginal deliveries. But it is more correct to do a scraping, or a vacuum, if the time permits. Because, sometimes, after medical abortions, you also have to do scraping, but already in fact of complications. Because the contents of the uterine cavity do not always come out completely, and inflammation is added, and this is a big trauma for the uterus and it is better not to allow this. Therefore, it is better to do a moderate, without severe injury and without complications, curettage on time than to do it as a necessary measure. And most importantly, scraping products can be sent for genetic testing to identify the causes of fetal development fading.

✅ Can there be a miscarriage without symptoms?

It happens that the pregnancy stops, and the patient knows absolutely nothing about it, and this is discovered at a later date, when she is told that the fetal egg does not correspond in size, that the pregnancy stopped earlier, but this, unfortunately, it is impossible to suspect in advance.