Mertvorozhdennosti

Stillborn is one of the fruit, which after birth or extraction from its mother's body has not made a single breath (regardless of the presence or absence of heartbeat or other signs of life). The concept of dead birth refers to the fruit born of the pregnancy for at least 28 weeks, length not less than 35 cm and weighing not less than 1000, the Birth of a fetus before the deadline, regardless showed whether it after birth signs of life or not (including breathing), is considered a miscarriage. Mertvorozhdennosti with premature childbirth occurs many times more than urgent. Mertvorozhdennosti can be antenatal when the fetus dies during pregnancy-from 28 weeks before the birth (see Fetal death), and intrapartum - when fetal death in childbirth (see Asphyxia). Mertvorozhdennosti can be caused by various diseases, pregnancy, including infectious diseases and pathology of pregnancy (see Toxicosis of pregnancyand childbirth, abnormalities of the fetus, placenta and other
Prevention of stillbirths lies largely in the health protection of women, especially during pregnancy (see Antenatal care of the fetus) and in the careful maintenance of normal and pathologically flowing delivery.

Mertvorozhdennosti - born after 28 weeks of intrauterine fetal life in length not less than 35 cm and weighing less than 1000 g, not made by birth a single breath. Stillborn are also children born with heart, but has not made a single breath, in spite of the measures of revival (fruit born of asphyxia and inanimate).
There are antenatal and intrapartum death of the fetus. To antenatal victims include fruits, fetal death which occurred in the period from 28 weeks before the birth. Intrapartum is the death of the fetus that occurred during the act of delivery.
Causes of dead birth diverse and not yet fully studied. Mertvorozhdennosti cause pathological processes occurring in the organism of the mother, the fetus and in the fertilized egg.
The pathology of the fetus and changes in the placenta is largely dependent on the mother's diseases, complications of pregnancy and childbirth.
In the pathogenesis of ante - and intrapartum fetal death plays a major role asphyxia (see), which may occur when the most varied diseases of the mother and the complications of pregnancy and childbirth. Have the value of infection (acute - flu, fever, pneumonia and other; chronic malaria, syphilis), intoxication (poisoning, toxicosis of pregnancy), hyperthermia, and other pathological during childbirth essential violations of cerebral circulation of the fetus and the so-called intracranial birth trauma.
Especially dangerous is the combination of asphyxia and birth trauma.
Etiology. In the antenatal period, the fetus may die due to infectious (viral) and severe systemic diseases of the mother (heart disease, hypertensive disease, nephropathy, diabetes and others), toxicosis second half of pregnancy, immunological incompatibility between the mother and the fetus, and also due to malformations of the foetus, placenta and umbilical cord, placenta previa, antenatal derogation waters and other pathological processes (see Fetal death).
Among the reasons of intrapartum fetal death essential complications of childbirth with a narrow pelvis, anomalies labour forces, incorrect positions (transversal, oblique) and various deviations from the normal mechanism of birth (incorrect insertion of the head, complications of childbirth in the pelvic presentation and some pathological processes). The death of the fetus during labor often comes with placenta previa, uterine rupture, eclampsia and other
Postmortem diagnosis. At antenatal death in 90% of cases there maceration of the skin. Because maceration occurs and live births (although very rare and limited areas), a sign of dead birth is only expressed maceration. Placenta following the termination of fetal and preservation of maternal circulation becomes anemic due to the strangulation of vessels Vorsin.
The most frequent causes of death of the fetus are: intrauterine asphyxia, caused by an abnormality of the placenta (her premature detachment, development defects, large heart attacks, blood clots, hemangioma), the umbilical cord (true nodes, twisting, korotkoi); diseases of the mother, accompanied by anoxemia; rarely - infectious diseases of the fetus (intrauterine pneumonia in early derogation waters, listeriosis); malformation of the foetus or proceeding without jaundice hemolytic disease. Great diagnostic value are negative hydrostatic tests (see Severodonecke). Lungs of the fetus usually fleshy and are drawn to the root, less often they are completely straightened, but contain no air, and amniotic fluid.
When intrapartum death maceration of the fetus and ischemia of the placenta is usually absent. Hydrostatic tests negative, but at carrying out of artificial breath can be positive. The most frequent causes of death are: asphyxia, birth trauma of cranial (breaks cerebellar nameta, sickle-shaped ridge, subdural hemorrhage, rarely a skull fracture) abnormal situation and the presentation of the fetus, early discharge of water, the mismatch between the size of the head of the foetus and the pelvis mother; rapid delivery. Rarely observed birth trauma of the spine (its stretch with EPI-, intra - or subdural or subarachnoid hemorrhages, rarely with hematomyelia or breaks), often with traction fruit for pelvic end. Trauma premature fetus possible and normal birth. Asphyxia occurs due presentation or placental abruption, entanglement, utoobasaurus, tension, pressure or loss of the umbilical cord, early ruptured membranes, long labor.
The presence of hyaline membranes (see), as a rule, excludes mertvorozhdennosti.
X-ray diagnostics of dead birth has mainly forensic interest during the autopsy of the newborn. Previously sectional recognition of dead birth was based on the absence of signs extrauterine breathing, i.e. in the absence of vozduhonosnye lungs. Initial hopes of researchers at the possibility of judgments of the dead birth the fetus only by x-ray picture of his airless lungs were not justified, as in forensic practice known cases of the complete besposchadnoe lung undoubtedly live births who has lived for several hours. However, x-ray examination of the corpse of a newborn with great precision data confirms pulmonary hydrostatic (swimming) of the sample and in this respect is the value of the objective control method. But x-ray diagnosis of the state alone Airways could not always be sufficient to answer the question, the child was born dead or alive, when his lungs were completely empty. Therefore, x-ray analysis in the study of corpses still-born and children who died from asphyxia, should be to study all of the corpse; special attention should be paid to the cardiovascular system. Many stillborn in the cavities of the heart and large vessels there is gas. This feature allows you to confirm your mertvorozhdennosti fruit with the highest credibility. The section of these gas concentrations usually not open. If the presence of large gas bubble in the heart sectional discover possible if the autopsy of the corpse of a newborn under water (which usually is not done, because there is no advance directives), set this way gases in containers impossible; radiographically they are detected without any problems (Fig., 1-4).


X-ray diagnostics of dead birth: 1 - the bell-shaped form of the chest stillborn fetus; 2 - gas cavities of the heart and blood vessels from stillborn fetus in the presence of gas in the stomach (front projection); 3 - the same case in the lateral projection; 4 - rotten decomposition of the corpse stillborn two weeks after childbirth: a large concentration of putrefactive gases in the subcutaneous tissue and in the cardiovascular system, in the absence of the lungs; stomach -
a relatively small gas bubble.

Prevention of dead birth. Pregnant prescribe a diet that is compatible with her condition and pregnancy. There shall be thorough examination of the pregnant woman, including serological (Wasserman, the definition rhesus factor, identification of toxoplasmosis). At detection of the disease - timely remedial measures, prior hospitalization of pregnant women with incorrect position of the fetus, pelvic presentation, multiple pregnancy, polyhydramnios, with RH-negative factor in the blood.