Non-developing pregnancy (missed miscarriage and delayed delivery) (Missed abortion, Missed labour)

Missed miscarriage is a condition in which the fertilized egg dies already in the relatively early stages of pregnancy, but the expulsion its still not the case, despite the bleeding started pointing to a miscarriage. This delayed the egg is called blood skidding; it is a dense voluminous education, consisting of blood layers surrounding the dead and decaying embryo or fetus.
When the delay blood drift in the uterus for a longer time, the blood clots are organized, will uplotnaet, discolored, get on the cut meat. This form is called fleshy drift.
Dead fertilized egg can remain in the uterus for several months, sometimes even years. If the former, the authors categorically denied the possibility of long delays of the ovum in the uterus, modern authors hold the opposite point of view.
Speaking about the changes of the ovum delayed in the uterine cavity, we can not ignore the issue of embryo (the fetus), which is subject to various transformations.
When miscarriages of earlier periods (up to 2 months) germ can dissolve. What happens, is still uncertain.
Later the fruit is exposed, depending on the presence or absence of uterus bacteria or maceration process, or ihorozny disintegration.
During this time, the coverings of the fetus imbibers, and then comes the autolysis. Amniotic fluid due to hemolysis get bloody color, the umbilical cord brown, the color of the skin becomes red - foetus sanguinolentus.
Much less for missed miscarriage occurs mummification of the fetus. In this case, the fluid is absorbed, the fruit shrinks and dries up, his skin is closely adjacent to the backbone, the torso is sealed.
This process is most often observed on fruits older than 3 months.
Even more rarely observed the skeletization, i.e. the collapse of the soft parts with the exposure of the bone that occurs without access bacteria.
In a few cases there petrified the fetus (litopaedion) with salt deposition in the tissues and shells of the eggs (kelyhopaedion).
With identical twins, one of the victims of the fruit can be flattening (foetus compressus) due to the second, properly developing fetus, and eventually becomes thin, transparent, developing into the so-called paper fruit - foetus papyraceus (Fig. 44).

Fig. 44. Paper fetus.

The reasons of death of the ovum is very diverse and not always amenable to clarify.
In the basis of long delays dead ovum in the uterus is the reduction of reflex activity, caused by violations by receptor apparatus of the uterus, and disorders of the functional state of the Central nervous system (cortex and subcortical centers), in close connection with which the state of hormonal balance (qualitative and quantitative). The result is that there is a decrease in the level of estrogen, pituitrin, acetylcholine and increased levels of progesterone.
Because follikulina is stimulator of acetylcholine, it is used for the purpose of initiating contractile activity of the uterus. For successful action you want to apply a relatively large dose (6000 up to 30 000 ME), and the smaller the period of pregnancy, the greater should be the dose, and Vice versa. Instead follikulina can be applied sinestrol. Confirmation of the correctness of such opinion is that such application of this method is that in some cases quite successful.
Microscopic examination of the placenta in cases of failed abortion always marked changes, in particular hyaline rebirth of the villi and the obliteration of their blood vessels. According to some authors (N. N. Chukalov), these changes occur in vivo and gradually, and the fertilized egg dies due to cessation of inflow of nutrient material. Other authors, such as efficiency UNESCO-Stroganov, consider these changes as post-mortem.
Along with necrotic, sometimes there are small areas of unchanged villi, which in the long-dead fetus penetrate deeply into the uterine wall. Removal of such plots placenta difficult.
Missed miscarriage 80% observed in nagaragawa (, A. Bulatov). The origin of such diseases in avtomobilnyh women have the value of morphological changes in tissues of the uterus, in particular the increased growth of connective tissue, on the soil of inflammatory and traumatic injuries, intoxications, etc., Have pervoverhovnyh missed miscarriage occurs when congenital hypoplasia of the uterus.
Missed miscarriage occurs suddenly. A woman who has observed a clear progression of pregnancy, and there were inherent in the latest sensation, said that they suddenly disappeared.
Objective research reveals the absence of pre-existing symptoms of pregnancy. In such cases, the woman is installed surveillance.
For missed miscarriage, in contrast to the cystic skid, the discrepancy between the period of delay your period and the value of the uterus is expressed in the lag values of the uterus from the expected life of pregnancy (for the duration of the delay of menstruation). This is the main symptom of the disease. In the future, the size of the uterus become increasingly reduced.
Due to the amniotic fluid intake and termination of hyperemia and serous soaking tissues of the uterus, normal when ongoing pregnancy, changes the consistency of the uterus, it becomes more tightly.
Bleeding and abdominal pain and lower back usually appear when the detachment of the ovum, more frequent dirty selection (sometimes with rotting smell), alternating with minor krovoisliania. The rise in body temperature is usually not observed. With the death of eggs pregnant woman notes the termination of bloating mammary glands and the disappearance of the usual signs of pregnancy. The status of women are oppressed, she was worried headache, she feels unwell and fatigue, aversion to meat because of overload of the body protein intake (R. P. Makarov). Sooner or later, dead fertilized egg is expelled from the uterus, and self-exile it is usually closer to the end of a normal pregnancy.

Failed delivery (missed labour) are very rare. In the world literature in recent years published only a few cases of prolonged delay in the uterine cavity brought dead fetus. There is no doubt that the number of cases missed labour much more than is published in press.
Delay the onset of birth dead fetus in the period depends, apparently, from a sharp reduction in the excitability of the uterus caused by razvijenosti in the work of the Central (bark and cortex) and peripheral (lying in the womb) neural and neuro-hormonal mechanisms and functional state conducting the nerve pathways, as was proven by G. M. the Lisovskaya using methods elektrogitara - and electroencephalography.
The death of the fetus depends on degenerative changes in the placenta, resulting in this body gradually loses its ability to deliver the fetus of oxygen and nutrients. Fetal loss depends also on the intoxication of his body with carbon dioxide and decay products due to disorders of blood circulation in overripe and degenerated placenta.
The dead fetus can be trapped in the uterus for a long time - a Jot a few weeks to several years. In the case described E. 3. Rabinovich, the fetus was in the womb 15 years, in case Kamerarius - 46 years (detected at autopsy old woman 96 years).
Treatment. For missed miscarriage recommended expectant way. Active intervention should be used only under special conditions (heavy bleeding, pain, fever, and others); deterioration of the General condition of the pregnant also serves as an indication for urgent evacuation of the uterus. The patient needs to clarify the nature of the disease and to lead her systematic observation. Manipulation tools in the uterus should be done with great caution, because in this case the uterus can be easily perforated (similar cases reported in the literature) or comes profuse bleeding, which is often the cause of death of the patient.
Only when delayed pregnancy later time (missed labour) to excite activity of the uterus in some cases it is appropriate assignment follikulina, pituitrin, quinine, hot vaginal douches (45-46 C), as well as other tools and techniques, stimulating and strengthening the contractility of the uterus.
In exceptional cases requiring a rapid emptying of the uterus (heavy bleeding with a slight opening of the pharynx), resort to vaginal or abdominal caesarean section.
Often have to resort to manual removal of the placenta, especially during pregnancy big time.