Obstetrician-gynecologist at the Lapino Clinical Hospital "Mother and Child" Elena Silantieva told what to do if you had a frozen pregnancy, and explained why there is so much talk about it now.
Obstetrician-gynecologist, deputy chief physician for rehabilitation of the Lapino Clinical Hospital "Mother and Child"
Why is everyone talking about this?
Cases of missed pregnancies have not become more frequent now, as many think, it is just that this problem is diagnosed more often.
Even 10-15 years ago, ultrasound machines did not allow doctors to see a small ovum in the uterine cavity and diagnose "miscarriage" at 6 weeks (counting from the moment of the first day of the last menstruation - and this is what is customary in obstetrics). Only at this time (and not before) the doctor can see the beating heart of the embryo.
And about 20 years ago, a woman did not have the opportunity to talk about a frozen pregnancy at all, she diagnosed her condition as a "delay", was waiting for menstruation, which came in a couple of weeks. In the end, she could only assume that she was pregnant.
Now there are laboratories where you can take an analysis for human chorionic gonadotropin (a hormone that begins to produce a fertilized egg when it enters the wall of the uterus). It is affordable and reliable. A pregnancy test is also based on an analysis for this hormone, but its sensitivity is an order of magnitude lower than a blood test, which is given in a laboratory.
Why does a frozen pregnancy happen?
If a woman has not had abortions, miscarriages, inflammatory diseases, a missed pregnancy may be associated with a genetic pathology. The fetus is formed with a genetic error, that is, nature itself considers it unviable.
It is now the most common cause of missed pregnancies at 5-6 weeks. After that, genetic analysis and analysis of the karyotype of both parents is done. Most often, a genetic error occurs already at the stage of embryo formation. It can be repeated, but everything is very individual and depends, for example, on age (the older, the more likely it is).
The problem of a frozen pregnancy is often compared with thrombophilic mutations, and there are many "Internet tales" here. Girls with frozen pregnancies come to me and confidently say that they have found the same mutations, laying the "sheets" of tests on the table. In this case, I always tell the story of my neighbor with the most severe varicose veins. She has two daughters, twins, who are 45 years old. Both are tall, slender, like a mother, but one constantly wears trousers due to varicose veins, and the second has barely noticeable veins on the legs, and at the same time they have the same genotype. This happened because one of them is an athletics coach, and the second is a stylist who spends half her life standing at a hairdressing chair. This I tell you to the fact that genetics is genetics, but there are always additional circumstances.
For example, a Leiden mutation always carries with it the risk of losing a pregnancy. But there are dozens of mutations (they are written on the very "sheets") that are realized if there are additional circumstances: chronic inflammation, infections, abortions.
What to do after?
First, find the reason: you need to look at infection screening, the results of hormone tests, the state of the endometrium (and if there were several losses, then, of course, its condition worsens). In 90% of cases, with a frozen pregnancy, scraping is performed. It would seem that a thousand years have passed, and scraping remains a dangerous operation. After all, this is a jeweler's work: first, a hysteroscopy is done, then a local, not total cleaning is performed. Any intervention in the uterine cavity injures it. Sometimes you can terminate a pregnancy with medication - everything is very individual.
If the cause is found, endometrial rehabilitation should be started. By the way, in the USSR, due to the undeveloped culture of protection, the post-abortion rehabilitation system was very developed: there were physiotherapy rooms in antenatal clinics and even special gynecological resorts. Today this system has been abolished, but, of course, there are methods for restoring the endometrium: ultrasound, electro-, sometimes laser therapy and others.
It is important to get to the right doctor, who will not burden you with expensive research, but will form in your head the correct message for a future pregnancy. It happens that women perceive pregnancy and childbirth as a great blessing that has fallen on their heads and melt like butter. Or another reaction: the great hardships that life has sent you and which you need to tragically overcome. All this is work, you need to be ready for it.
Not every missed pregnancy is a deliberate evil. I have already said that this is how nature bothered to correct the genetic error. After all, the woman was not given a choice at 22 weeks, saying that the child has vices incompatible with life - and this is a much greater tragedy when the help of a psychologist may also be needed.
To my clients who suffered from infertility, did IVF, and then became pregnant and lost a child in the early stages, I always say that this is a step forward!
Because they are moving from the category of infertile patients (where there is a 50% chance of getting pregnant) to the category of patients with miscarriage. In this case, the pregnancy rate increases to 80%, and the probability of gestation is more than 85%. This is a surmountable problem that depends on the efforts of the woman herself.
A patient came to me recently. She is 40 years old, and the child is about a year old. The story is this: she lost four pregnancies, all of them were interrupted at a short time.
In one of the cases, she turned to the doctor late: the frozen ovum remained in the uterus for about three weeks and the inflammatory process began.
She was scraped, but part of the ovum remained in the cavity. A week later, a second operation was performed, after which long-term treatment was required. The same "sheets" of test results, the appointment of progesterone, etc., but there was no result. At the forum, she learned that it is possible to solve the problem with physiotherapy, and that's how we met. The treatment took four months, and after that she became pregnant and gave birth to a baby, and now she is already planning a second pregnancy. Yesterday she came to me and said: let's get training in advance while I finish lactation. I hope that the second pregnancy will pass almost without my intervention, because now everything is really good with her!
Assess your options and try to overcome risk factors. And you can try to get pregnant in 3-6 months!
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