Pregnancy is the most exciting and happiest period in a woman’s life, so it is especially painful to hear at a doctor’s appointment, especially in the early stages, the following diagnosis – arrested fetal development or frozen pregnancy, in other words. Not a single woman wants to believe this verdict, so it is very important to understand why the fetus stops developing, what signs can be used to understand this, and what methods are used for diagnosis. And also the most important question: can doctors make mistakes?

• What is a frozen pregnancy?

  Currently, experts use this term to mean two conditions:

  • Anembryony: the presence of a fertilized egg without an embryo in the uterus, this happens if the formation of the embryo has not begun in principle or if its development has stopped at a maximum of 5 weeks of pregnancy.
  • Fetal death: means that the fetus developed normally for some time, but for a number of reasons all signs of life began to be absent.

  Causes

  Despite the fact that the etiology and mechanisms of fetal development arrest have not yet been fully elucidated, experts identify the following reasons:

  • Genetic abnormalities of the embryo,
  • Violation of the anatomy of the reproductive system,
  • Chromosomal pathologies of the embryo,
  • Pathological condition of the endometrium

  There is a high probability of early fetal loss in two cases: at a high reproductive age of the mother and after a large number of previous miscarriages.

  Risk factors

  Unfortunately, experts identify a number of such reasons, and all of them are somehow related to the mother’s health. We are talking about the following factors:

  • The mother has alcohol, nicotine or drug addiction,
  • Chronic kidney diseases,
  • Systemic connective tissue diseases,
  • Uncompensated diabetes mellitus,
  • Arterial hypertension in severe form,
  • Uncompensated thyroid diseases,
  • Low body mass index,
  • Stress.

  

  Is it possible to sense the death of an embryo?

  Early

  The clinical picture of a frozen pregnancy in the early stages is always specific:

  • nausea, vomiting disappears,
  • feeling dizzy, general weakness,
  • fever appears
  • The mammary glands become smaller.

  If a woman does not contact a specialist in time, and the dead fetus remains in the uterus for a period of 2 to 6 weeks, pain in the lower abdomen and bleeding will occur.

  At a later date

  If pregnancy stalls in the later stages, then the main signs are the cessation of fetal motor activity, followed by heavy vaginal bleeding and uterine pain.

  Why ultrasound during a frozen pregnancy?

  Ultrasound is the most informative way to diagnose an undeveloped pregnancy. After such a study, it becomes possible to make a diagnosis not only when complaints appear, but even long before any immediate signs.

  Ultrasound reveals the absence of an embryo in the cavity of the ovum or the absence of a heartbeat at 7 weeks.

  How is this ultrasound performed?

  The patient needs to remove all clothing below the waist, then lie on her back on the couch with her knees bent. The examination is carried out transvaginally, so the doctor first places a condom on the sensor, and only then inserts it into the body. Next, using the device, the doctor scans the reproductive system, including the uterus and fertilized egg.

  

  In the early stages, the specialist measures the size of the embryo, its average diameter and location, the size of the uterus, the echogenicity of the structures, the coccygeal-parietal size of the fetus, the size of the yolk egg and compares these parameters with standards corresponding to the timing of embryo development. The presence of a heartbeat is also assessed. Of course, the specialist compares the indicators of the previous examination in order to compare and draw the most accurate conclusion.

  In the second and third trimester, the diagnostician already assesses the condition of all systems of the embryo, and also, due to contraindications to transvaginal examination, Doppler sonography or examination through the abdominal wall is performed.

  What does an ultrasound scan show?

  In the early stages of such diagnostics, the doctor notes a dead fetus that cannot be visualized. It is also possible to assess the fact that the size of the fertilized egg is lagging behind, while at the same time the size of the uterus does not correspond to the required size. The deformation of the fetal egg is also clearly expressed: the contours are unclear, there are multiple constrictions, and separate scattered echostructures. Another indicator that makes a clear diagnosis is oligohydramnios. Another advantage of this research method is the 100% ability to distinguish a “false” fertilized egg from a true one.

  

  Signs of a frozen pregnancy: the fetus has no heartbeat, and swelling of the patient’s tissues is also observed

  In the second and third trimester, the immediate signs of a dead fetus are the following: disappearance of the contours of the head, divergence of the edges of the skull bones, drooping lower jaw, pathological curvature of the spine, abnormal flexion of the head, blurry contours of the skeleton, deformation of the chest, abnormal position of the fetus relative to the uterus, discrepancy in the size of the fetus corresponding to the norm, a peculiar “throwing” of the limbs, the absence of physiological curvature of the spine.

  What to do if the diagnosis is a frozen pregnancy?

  Based on statistical data, it can be stated that in 61% of cases, 2 weeks after an ultrasound, the uterus empties of the dead fetus on its own; in the remaining women, the fertilized egg remains in the uterus due to the tight attachment of the developing placenta or the inferiority of immune reactions of rejection, which can subsequently lead to development of infectious and inflammatory diseases.

  In any case, doctors usually do not wait for further developments, but immediately send the patient for an abortion.

  Medical abortion

  In the early stages (up to 6 weeks), medical abortion is traditionally used. In this case, the patient should under no circumstances select medications on her own, as this can lead to complications and death. The specific drug, its dosage, method of administration (orally or vaginally) should be selected only by an experienced specialist, and the process of emptying the uterine cavity itself should be carried out strictly under the supervision of a doctor. If, after using the drugs, the abortion is not complete, surgical intervention will be required, and ultrasound will again help determine this.

  

  Vacuum aspiration

  Another method for removing a frozen embryo is vacuum aspiration; its use is possible in the early stages (up to 15 weeks). This method has enough advantages: it can be performed on an outpatient basis, such aspiration requires less medications and painkillers, and it does not worsen the prognosis for further conception. Such an abortion is carried out by removing the fertilized egg from the uterine area using a special vacuum apparatus (without scraping): in this case, a special catheter is inserted inside and, thanks to the uniform pressure created, the egg comes out. A mini-abortion can take no more than 10 minutes and is still the preferred method of terminating a pregnancy with a frozen fetus.

  

  Vacuum aspiration diagram

  Scraping

  After the second trimester, the only option is abortion by curettage of the uterine cavity. The curettage process itself and the accompanying dilation of the cervix cause pain. In this regard, they are always carried out using anesthesia and general anesthesia. For curettage, a specialist always uses a special device - a curette, a spoon-shaped object. During curettage, the mucous membrane and all contents of the uterus are removed. After curettage, unfortunately, complications, injuries and, in some cases, infertility often appear.

  

  Instrument for fetal curettage – gynecological curette

  Are any other steps necessary?

  Vacuum aspiration requires further monitoring via ultrasound, the doctor needs to make sure that the embryo is completely removed. Otherwise, additional suction of the remaining tissue in the uterus will be required.

  After curettage, the patient must undergo a rehabilitation period, which, in the absence of complications, ranges from 10 to 14 days and includes taking antibacterial drugs, hormonal contraceptives and sexual abstinence. After this period, an ultrasound is required to assess the condition of the uterus, and the specialist must also make sure that the embryo is finally removed.
  

  Is medical error possible?

  Each diagnostician, unfortunately, can make a mistake, since doctors are living people and are also subject to the influence of subjective factors like everyone else. In the early stages, the probability of error is greater than already in the second trimester, for example, but in absolute terms it is still small.

  To independently assess whether a specialist’s conclusion is a mistake and rule out suspicions that the embryo has stopped developing, you should pay attention to the following:

  • The patient needs to once again familiarize herself with the prerequisites and, after soberly assessing the situation, draw a conclusion - whether her fetus could have frozen in its development or not.
  • It is necessary to recall complaints in recent weeks and the presence of immediate signs of developmental arrest.
    In any case, you need to undergo an ultrasound again from another specialist.
  • If necessary, you can change the antenatal clinic.
    It is prohibited to take any medications that could harm the embryo until the situation is cleared up.

  Thus, it may turn out that the diagnostician’s conclusion is not a verdict, but a medical error, so the result of the medical examination and the final accuracy of the diagnosis depend on the vigilance of the expectant mother.

  The most common erroneous practice is scraping the walls of the uterine cavity even after the absence of fetal egg remains has been confirmed by ultrasound. Thus, the doctor performs an artificial abortion after a successful natural miscarriage.

  Surgical evacuation is carried out in this case “to be on the safe side”, despite the high probability of complications, such as structural and functional inferiority of the endometrium, for example. Therefore, again, the patient should have a repeat ultrasound and, if possible, contact another specialist in order to get a clear picture and understand whether there are indications for curettage or not.

Fetal fading (death) is possible up to the 20th week of pregnancy. What is the essence of a frozen pregnancy? The answer is simple: “For various reasons, intrauterine embryo death occurs.” Usually a frozen pregnancy becomes a prerequisite for a miscarriage. The dead fetus is rejected by the body (but this is not in all cases).

When making this diagnosis, specialists must conduct repeated diagnostics. Initially, when symptoms of this pathology appear, doctors refer the pregnant woman for additional ultrasound examination.

Every pregnant woman hopes that the diagnosis of missed pregnancy is an ultrasound error and nothing more. Naturally, expectant mothers are concerned about the accuracy of ultrasound and the possibility of errors during ultrasound examination. Can ultrasound make a mistake in determining embryo freezing?

Causes of fetal freezing

The cause of a frozen pregnancy may be:

• Chromosomal error;
• Antiphospholipid syndrome, which consists of a complex of disorders in which the body produces antibodies with its own phospholipids.
• Anembryony;
• Rhesus conflict;
• Hormonal disorders;
• Infectious diseases;
• Bad habits, including not only smoking or alcohol, but also coffee;
• Excess/underweight;
• Taking hormonal drugs;
• Pathologies of the uterus;
• Pregnancy using IVF.

According to statistics, the most common cause of fetal death in the early stages of pregnancy is a genetic failure that affects the development of the embryo. Considering the fact that the most important processes associated with the formation of basic systems, as well as internal organs, occur in the first stages of pregnancy, it is chromosomal errors at this time that become lethal for the child.

Unfortunately, gene pathologies can occur in the embryo even when the parents are absolutely healthy. Most often, for this reason, fetal freezing occurs during the period from 2 to 8 weeks. Less common is frozen pregnancy after the 13th week.

What are the signs of a frozen pregnancy?

Women who are at risk for fetal death are concerned about how to determine the death of the embryo. After all, very often this pathology is completely asymptomatic. The woman may not feel pain or any changes in well-being. A miscarriage can occur several days or weeks after the death of the embryo.

Suspicion of a stop in the development of pregnancy may arise in the following cases:

• Beginning of bleeding;
• Painful sensations in the lower abdomen, back;
• Abrupt cessation of present symptoms of toxicosis (not in all cases);
• Temperature rise above 37.5 0 C (only with the development of the inflammatory process);
• Disappearance of breast pain.

However, do not panic immediately if you notice one or more of the above symptoms. They can also occur during normal pregnancy. The main thing is to let the obstetrician-gynecologist observing you know about the occurrence of complaints.

Signs of a non-developing pregnancy in the first trimester

First trimester

In different semesters, fetal freezing has distinctive symptoms. In the first trimester, toxicosis may suddenly stop (in about a day).

Softening of the mammary glands appears. This symptom is noticeable to a woman, because from the moment the baby is conceived, there is an increase and tenderness of the mammary glands. At the same time, this symptom remains doubtful, like any other (except for ultrasound, blood tests for hCG).

A decrease in basal temperature as a result of a decrease in the amount of progesterone. An error in results occurs in case of illness or taking hormonal medications.

Absence of embryo during ultrasound examination. But ultrasound can also be wrong. It is recommended to undergo it after 5-6 weeks, because at this stage the fetal heartbeat is clearly visible. Experts advise waiting to clean the uterus and conducting a diagnosis after 1-2 weeks.

Second trimester

The main sign of a non-developing pregnancy is the cessation of the baby’s movements. Of course, there is no need to worry if the child does not move for a day or day. If they have not been observed for a longer time, go to the doctor. This way you will get rid of unnecessary worries. The solution to your worries is to check your baby's heartbeat with an obstetric stethoscope.

The release of a significant amount of colostrum, and after some time, milk. These symptoms appear after 25 weeks. But if there are no other symptoms besides this one, there is no need to worry. If there are fetal movements, this is simply preparing the body for breastfeeding.

Stopping the growth of the uterus.

Ultrasound diagnostics for suspected missed abortion

The diagnosis of a frozen pregnancy is never made by a specialist solely based on the presence of the above symptoms in a pregnant woman. The woman must undergo additional examination. Since ultrasound diagnostics is considered the most effective way to diagnose embryo development arrest, it is recommended that pregnant women undergo it.

An ultrasound will allow not only to determine/refute a frozen pregnancy, but also in the event of fetal death, to determine the period of its fading. Doctors prescribe diagnostics only after 6-7 weeks of pregnancy. When examined at earlier stages of embryo development, information obtained through ultrasound may be unreliable.

Detection of a frozen pregnancy in very early stages is true in the following cases:

• The embryo was not found, although the size of the fertilized egg is more than 20 mm. In this case, anembryonia is diagnosed. In a normal pregnancy, already at the 7th week the size of the embryo reaches 20 mm;
• Absence of cardiac activity in an embryo whose size reaches 16 mm (during transvaginal examination) or 25 mm (during transabdominal examination).

There are times when a doctor doubts the accuracy of the results obtained. Then the specialist prescribes a repeat examination after a week or two. The quality of the results is influenced by both the qualifications of the specialist conducting the inspection and the quality of the equipment. Older ultrasound machines may be misdiagnosed because they may not pick up the fetal heartbeat.

Ultrasound errors

Very often, a woman does not even suspect that the embryo is dying. Arriving at the next scheduled ultrasound examination, a pregnant woman may be shocked by a similar diagnosis. There are cases when the diagnosis was made incorrectly. Of course, for doctors this is just another diagnosis, but for a woman expecting a child it is simply a disaster.

If the doctor, after recording the complaints of a pregnant woman characteristic of a frozen pregnancy, makes a hasty diagnosis, do not rush to clean it. An experienced specialist will definitely prescribe an ultrasound examination to confirm fetal death. In the early stages, everything is much more complicated, but thanks to modern technology and the qualifications of gynecologists, confirmation/denial of freezing is possible.

If your health allows you to wait, do not rush to clean the uterus. There have been cases when doctors made mistakes, and women gave birth to healthy children, without any pathologies. The most accurate information about the probable death of the fetus can be obtained from an ultrasound scan performed at 6-7 weeks of embryo development. At this time, its size is quite large and the heartbeat is clearly audible.

It is necessary to undergo an ultrasound examination using new equipment, since old ultrasound machines may not notice the work of the embryo’s heart. Such an error could cost your baby's life.

Many women believe until the last moment that a missed pregnancy is an ultrasound error. The birth of a strong baby is the dream of every woman. Unfortunately, often a long-awaited pregnancy occurs with various abnormalities. Fading pregnancy is a death sentence for the unborn child and it is impossible to come to terms with it. Can a modern diagnostic method fail? Answers to this and some other questions can be found in the article.

A frozen or non-developing pregnancy is an interrelated combination of intrauterine death of the fetus (embryo) with absolute laxity of the uterine muscles and a disturbed homeostasis reaction.

The normal protective reaction of the body in the event of the death of an embryo or fetus is a miscarriage - a spontaneous contraction of the muscles of the uterus, rejecting a non-viable fetus from its cavity. In the case of a frozen pregnancy, such a reaction does not occur. The difference between this type of pregnancy and a miscarriage is the cessation of production of the hormone progesterone, which leads to insufficient blood circulation in the uteroplacental tissues. Another medical name for a frozen pregnancy is a missed miscarriage.

It is difficult to establish a single cause for the appearance of this pathology.

In 70% of the total number of cases, the cause is a genetic malfunction, which is often detected in the early stages of gestation - up to 8 weeks.

The likelihood of embryonic or fetal death increases if the following factors are present:

1. Psycho-emotional stress.
2. Physical overload.
3. Mismatch between mother and fetus in terms of blood type and Rh factor.
4. Intoxication with harmful substances. Before and after conception, you should stop smoking, drinking alcohol and taking drugs.
5. Infectious diseases, especially untreated ones. The danger of complications exists throughout the entire period. A common cold disrupts the normal rhythm of a woman’s most important organs, after which deviations in the development of the fetus and its death occur.
6. Hormonal disbalance. The lack of certain hormones does not allow the embryo to firmly establish itself in the uterus. Excessive levels of testosterone, the male hormone, affect the viability of the embryo during the first 12 weeks.
7. Pregnancy after 40 years of age. The age is critical for normal pregnancy; the condition is aggravated by the presence of chronic diseases.

Such a pathology can appear at any time. Often observed during artificial fertilization of an egg. Getting pregnant this way is not always possible on the first try.

The presence of previous miscarriages indicates reproductive problems, which increases the possibility of an anomaly.

Classification of pathology

In professional medicine, there are two types of frozen pregnancy in the earliest stages, which can only be diagnosed using ultrasound:

1. Anembryony. Divided into types I and II. In option 1, there are lags in the size of the uterus and fertilized egg, which are relatively normal for a specific period. In option 2, these indicators correspond to the norm, but the embryo is missing (residual elements are visualized in the photo).
2. The death of the embryo is established in the absence of a heartbeat and signs of motor activity inherent in a normally progressive process.

Type II anembryony of one fertilized egg during the conception of twins is a special case and is defined as failed twins. The remaining living embryo retains the possibility of further full development.

The symptoms of this pathology depend on the stage of pregnancy. Most often, fetal fading occurs in the early stages of gestation; during this period, a woman should especially carefully monitor her condition.

• toxicosis disappears;
• The mammary glands become smaller.

Sometimes the signs of a frozen pregnancy in the first weeks are so weak that it is almost impossible to catch them yourself. A woman, on the contrary, may feel a surge of strength, and the pain and discomfort typical of pregnancy will disappear.

Clear signs appear already at the stage of decomposition. Not earlier than 14 days after the death of the fetus (there are cases when after 6 weeks). Constant pain in the lower abdomen begins to bother you, bloody discharge appears, which indicates an advanced form of intoxication.

At a later date, you should be wary if fetal movement is not noticed for more than 2 days. It becomes more alarming from a feeling of heaviness in the stomach, severe weakness. At a period of more than 25 weeks, copious release of colostrum may begin, which is not typical for a normal pregnancy.

It is important to establish pathology as early as possible. This helps prevent the spread of infections and complications in the mother's body.

DIC syndrome is very dangerous, in which the blood loses its ability to clot. Excessive blood loss after removal of a non-viable fetus or embryo can lead to a fatal result.

Prevention

Powerful hormonal changes occur in a woman’s body, and a lot of effort is spent on the development and protection of the fetus. The body's immune strength decreases, which must be supported by immunomodulators.

Some attention should be paid to the state of the vaginal microflora, restoring it to normal levels using accessible methods.

Well-known pregnancy tests based on the level of hCG in urine can provide additional information at home if the embryo is not viable.

In this case, the hormone content in the urine gradually decreases. A few days after the death of the embryo, the morning hCG test will show one line - a result indicating the absence or fading of pregnancy.

It should be noted that experts do not recognize the hCG test for diagnosing this pathology as reliable and reliable.

Ultrasound

Examination using ultrasonic waves is the most informative and accessible diagnostic method. During the entire period of gestation, for a complete picture of pregnancy, it is necessary to undergo from 2 to 4 diagnostics. Various deviations during gestation are an indicator for additional research.

• confirm normal intrauterine pregnancy;
• exclude the presence of a dangerous disease - hydatidiform mole, the symptoms of which and the results of laboratory tests are similar to those during pregnancy;
• set an exact deadline
• the quality of physiological processes characteristic of this position;
• prove the presence or absence of pregnancy if menstruation is delayed (relevant for women suffering from infertility or after artificial insemination);
• identification of various gynecological diseases: the presence of fibroids, possible abnormal structure of the uterus (saddle-shaped, double).

Anomalies in the development of the LRS ultrasound can be assumed if a heartbeat is not heard, due to the small size of the fertilized egg and uterus for a given period.

Ultrasound makes it possible to determine their specific indicators, which are approximately equal in the early stages for everyone, when there are still no distinctive individual characteristics.

Ultrasound is recognized as the most comprehensive and accurate diagnostic method.

1. Fixing the approximate date of conception leads to an incorrect result. During this period, the heartbeat of the embryo should be heard; a discrepancy of 1-2 days is significant. The absence of a heartbeat gives reason to consider the embryo not alive. An experienced doctor, not excluding the possibility of error, conducts a second examination a week later, which confirms or refutes the diagnosis.
2. The peculiarity of the course of ectopic embryo development complicates diagnosis. A so-called false fertilized egg without an embryo, filled with fluid, can be fixed in the uterus. Pathological development takes place in the fallopian tube. A medical error like this can cost a woman her life. Only transvaginal ultrasound can absolutely accurately identify an abnormal ectopic pregnancy.
3. In practice, there are cases when, during laboratory tests that refute pregnancy, an ultrasound scan reveals a specific body with smooth contours inside the uterus, similar to an embryo. In the uterine cavity there may be a glandular polyp, a myomatous nodule or a nabothian cyst, which is mistaken for a fertilized egg.

As practice shows, the probability of developing pathology exists for 28 obstetric weeks of gestation. The last weeks of the term are no exception.

Transvaginal ultrasound of a frozen pregnancy in the early stages is considered more informative than examination through a massive abdominal wall. Up to 12 obstetric weeks (from the first day of the last menstruation), it is absolutely safe and recommended for detecting ectopic pregnancy. 6 weeks after conception, the transvaginal method shows the heartbeat of the embryo, and after seven, it allows you to discern its presence in the gestational sac.