Parchment fruit. Concomitant pathology of feto-fetal transfusion

– Pregnancy 5–6 weeks, - confidently said the gynecologist.
It is difficult to say what feelings arise in the soul of a woman when she hears these words. Most of this news will be delighted, however ...

It often happens that pregnancy was not included in the plans of a woman. This is where our Scary Tale begins.

Definitely an abortion. - this is bad. However, there are situations when, sadly, it is necessary. But the most terrible thing is when the girls who find themselves in this situation begin to engage in amateur performances. The reason why ladies decide on a criminal abortion is as old as the world - the reluctance of publicity. This may be a minor girl, and a wife who cheated on her husband, and a woman who missed the deadline for a simple abortion. This is where miracles begin in our fairy tale ...

It is useless to explain to a woman that no reasons are worth such bullying. To talk about the supposed dire consequences - Same. Because the news of an accidental pregnancy is a shock. And in a state of shock, people often behave inappropriately and perceive little. So sounding the alarm and teaching life when the thunder has already struck is a thankless task. At that moment, in my head, there are not distant, not rosy prospects, but urgent problems: to pass the test in a week, the husband returns from a long voyage only six months later, in the washing house above the roof (just kidding, of course) ... Appealing to reason at this time is a disastrous business. And before, such conversations were somehow useless. But still, it would not hurt to have an idea about these things.

Somehow I came across an article where the pathologist described several cases of criminal abortions, as a result of which he was "lucky" to meet their participants ... posthumously. Everything is clear, clear, without emotions and with a share of cynicism. So to speak, information for reflection or broadening one's horizons. Let everyone draw their own conclusions.

The definition of "criminal abortion" includes cases when the pregnancy is more than 12 weeks, when the patient is a minor and wants to "quietly" turn this case, when the abortion is not done in a medical institution or when it is done by a non-specialist, and the so-called "traditional medicine".

As a rule, girls get information from the OBS Agency. - "One Baba Said". Someone's "friend of a friend" heard from another friend that her friend had an abortion by some doctor who practices such surgeries at home. Confidentially. Expensive. And it doesn’t matter that the main occupation is a doctor - dentist. Medical education.

However, even if this is a gynecologist, but at home, there are few chances to survive. First, outside the clinic, sufficient cleanliness is impossible. The abortion instrument is large, and it takes a long time to disinfect it so that there are no bacteria on it, since a huge fibrin layer of clotted blood forms in the uterus, and this is an excellent breeding ground for any bacteria. A small oversight is enough - and in a week you are guaranteed a meeting with a pathologist.

Secondly, for a conventional abortion, you need a whole set of special tools:
Mirror - to open the vagina
Bullet tongs, like long scissors with claw-like ends. They cling to the edges of the uterus and pull up to the entrance to the vagina.
Bougie set different size. They are needed to open a narrow cervix.
Abortsang. These are tongs with sharpened rings at the end. They are introduced into the uterus and there are cheerfully clicked several times.
Curettes - curved blades on a long handle. They need to scrape the uterine lining.

As a rule, it is rare that any of the criminal abortion clinics has a complete set.

An important nuance: no matter how experienced the doctor is, every time he works blindly. And none of them are immune from chance - inadvertently pierce the wall of the uterus with an abortion collet or curette and exit into the abdominal cavity. And in her - do not touch the intestines and do not release their contents. And if this happened by chance, then only abdominal surgery can save the patient. If she lives to see her, of course.

Let's move on to self-employment. Whatever women swallow to "quietly" terminate a pregnancy. Decoctions, pills ... Who brews Bay leaf in wild quantities: he drinks the decoction, and puts the leaves into the vagina at night. And then he gets intoxication, exhaustion and "parchment fruit". This is when the uterus does not reject the dead fetus, but leaves it in itself. It partially resolves, and the rest becomes like a paraffin model.

Someone brews "highlander meat-like". Since there is a rumor among the people that he helps in the female part. The result is a thrombus. And as a result, in both cases - meeting with the aforementioned doctor in the morgue.

"One Baba Said" to someone that you can cause a miscarriage with a simple aspirin: drink two packs and one - into the vagina. In this scenario, at first it can terribly twist the stomach, terrible heartburn begins. But then comes salicylic intoxication and euphoria. The gag reflex is suppressed, the pain threshold is lowered. So when the acid corrodes the stomach, there is no particular discomfort. Well, when the delicate biochemical mechanism that regulates the state of the blood breaks down, - it's already late. Blood begins to seep through the walls of blood vessels. And then - Hello, Doctor! Someone was advised to simply increase the dose of steroidal contraceptives. And as a result, get multiple vascular infarcts throughout the body ...

And what mechanical devices come up with - You can only spread your hands! In one military unit, a training catapult was adapted for this business. From such overloads, and in men, sorry, incontinence happens. And in pregnant women, the fetus simply tears off from the uterine wall. If you do not go to the hospital in time, then you can die from blood loss overnight. Ladies do not disdain to cause miscarriages and all sorts of plants. Who agrees to insert a ficus bud with a sharp end into the vagina. And thereby agree to the risk of earning gas gangrene. Since the ficus absorbs all the rubbish from the ground.

Or is there another "rustic" way - an ordinary small bulb is placed in the vagina. In a warm and humid environment, onion roots quickly germinate into the uterus with the embryo. Then the bulb rots. This method rarely causes a miscarriage, more often an infection. And if you don't take action - "ambulance", for example, call and tell everything - and then death. Some girls decide to go to grandmothers who get rid of pregnancy with an elementary knitting needle. But often they get multiple punctures of the uterine wall and peritonitis.

But the leader traditional medicine"is a hot bath. For some reason, dear ladies are sure that you just have to warm up well, and a miscarriage is guaranteed. They don’t think about the fact that in this way the fetus can be welded even more strongly to the wall of the uterus. And that you can die from a primitive heatstroke, too, few people worry.By the way, a hot bath really helps to prevent pregnancy.Only this method is for MEN.If in very hot water warm the scrotum for a long time, then for several months the man becomes infertile.

... The world is wonderful, and the people in it - even weirder. But for some reason, more and more I want these miracles to be smaller ...

Antenatal fetal death in twins occurs with a frequency of 1 case per 1000 pregnancies.

The causes of intrauterine death of the fetus can be different, most often this occurs due to the presence of developmental anomalies in it or circulatory disorders, both due to the pathology of the vessels of the placenta and umbilical cord, and due to mechanical factors (for example, nodulation and acute hypoxia in monoamniotic twins).

Intrauterine fetal death poses a direct threat to the life and health of the second child. According to studies, the death of the second fetus in the antenatal and perinatal periods occurs in 38% of cases. The statistics of a missed pregnancy with twins indicates that if one of the twins dies in the first trimester of pregnancy, the outcome for the second fetus is favorable in 90% of cases. The death of the fetus in the later stages, in the second and third trimester, if it does not lead to immediate death, then it causes lesions internal organs and central nervous system with the second twin.

How common is intrauterine fetal death in twins?

Frozen pregnancy, statistics:

With twins, fetal death in the womb occurs with a frequency of 2 to 6%.
- The highest frequency of missed pregnancy with monochorionic twins - up to 25%
- Monozygotic twins occur in 3-5 cases per 1000 pregnancies, while 70% of these twins are monochorionic. Thus, intrauterine death of a twin occurs 1 time per 1000 pregnancies.

Symptoms of fetal death may be completely absent, the pathology is detected during an ultrasound examination. On ultrasound, signs of fetal death are the absence of a heartbeat and movements.

The death of the fetus in the early stages of pregnancy with twins usually ends either with its complete resorption (if the fading occurred before the 3rd week of pregnancy), or with maceration, and then with the drying of the fetus (paper fetus).

Frozen pregnancy in the later stages with twins is dangerous because the second fetus is bleeding. According to the anastomoses, blood from him begins to be discharged into the vascular bed of the dead twin, so now his heart does not work, and the vascular system turns into a bottomless reservoir that can fit a lot of blood. Blood loss leads the second fetus to hypovolemia, severe anemia, which causes damage to the central nervous system, the development of acute hypoxia.

The tactics of obstetricians depends on how long the pregnancy stops.

In the third trimester, the question arises of the need for emergency delivery. Although the second fetus is not ready for childbirth, has an immature respiratory system, for him premature birth less dangerous than being next to a dead twin. Signs of intrauterine fetal death in twins are not obvious, and the outcome for the second child largely depends on the time that elapses between the death of the child and delivery. If a missed early pregnancy can end safely for the surviving fetus, in the second and third trimester, everything is decided by time. With timely diagnosis, survival with a favorable outcome is possible in 50-60% of cases.

Sometimes if a woman has twins, the death of the fetus can be predicted in advance. In the treatment of the second fetus, the interruption of communications between the circulatory systems of the twins and the transfusion of blood products to the fetus if it is not yet ready for birth (second trimester) are considered optimal.

In the third trimester, only childbirth is justified, since a dead fetus not only poses a threat to the second twin, but also to the life of the mother, its presence can cause coagulation disorders in her.

Missed miscarriage is a disease in which fertilized egg dies already in the relatively early stages of pregnancy, but its expulsion still does not occur, despite bleeding, indicating a miscarriage that has begun. Such a delayed egg is called a blood mole; it is a dense, voluminous formation, consisting of blood layers surrounding a dead and decaying embryo (fetus).

With a delay in blood drift in the uterine cavity for a longer time, blood clots are organized, thickened, discolored, and take on the appearance of meat on the cut. This form is called fleshy skid.

A dead fetal egg can remain in the uterus for several months, sometimes even years. If the former authors categorically denied the possibility of a long retention of the fetal egg in the uterine cavity, then modern authors adhere to the opposite point of view.

Speaking about the changes in the fetal egg during its retention in the uterine cavity, one cannot ignore the issue of the embryo (fetus), which in this case undergoes various transformations.

With miscarriages early dates(up to 2 months) the embryo can dissolve. What process occurs in this case has not yet been precisely established.

At a later date, the fetus undergoes, depending on the absence or presence of bacteria in the uterus, either the process of maceration or ichorous decay.

During maceration, the integument of the fetus is imbibed, and then autolysis occurs. Due to hemolysis, the amniotic fluid becomes bloody, the umbilical cord turns brown, the skin color turns red - foetus sanguinolentus.

Mummification of the fetus is observed much less frequently in a failed miscarriage. In this case, the amniotic fluid is absorbed, the fetus shrinks and dries out, its skin is closely adjacent to the skeleton, and the trunk becomes denser.

This process is most often observed on fruits older than 3 months.

Skeletonization is even more rarely observed, i.e., the disintegration of soft parts with the exposure of bones, which occurs without the access of bacteria.

In isolated cases, there is a petrification of the fetus (litopaedion) with the deposition of salts both in its tissues and in the shells of the egg (kelyhopaedion).

With identical twins, one of the dead fetuses can undergo flattening (foetus compressus) due to the second, properly developing fetus, and eventually becomes thin, transparent, turning into the so-called paper fetus - foetus papyraceus (Fig. 44).

Rice. 44. Paper fruit.

The reasons for the death of the fetal egg are very diverse and not always amenable to clarification.

The long-term delay of a dead fetal egg in the uterus is based on a decrease in the reflex activity of the latter, due to both violations of the receptor apparatus of the uterus itself and disorders of the functional state of the central nervous system (cortex and subcortical centers), in direct connection with which there is a state of hormonal balance ( qualitative and quantitative). As a result of this, there is a decrease in the level of pituitrin, acetylcholine and an increase in the level of progesterone.

Since folliculin is considered a stimulant for the production of acetylcholine, it is used to stimulate the contractile activity of the uterus. For successful action, it is necessary to use relatively large doses (from 6000 to 30,000 IU), and the shorter the gestational age, the greater the dose should be, and vice versa. Instead of folliculin, sinestrol can also be used. A confirmation of the correctness of this view is that such an application of this method is in some cases quite successful.

Microscopic examination of the placenta in cases of missed miscarriage always shows changes, in particular, hyaline degeneration of the villi and obliteration of their blood vessels. According to some authors (N. N. Chukalov), these changes occur in vivo and gradually, and the fetal egg dies due to the cessation of the influx of nutrient material. Other authors, such as, for example, K. P. Ulezko-Stroganova, consider these changes as posthumous.

Along with necrotic, sometimes there are small areas of unchanged villi, which, with a long-dead fetus, penetrate deep into the wall of the uterus. Removal of such areas of the placenta is difficult.

A failed miscarriage in 80% is observed in multiparous women (V, A. Bulatov). In the origin of this kind of disease in multi-pregnant women, morphological changes in the tissues of the uterine wall are important, in particular, increased growth of connective tissue, on the basis of inflammatory and traumatic disorders, intoxications, etc. In primigravidas, a failed miscarriage is observed with congenital uterine hypoplasia.

A failed miscarriage occurs quite unexpectedly. A woman who had a clear progression of pregnancy and there were sensations characteristic of the latter notes that they suddenly disappeared.

An objective examination reveals the absence of pre-existing signs of pregnancy. In such cases, the woman is monitored.

With a failed miscarriage, in contrast hydatidiform mole, the discrepancy between the period of delay of menstruation and the size of the uterus is expressed in the lag of the size of the uterus from the expected gestational age (according to the duration of the delay of menstruation). This is the main symptom of the disease. In the future, the size of the uterus becomes more and more reduced.

due to suction amniotic fluid and the cessation of hyperemia and serous impregnation of the tissues of the uterus, common in progressive pregnancy, the consistency of the uterus changes, it becomes much denser.

Bleeding and pain in the abdomen and lower back usually appear when the ovum is detached, “dirty” discharge (sometimes with a putrid odor) is more often noted, alternating with slight bleeding. An increase in body temperature is usually not observed. With the death of the egg, the pregnant woman notes the cessation of breast engorgement and the disappearance of the usual signs of pregnancy. The woman's condition is oppressed, she is worried about a headache, she feels unwell and a breakdown, aversion to meat food on the basis of an overload of the body with absorbable proteins (R. R. Makarov). Sooner or later, a dead fetal egg is expelled from the uterine cavity, and its independent expulsion usually occurs closer to the end of a normal pregnancy.

Failed childbirth(missed labor) are extremely rare. In the world literature last years only isolated cases of a long delay in the uterine cavity of a full-term dead fetus have been published. There is no doubt that the number of cases of missed labor is much higher than published in the press.

The delay in the onset of delivery by a dead fetus on time depends, apparently, on a sharp decrease in the excitability of the uterus, due to the disorder in the work of the central (cortex and subcortex) and peripheral (lying in the uterus itself) nervous and neurohormonal mechanisms, as well as on the functional state conducting nerve pathways, as was proved by the studies of G. M. Lisovskaya using the methods of electrohystero- and encephalography.

Fetal death depends on degenerative changes in the placenta, as a result of which this organ gradually loses its ability to deliver oxygen and nutrients to the fetus. The death of the fetus also depends on the intoxication of its body with carbon dioxide and decay products due to impaired blood circulation in the overripe and degenerated placenta.

The dead fetus can stay in the uterus for a long time - from several weeks to several years. In the case described by E. Z. Rabinovich, the fetus was in the uterus for 15 years, in the case of Kamerarius - 46 years (found during autopsy of an old woman 96 years old).

Treatment. With a failed miscarriage, a waiting course of action is recommended. Active intervention should be used only for special indications (severe bleeding, pain, fever, etc.); deterioration in the general condition of the pregnant woman also serves as an indication for urgent emptying of the uterus. The patient should be explained the nature of the disease and systematically monitor it. Manipulation of instruments in the uterine cavity should be done with great care, since in this disease the uterus can be easily perforated (such cases are described in the literature) or profuse bleeding occurs, which is often the cause of death of the patient.

Only with delayed pregnancy more late deadline(missed labor) in order to stimulate the activity of the uterus, in some cases it is appropriate to prescribe folliculin, pituitrin, quinine, hot vaginal showers (45-46 ° C), as well as other means and methods that stimulate and enhance the contractility of the uterus.

In exceptional cases, where rapid emptying of the uterus is required (heavy bleeding with a slight opening of the pharynx), resort to vaginal or abdominal caesarean section.

Often you have to resort to manual removal of the placenta, especially during long-term pregnancy.

Persistent deviations from the normal anatomical structure of the animal in the process of individual development (ontogenesis) are called malformations. Due to the fact that the body is formed throughout life, there are malformations of the intrauterine period and after birth.

Malformations of the whole organism or its parts that have arisen in the embryonic period are called deformities, and in the extrauterine period - postnatal malformations. The latter include dwarfism, gigantism and other underdevelopment, most often associated with a disorder of the endocrine glands.

The branch of biology that studies deformities is called teratology. Congenital minor morphological deviations from the norm of individual parts of the body are considered anomalies. Deformities cannot include injuries that occurred during childbirth (birth trauma) as a result of infectious and invasive lesions of the fetus, as well as eye damage (mutilation), removal of horns, curvature of the spine with rickets, etc.

Causes of deformities are divided into internal and external. The former include factors that affect the chromosomal apparatus of the germ cells of producers (eggs and sperm). This can manifest itself in the offspring of normal producers as a result of exposure to ionizing radiation, chemical factors - natural or synthetic origin. The second group includes various influences external environment that violate the development of the fetus: bruises, strokes, various lesions of the uterus, squeezing it, temperature, hormonal effects and various diseases of the mother. This division of the causes of deformities is conditional, since both causes are based on the influence of the external environment.

The appearance of new traits in the offspring is called mutation (Latin mutare - change), or variability. If they correspond to the conditions of existence, they: are fixed by natural selection and determine the emergence of new species and breeds of animals, and also serve as the basis for artificial selection by selection methods.

The mechanism of teratogenic factors is expressed in a change in the structure of individual sections of chromosomes (chromosomal aberration), the exchange of sections of the same pair of chromosomes (crossing over), the appearance of new genes, etc., which is combined by the concept of gametopathy. Such changes in gametes can stop the development of the embryo. If they do not interfere with its life and development, then ugly fruits appear, anatomically different from the parents and fixed as a dominant or recessive trait transmitted to offspring. Traits arising from external causes are not transmitted to offspring.

Teratogenic factors acting in the same period of embryogenesis cause the same deformities. But each of them, acting at different periods of fetal development, determines various deformities. Therefore, depending on the moment of exposure to a teratogenic factor, embryopathies are distinguished - deformities that have arisen from the moment of gamete formation to the beginning of organ formation (for example, the formation of identical twins, the absence of organs), and fetopathy - defects that appear in the subsequent period approximately after the tenth week of pregnancy and are characterized wrong, the formation of organs.

Each organ has its own teratogenic termination period, when its vicious formation can begin.

Depending on the mechanism of deformity, deviations from the norm in the size of organs, expressed in an increase, decrease or cessation of its development, heterotopias - displacements in the anatomical arrangement of organs, lacing of parts of organs, and their multiple formation, are of the greatest importance.

The types of deformity are extremely diverse, they can affect the entire body of the fetus, its individual organs. or their parts, localization of malformed organs, and also expressed by the simultaneous development of several fetuses. Deformities are divided into single malformations of one fetus (persistence, agenesis, hypogenesis, hypertensia, fusion of paired organs, multiple organs, atresia, dysraphia, dystopias, hermaphroditism) and multiple, associated with the simultaneous development of two or more fetuses: free twinning (identical , multi-egg, symmetrical, asymmetric twins), not free (symmetrical, asymmetric twins).

persistence
(lat. persistere - remaining, remaining) is the preservation of those parts of the embryo that usually disappear by the time of birth. For example, the preservation of gill slits, the ductus arteriosus connecting the pulmonary artery with the aorta, openings between the atria and ventricles of the heart, etc.

agenesia(aplasia) - the complete absence of certain organs or parts of the body in the fetus. For example, the cranial lid (acrania), the brain (acephaly), the limbs (amelia), the heart (acardia), the testicles (anorchism).

Hypogenesis(hypoplasia) - underdevelopment of organs, such as the lower jaw (hypognathia), limbs (micromelia), eyes (microphthalmia).

hypergenesis
- excessive increase in the volume of the body, such as one of the limbs, fingers.

Fusion of paired organs: one-eyedness (cyclopia), when two underdeveloped eyes, kidneys (“horseshoe-shaped kidney”) are located in one eye orbit, fusion of the front or hind limbs (simmelia, simpus), fusion of fingers (syndactyly).

Atresia- lack of natural openings: nasal, pharyngeal, anal, genital, etc.

The opposite defect is dysraphia (Greek raphe - seam) - non-closure of natural cavities: palate (“cleft palate”), chest (thoracoschisis), etc.

Dystopia- incorrect arrangement of organs, for example, their mirror location, when the heart and spleen are in the right half of the body, the liver is on the left, the abdominal organs are displaced into the chest in the absence of a diaphragm, the protrusion of the brain under the scalp ( cerebral) with acrania. The prolapse of organs on the surface of the body during thoracoschisis and on the surface of the abdominal wall is called ectopia.

Hermaphroditism (bisexuality) is true if one animal has testes and ovaries, and false if the sex glands do not correspond to the external genital organs.

In veterinary practice, other anomalies of the genital organs are important, for example, in bulls - cryptorchidism (from the Greek kripte - hidden), nutrets with the location of the testes not in the scrotum, but in the abdominal cavity, monorchism - the presence of one testis in the scrotum; in heifers, freemartinism is an underdevelopment of the vagina. Sometimes there are tissue anomalies: heterotopias - the presence of one organ in another, for example, the inclusion of the adrenal gland in the kidney, liver tissue in the spleen, and vice versa, as well as dysplasia - the replacement of normal organ tissue with an unusual one for it, for example, in the esophagus there are sections of the gastric mucosa, and in stomach - intestinal mucosa.

Multiple deformities are characterized by anatomical abnormalities in twins.

multiple pregnancy
- a normal feature of many animal species (sheep, pigs, carnivores, rodents) and depends on the simultaneous maturation and fertilization of several eggs. The same phenomenon occurs in animals bearing one fetus during pregnancy (this unusual multiple pregnancy may be a hereditary trait). Twins born from the fertilization of many eggs are called fraternal twins. They are of different sexes, develop normally in different fetal membranes, outwardly dissimilar to each other, their number may be odd - (fraternal free symmetrical twins). But sometimes there is underdevelopment and even death of one of the twins (fraternal free asymmetric twins), which is associated with incorrect pregnancy conditions. When one of the twins dies, his body dries up and turns into a parchment-like plate (parchment fruit - fetus pa-pyrocens).

Another reason for the appearance of twins is the separation of a fertilized egg at an early stage of pregnancy (identical twins).

When the blastula is completely divided into two halves, the fetuses develop normally in one fetal membrane, they are of the same sex and are very similar to each other in appearance (identical free symmetrical twins), less often there is underdevelopment or death of one of them (identical asymmetric twins).

In some cases, the separation of the embryo is incomplete and, depending on the period of pregnancy, its twins are connected to each other by various parts of the body (identical non-free twins), which gives the impression of twin fusion and therefore is indicated by the ending pag (Greek pagos - fusion). Such twins can be symmetrical (identical non-free symmetrical twins) or one of the twins is, as it were, an appendage of the other (identical non-free asymmetric twins). Symmetrical twins are connected by the skull (craniopagi), sternum (sternopagi), pelvic region (pygopagi). They may have common great vessels, and surgical separation of them is not always possible. Asymmetric twins, in which a plane of symmetry cannot be drawn, have a lower degree of splitting of embryonic rudiments that concern only individual organs. These are two-headed twins (dicephalus) with a common neck, freaks with two lower jaws, with an additional front or hind limb, which is located on the chest, back, in the pelvis.

Cleavage, or displacement, of the rudiments of organs gives tumor-like formations - teratomas. These include dermoid cysts - closed cavities lined with epidermis with wool and skin glands. In teratomas, rudiments or relatively 'formed teeth, bones, intestinal tubes and other organ formations are found.

Malformed organisms are often incapable of independent existence and die at the time of birth or are viable and can be delivered from the malformation by surgical intervention.