A SURVEY OF PREGNANT WOMEN WITH THREATENED SPONTANEOUS ABORTION

A SURVEY OF PREGNANT WOMEN WITH THREATENED SPONTANEOUS ABORTION

the threat of termination :

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A SURVEY OF PREGNANT WOMEN WITH THREATENED SPONTANEOUS ABORTION

History

Note on reproductive and menstrual function: the course and outcome of previous pregnancies, the formation of menstruation, characteristics of the menstrual cycle. This helps to suggest possible infantilism or failure of corpus luteal function in subjects in the non-pregnant state, which leads to progesterone deficiency in the first months of pregnancy.

General inspection

He suggests special attention to peculiarities of Constitution, the presence of obesity and hypertrichosis (excessive body hair), which may indicate the dysfunction of the endocrine glands.

Hormonal studies

Carried out in cases where it is possible to save the pregnancy at danger of abortion and early abortion, as well as if you suspect a failed abortion. Abortion in progress and incomplete abortion easily and accurately clinically diagnosed. Hormonal studies in such cases aimless.

Of diagnostic importance are:

  • the study of basal temperature (in the first 3 months of pregnancy);
  • colpocytology research;
  • the study of estrogens, progestins, COP 17, human chorionic gonadotropin in the urine and blood.

Basal temperature

The beginning of pregnancy is characterized by a hyperthermic action of progesterone, which causes a stable increase in the basal body temperature (measured in the rectum) above 37oC. After 12 weeks of pregnancy, this phenomenon disappears, which is probably caused by increased biosynthesis of hormones of fetoplacental complex with timodepressin action. When threatened abortion early pregnancy associated with lack of progesterone, basal temperature varies in the range of 36,5-36,9aboutWith, and for missed abortion, she also is always reduced.

The'pocitogramma

Threatened spontaneous abortion pathological smears reflect the changed hormonal balance and can be of two types: dystrophic and giperestrogennoy. Cytological and inflammatory types of strokes occur when the threat of abortion with the same frequency as in normal pregnancy, and not have diagnostic value.

The study of hormones

1. Determination of urinary total estrogen or estriol

Diagnostic importance is the study of the excretion of estrogens starting from the 12th week of pregnancy, and estriol — with the 20th week. The reduction of urinary excretion of estrogen or estriol 40% and more indicate a lack of ovarian function or the fetoplacental unit. The special value of this test is in diagnosing a failed abortion, when the excretion of estrogens is reduced especially sharply. The decrease in the content in the urine of estrogen to 1.7 mol\day 15-20 weeks of pregnancy and up to 3.5 μmol/day in 21-28 weeks indicates fetal death.

2. The definition of excretion of pregnandiol or the content of progesterone in the blood

Usually decrease excretion of pregnandiol or the content of progesterone in the blood is combined with estrogen deficiency; only in 10-15% of cases there is luteal insufficiency with normal secretion of estrogen. Diagnostic importance is the reduction of excretion of pregnandiol to 8 mmol/day or less before the 12th week of pregnancy and 18 µmol/day or less — at 13-18 weeks. The content of progesterone in the blood of less than 50 nmol/l at 12-13 weeks gestation, less than 80 nmol/l in 16-17 weeks and less than 170 nmol/l at 24-28 weeks indicates inadequate production of hormones of the corpus luteum. For missed abortion, diagnostic value of the determination of pregnandiol or progesterone is lower than estrogen; their concentration usually decreases when expressed clinical signs of fetal death.

3. Determination of urinary human chorionic gonadotropin

The greatest diagnostic value of this test is in the 1st trimester of pregnancy. The reduction of urinary excretion of human chorionic gonadotropin by 40% or more in comparison with normal values indicates the failure of the tissues of the chorion. For missed abortion, with a delay of the ovum in the uterus human chorionic gonadotrophin in biological fluids of the pregnant organism may be in the normal range. Sufficient information can only be obtained by repeated determination of the content of hormones in dynamics.

4. Determination of urinary 17-KS

Research is essential in cases of suspected androgenization pregnant as a cause of miscarriage. The increase of urinary 17-KS up to 45 µmol/day or more can be considered a cause of spontaneous abortion is a hyperandrogenism (increased levels of male sex hormones).

5. The definition of the content of human chorionic somatomammotropin in the blood

The most valuable determination of hormone for missed abortion: a decrease in the content of his MK to 50 g/l at 12-17 weeks of gestation and up to 75 MK g/l after 17 weeks indicates developing pregnancy.

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