Many pregnant women are faced with a doctor’s diagnosis such as the threat of termination of pregnancy. Quite often this term can be heard in the early stages. Even before conception, during pregnancy planning, a representative of the fair sex must prevent the threat of miscarriage from occurring in the future.

If you had to deal with this diagnosis already during pregnancy, then you should not worry or panic, since this condition can be successfully dealt with.

Threatened miscarriage: what is it?

The possibility of miscarriage is a scary situation that any pregnant woman can face. According to statistics, spontaneous abortion occurs in 10-20% of cases, and more than half of them occur in the early stages (from the moment of conception to 22-23 weeks). Other women face the risk of premature birth between 22-23 and 37 weeks.

Threat of early pregnancy loss is more dangerous, since if a woman does not seek help in a timely manner, the fetus may not be saved. In cases of premature birth, children survive thanks to modern technologies and advances in medicine. That is why doctors, when detecting a threat of miscarriage, strive to prolong the pregnancy (increase the period of intrauterine development of the child).

Reasons for the threat of miscarriage in the early stages

Every woman should know about the factors that can cause a miscarriage. The reasons for the threat of miscarriage may be different. Some of them are genetic. Violations of the chromosomal and gene structure of the fetus are accompanied by malformations of its development.

Pregnancy can be terminated from conception to 8 weeks if the violations are incompatible with life. In case of pathologies compatible with life (for example, Patau, Edwards, Down syndromes), a miscarriage may not occur, but the threat of termination of pregnancy will accompany the woman throughout the entire pregnancy.

A representative of the fair sex in this position is subject to various infections. They do not pass without a trace. Even the most seemingly harmless diseases can lead to tragic consequences. Miscarriages are very common due to infections. Only competent and timely treatment of diseases can prevent fetal death.

Pregnancy may be terminated by immunological reasons. For example, some women with a negative Rh factor who are carrying a child with a positive Rh factor may experience Rhesus conflict: The mother’s immune system may react inadequately to the fetus, since it is half a foreign body. However, this only happens to 30% of women. In the remaining 70%, the immune system does not respond to the fact that the fetus has the opposite Rh factor.

Another reason for the threat of miscarriage in the early stages is hormonal imbalance. It is known that pregnancy is supported by certain hormones produced in the female body. Deviations from the norm can negatively affect the condition of the fair sex.

For example, one of the reasons for a miscarriage may be hyperprolactinemia when there is an increased level of prolactin. In the early stages, this hormone inhibits the production of the main hormone that supports pregnancy - progesterone. If its level decreases, a miscarriage may occur.

Another hormonal reason for the threat of interruption of the “interesting situation” is hyperandrogenism, characterized by an increase in the level of production of male sex hormones in a woman’s body.

Irregularities at work thyroid gland- another reason, the consequence of which may be a miscarriage. Thyroid hormones are very important for the normal course of pregnancy. A risk to pregnancy can occur with both hyper- and hypofunction of the thyroid gland.

The threat of miscarriage in the early stages is also pathological cervical condition and the isthmus of the uterus, called isthmic-cervical insufficiency. They are not able to hold an expanding fetus. As a rule, a miscarriage with this condition occurs at 12-18 weeks of pregnancy. With timely diagnosis, disastrous consequences can be avoided, since the pathology can be corrected.

Anomalies in the structure of the genital organs can lead to miscarriage. Disturbances in the anatomical structure of the uterus (bicornuate uterus, the presence of a septum in its cavity) are often combined with a lack of sex hormones. All this is the reason for the inferiority of the muscular layer of the organ in which the fetus should be born.

The development of pregnancy can be affected by various injuries. Concussions are especially dangerous: past injuries that disrupted the brain’s blood circulation can be recalled after conception.

Thanks to timely diagnosis of any abnormalities, the threat of miscarriage can be prevented. At the slightest symptoms of this condition, you should contact a medical facility for help.

Symptoms of threatened miscarriage in the early stages

One of the signs of an impending miscarriage is nagging pain lower abdomen, lower back pain. At the beginning of pregnancy, discomfort in the lateral parts of the abdomen may make itself felt. They are not related to miscarriage, since their occurrence is associated with changes in the ligaments of the uterus.

Blood, secreted from the genitals, may indicate the presence of a threat of termination of pregnancy in the early stages. Unfortunately, some women perceive it as their period. This point of view is absolutely wrong. There cannot be menstruation during pregnancy.

Even a small amount of bloody discharge signals an unfavorable course of pregnancy. In the early stages, the cause of their occurrence lies in the detachment of the fertilized egg.

Hypertonicity of the uterus- another symptom of a threatened abortion in the early stages. Increased tone in the 1st trimester can be observed on the back or front wall of the uterus. The woman does not feel it, but this is determined by ultrasound. This condition may be the result of psychological stress. For such a woman, the doctor prescribes the necessary antispasmodics and recommends repeating an ultrasound scan after 10 days.

In a condition called total hypertonicity, the uterus becomes “stony” and painful sensations occur. For doctors, this is a sign of a threat of miscarriage. The sooner it is diagnosed, the easier it will be to maintain the pregnancy, so it is very important to monitor the condition of your body and, if you suspect it, you should immediately consult a doctor for help.

Possible treatment for threatened miscarriage

If the condition of a pregnant woman does not cause serious concern, then the specialist may prescribe outpatient treatment. The pregnant woman will have to maintain psychological as well as physical rest. Some women are prescribed sedatives if necessary, because they are very anxious and worried that the baby they carry under their hearts is in danger.

If there is a strong threat of miscarriage, the woman is hospitalized in gynecological department. She finds herself isolated from her relatives, friends, and work. For many this is beneficial. This makes it easier to concentrate on your baby and push all problems and worries into the background.

A woman staying in a medical facility feels especially protected, because if necessary, she will quickly receive qualified assistance.

Specific treatment for threatened miscarriage in the early stages depends on the cause of its occurrence. For example, if there is a possibility that a miscarriage may occur due to hormonal imbalance, then certain hormones are prescribed to promote the normal course of pregnancy.

If an ultrasound and examination reveals isthmic-cervical insufficiency, then doctors put sutures on the cervix, thanks to which the fertilized egg will not be “released” from the organ. The operation is performed under general anesthesia using drugs that relax the uterus.

When immunological factors are identified, treatment of threatened miscarriage in the early stages is aimed at suppressing the production of antibodies.

If a woman has uterine tone, then medications are prescribed to relieve spasm of the uterine muscles. Most often, such drugs are administered using a dropper.

In the presence of infectious, chronic, inflammatory diseases, the doctor will prescribe appropriate treatment.

Prevention of threatened miscarriage in the early stages

In any situation and for any illness, it is much easier to take preventive measures than to find yourself in a situation in the future in which medical workers can no longer help.

Any woman needs in advance plan a pregnancy. This preparatory period is of great importance. During planning, various examinations are carried out and tests are taken. Thanks to all this, you can find out if your partners have any problems or diseases that could lead to a risk of miscarriage after conception.

Don't forget that planning can take a long time. By starting to prepare for conception early, you can significantly improve your health.

A pregnant woman should regularly visit a doctor who monitors her condition and the development of the fetus. The main goal of pregnancy monitoring is to identify possible risks and pathologies as early as possible. Only timely diagnosis can have an impact on the course of pregnancy, child development and childbirth.

During pregnancy, it is necessary to protect your body from stress, overwork, because all this weakens the immune system. This can lead to the appearance of various diseases, which may result in the threat of miscarriage in the early stages.

Representatives of the fair sex in position, leading healthy lifestyle and those who wish to engage in physical exercise should consult a doctor about this. He will help determine whether a woman has any contraindications for exercise, and will recommend specific exercises that will not harm either the expectant mother or her baby, but will only benefit both.

If there are any infectious, inflammatory diseases There is no need to self-medicate and take medications that the doctor did not prescribe. In general, during pregnancy you should protect yourself from illnesses, since taking medications during this important period for any woman is undesirable. If, nevertheless, it was not possible to avoid infections, then you need to strictly follow the treatment prescribed by the doctor and follow all his recommendations. Only an experienced specialist can prescribe medications that will not harm the fetus.

A pregnant woman with or without a threat to her position shouldn't worry. It is worth reminding yourself as often as possible that at the moment the most amazing and wonderful days are going on in life. You need to enjoy this period. You should pay special attention to your diet, sleep patterns, walks, and work.

A woman must learn to relax, discard bad thoughts, and avoid negativity. This is the only way to achieve the birth of a healthy, nice and strong baby.

Thus, most life situations in which the threat of miscarriage makes itself felt can be safely avoided. It is very important to plan ahead for your pregnancy. Examinations will help identify reasons that may lead to the loss of a child in the future.

The emerging threat of termination of pregnancy means that a woman can lose her child at any stage - from the first to the last day. According to statistics, every second woman faces this diagnosis, but only 20% of pregnancies end in miscarriage and most of them are under 12 weeks.

There are many reasons for termination of pregnancy. Doctors classify the threat into two types: before 22 weeks of pregnancy - we are talking about the threat of miscarriage and after 22 weeks up to 37 weeks - premature birth. This division was led by the fact that children born as a result of premature births are able to survive and become productive members of society.

The threat of miscarriage is characterized by the following signs:

• aching and nagging pain in the lower back and lower abdomen;
• bloody and bloody discharge from the genital tract.

Pain in the lower abdomen is similar to menstrual pain, but it is found in the central part, right above the womb. If similar symptoms occur on the sides, then the pain is associated with physiological stretching of the uterine ligaments and does not pose a danger.

Increased tone of the uterus can be local, it affects one of its segments - the back or front wall, while in the early stages the woman does not feel the tone. It is usually determined during an ultrasound as a reaction to the procedure.

If hypertonicity is diagnosed in the second trimester, this indicates high excitability of the muscular layer of the uterus and a true threat of interruption.

There is also total hypertonicity of the uterus, in which tension covers the organ completely - the uterus seems to “turn to stone.” This condition is accompanied by nagging pain. Total uterine tone appears from the second half of pregnancy and can periodically occur until the onset of labor.

Its appearance means a threat of interruption, so the woman should undergo examination and an appropriate course of treatment in a hospital. Sometimes total hypertonicity is confused with training hypertonicity, but the latter appear only from the 30th week of pregnancy, they are painless and short-lived in nature.

Bloody discharge that appears during any week of pregnancy is a dangerous sign, even if it is very small. Symptoms of bleeding indicate that there are problems with the connection of the fertilized egg or placenta with the uterine wall (depending on the stage of pregnancy).

Also, spotting appears when or has begun. This condition can be diagnosed using ultrasound.

Reasons

Hormonal disorders

Malfunctions that occur in the functioning of the internal secretion organs are dangerous during pregnancy. For example, insufficient progesterone levels lead to miscarriage. This hormone is necessary for the body until 16 weeks of pregnancy, as it temporarily takes over the functions of the unformed placenta and is responsible for the safety of the fetus.

Androgen imbalance is also undesirable for pregnancy - these are male hormones. High levels of which can lead to miscarriage.

Immune and genetic factors

In the first trimester of pregnancy, miscarriage usually occurs due to chromosomal or genetic abnormalities. These mutations lead to gross abnormalities in the development of the fetus, due to which it becomes non-viable. That is, such a pregnancy, in the language of scientists, is subject to “natural selection” and there is no point in preserving it.

The immune factor in the case of a miscarriage is unpredictable, since the body itself rejects the fetus, perceiving it as a “foreign body” due to the antibodies that have appeared against it.

Maternal diseases

Illnesses of a woman at any stage of pregnancy can provoke the threat of miscarriage. Diseases can be both chronic and acute. Diabetes mellitus, heart defects, appendicitis, influenza, cytomegalovirus and herpes infections, and other diseases become a threat to the fetus.

It is important that a woman’s medical history contains information about all the diseases she suffered during her life.

Psycho-emotional reason

Only in the presence of the above factors - maternal illness, immune and hormonal imbalances, stress can accelerate the process of miscarriage or the onset of premature labor.

Pathologies of pregnancy

In this case, we are talking about gestosis in the second half of pregnancy, premature placental abruption, placental previa or polyhydramnios. These pathological factors interfere with the normal blood supply to the placenta, causing the fetus to lack nutrients and oxygen, which negatively affects its development.

In such cases, doctors prefer not to hesitate and recommend urgent delivery, taking into account the information contained in the patient’s medical history: the condition of the fetus and the results of diagnostic examinations (CTG, ultrasound).

Isthmic-cervical insufficiency

This is a complication that results from abortions and childbirth that a woman has had previously. During them, the isthmus and cervix could be injured, and with the development of a new pregnancy, the damaged muscles simply cannot support the growing fetus.

Usually, isthmic-cervical insufficiency is diagnosed at 16-18 weeks - the pregnancy is terminated. This can be avoided by using pre-placed sutures on the cervix, but it is impossible to predict this situation.

Information about past abortions and childbirths should be contained in the woman’s medical history, which will allow the doctor to be on the safe side and additionally monitor the patient in case of isthmic-cervical insufficiency.

Injuries

Bruises, head and abdominal injuries, and concussions can pose a threat to pregnancy. If a woman's medical history includes information about a history of concussions, this should also be noted. Since impaired blood circulation can negatively affect the hypothalamus and pituitary gland - endocrine glands that produce hormones, an imbalance of which can lead to the threat of interruption.

Treatment

Treatment of threatened miscarriage always begins with eliminating the root cause of the pathological condition; the medical history must contain complete information about the diagnosis and treatment of the patient. The woman is also prescribed symptomatic therapy, which should be carried out against a background of bed rest and sexual rest.

If a woman discovers alarming symptoms of a threatened miscarriage, she needs to immediately inform the doctor.

If blood discharge appears, you should immediately call an ambulance.

1. If the cause of the threat is hormonal imbalance, which often happens in the first trimester of pregnancy, the patient is prescribed compensatory hormonal therapy. To compensate for the lack of progesterone, the doctor prescribes the drugs Utrozhestan (suppositories) and Duphaston (tablets). Progesterone injections may be prescribed as an additional measure. The dose of the hormone is selected individually by the attending physician. Treatment with progesterone drugs can last up to 22 weeks of pregnancy.
2. If the threat of interruption arose due to infectious or viral diseases, as evidenced by the patient’s medical history, she is being treated with antibiotics and antiviral drugs. It is advisable to carry out treatment as early as possible to avoid negative effects on the fetus. But not all antibiotics are allowed in the first trimester, since at this time the formation of all the vital systems and organs of the fetus occurs, so in the first weeks of pregnancy, taking any medications should be kept to a minimum.
3. Local hypertonicity, which is diagnosed during an ultrasound examination, does not require specific treatment. It is usually explained by the woman’s anxiety before the procedure.
4. If you experience nagging pain after physical activity, you can independently administer a Papaverine suppository or take a No-shpa tablet. But if there is a recurring situation with nagging pain, there may be a threat of termination of pregnancy, so it is better to consult a doctor. Nagging pain may be a sign of uterine hypertonicity, which is treated in a hospital setting with antispasmodic drugs - Papaverine, No-shpa or Platiphylline. They are introduced into the body in the form of injections, so they begin to work faster.

From the second trimester of pregnancy, it is more effective to replace antispasmodics with magnesium droppers. They normalize and improve blood flow in the uterus and placenta, ensuring relaxation of the muscular layer of the uterus.

According to statistics, every 10 pregnancies end in fetal rejection.

In most cases, the woman does not even suspect this, since a miscarriage occurs a few days after conception, when the fact of pregnancy is not established.

However, there are risks of embryo rejection at a later stage.

The risk of miscarriage is the risk of spontaneous abortion.

An early miscarriage is considered to be a pathology that occurs during the first 12 weeks after conception.

The critical period is 2-3 weeks, when the chorion is implanted into the endometrium of the uterine wall. At this time, it makes sense to talk about biochemical pregnancy.

The body may mistake the embryo for a foreign body and provoke its rejection.

A smear is taken from 3 places: the mucous plug of the cervix, the urethra, and the epithelial layer of the vagina.

The samples are dried, first placed on glass, and examined under a light microscope, staining the material with contrast agents.

A set of tests is considered a guarantee of identifying a threat of miscarriage

• Hormone analysis.

It is carried out to identify a deficiency or excess concentration of hormones such as prolactin, testosterone, progesterone, substances produced by the thyroid gland. A change in the normal level is a warning about the threat of miscarriage.

• Analysis for the presence of antibodies to lupus anticoagulant and hCG.

For a number of reasons, a woman’s body can produce antibodies to hCG, human chorionic gonadotropin, which is necessary for the normal course of pregnancy. In this case, the risk of spontaneous abortion increases significantly.

In addition, the blood is tested for the presence of antibodies to the lupus anticoagulant.

Their presence does not necessarily indicate the presence of lupus erythematosus, but makes it possible to identify an infectious process and decreased immunity.

• Analysis for Rh factor.

Every woman's Rh factor is determined during pregnancy. A positive Rh of the child and a negative Rh of the mother lead to a conflict, which is difficult to accurately predict, since it is almost impossible to take a fetal blood sample for research.

However, the conflict between the Rh factors of mother and child is accompanied by the formation of antibodies, which can be detected by analyzing a blood sample.

• Analysis for intrauterine infection.

A blood test to detect pathogens such as cytomegalovirus, toxoplasmosis, rubella, and herpes also helps determine the cause of a miscarriage or prevent its threat.

If the diagnosis is confirmed, treatment should be carried out in an inpatient department.

How to prevent the threat of miscarriage: what treatment can a doctor prescribe?

Throughout the treatment, the woman should be at rest, avoiding physical exertion and emotional stress.

Sex when there is a threat of miscarriage is contraindicated.

As a rule, a veto on intimacy is imposed by the patient’s attending physician. And only a specialist can remove this restriction when he considers that the danger has passed.

The following measures are used to prevent fetal rejection:

• administration of hemostatic drugs to block bleeding;
• the use of vitamin therapy to improve the general condition of the woman and fetus;
• maintenance hormonal therapy. If there is a threat of miscarriage, pills are prescribed or if a hormonal imbalance is detected to normalize progesterone levels;
• Treatment of threatened miscarriage is also aimed at reducing uterine tone and pain with the help of antispasmodics: no-shpa, intravenous magnesium.

Since the blood supply to the fetus is deteriorating, special means are used to normalize it: Actovegin, and others.

Personal experience

I had to face the diagnosis of “threatened miscarriage” only once - during my first pregnancy. At 7 weeks, spotting appeared. At first the discharge was very pale, even pink, but then it became.

The bleeding was not severe - only a few drops, but this was the reason for going to the hospital. Moreover, I had no other symptoms: pain, tone, etc. First, I called the doctor and described the symptoms. Then it was decided to go to the gynecologist.

There they processed me and scheduled an ultrasound for the next day to rule out a miscarriage and see if the fetus is developing. By this time there were no longer any discharges. But I was in the hospital. Treatment has not yet been prescribed either.

I had an ultrasound in the morning. They did it with a transvaginal sensor. The doctor was not in a good mood, there were many pregnant women, and she looked very painful. I will say more, this was the most painful examination of all the transvaginal ultrasounds I have done in my entire life.

Ultrasound revealed no pathologies, the heartbeat is normal, the fetus is developing. After the ultrasound, I began to smear scarlet blood, which really scared me. Apparently there was no need to go inside and conduct an abdominal examination. I told the doctor about this. She advised me to lie down more and prescribed treatment: , and Duphaston, 1 pc. at night for 2 weeks.

Treatment began on the same day. There were no more allocations. After 8 days I was discharged and I finished Duphaston at home. This problem did not arise again, and my first pregnancy ended in a successful birth.

Ksenia, 34.

How to maintain pregnancy: preventive measures

1. To prevent the threat of miscarriage, it is advisable to undergo treatment for chronic diseases.
2. It is necessary to get rid of bad habits, move more, and avoid stress.
3. Under unfavorable working conditions, it is better to switch to light work.
4. You need to adhere to a reasonable daily routine and undergo timely examinations prescribed by the gynecologist.

The threat of miscarriage is not a final death sentence. Most often, it is possible to maintain a pregnancy if you inform your doctor about it at the first sign of discomfort.

The threat of miscarriage can arise at any stage of pregnancy. If this condition occurs before the 28th week of pregnancy, then it is said to be threat of miscarriage, if after 28 weeks, then about the threat of premature birth. Recently, this diagnosis is quite common among expectant mothers, which is due to the intense rhythm of life of pregnant women, the environmental situation, the spread of infections, as well as the increase in the frequency of pregnancies after 35 years. Spontaneous abortion occurs in 10-20% of all pregnancies, with the majority of miscarriages occurring in the first trimester. If the pregnancy was terminated after 28 weeks, then they talk about.

Symptoms of threatened miscarriage are:

• Drawing and aching pain in the lower abdomen and lower back;
• Hypertonicity of the uterus;
• Bloody discharge from the genital tract; Moreover, the discharge can be either bloody or brown (traces of “old” blood).

Abdominal pain characteristic of a threat is usually localized centrally above the pubis, and may resemble pain during menstruation. Pain in the lateral parts of the abdomen is associated with stretching of the ligamentous apparatus of the uterus and has nothing to do with the threat of interruption.

Hypertonicity of the uterus can be local (a woman usually does not feel it), it is most often detected by ultrasound and affects only a small segment of the uterus (usually the anterior or posterior walls). In the first trimester of pregnancy, it may occur as a result of a reaction to ultrasound. If hypertonicity is observed at a later date, this indicates increased excitability of the uterine muscles, and the woman is at risk for the threat of miscarriage. In order to prevent this condition, she may be prescribed drugs that reduce the tone of the uterus (magnesium drugs (Magnesium B6, magnesium), papaverine in suppositories, no-spa).

Total hypertonicity characterized by the fact that the entire uterus “turns to stone.” It may be accompanied by painful sensations. Typically, total hypertonicity occurs in the second half of pregnancy, and can be observed until childbirth. The occurrence of such hypertonicity is regarded as a threat of miscarriage; treatment and examination in a hospital are indicated for the pregnant woman. Separately, we note that after 32 weeks of pregnancy, Bracketton-Higgs training contractions appear, but they are not accompanied by pain and their duration is short.

The appearance of bloody discharge at any stage of pregnancy a formidable symptom, even if the discharge is very slight. The appearance of such a symptom indicates a disruption in the connection of the fertilized egg (in the early stages of pregnancy) or the placenta (in later stages) with the wall of the uterus. Bloody discharge may be a symptom of a complication such as detachment. With partial placental abruption, a retroplacental hematoma occurs, which can be detected by ultrasound. Bloody discharge in a pregnant woman requires urgent hospitalization and ultrasound examination. Ultrasound is necessary for fetal assessment(presence of heartbeat and heart rate), assessment of uteroplacental blood flow, presence of retroplacentral hematoma.

In the second half of pregnancy, infections, hormonal imbalances, pathology of the blood coagulation system, immunological problems (), gestosis, polyhydramnios, and isthmic-cervical insufficiency most often cause a threat.

In order to identify the cause of the threat of interruption, an examination in a hospital is required.

What tests should be taken if there is a threat of miscarriage:

1. Clinical blood test, general urine test;
2. Coagulogram (expanded) + homocysteine ​​+ D-dimer;
3. A smear from the cervical canal for microflora and its sensitivity to antibacterial drugs (a vaginal smear is not suitable!);
4. A quantitative urine test for hCG (human chorionic gonadotropin) is performed in the first trimester;
5. Tests for TORCH infection (in the first trimester of pregnancy);
6. An ultrasound examination and examination by a competent obstetrician-gynecologist are mandatory.

Treatment of threatened miscarriage:

Treatment of this condition should begin with eliminating the cause of the threat of interruption. All other means of relaxing the muscles of the uterus are only symptomatic treatment. Sexual rest and bed rest are required.

The threat of termination of pregnancy in its first trimester is always accompanied by hormonal deficiency. Therefore, it is necessary to prescribe hormonal progesterone drugs to compensate for the deficiency. The drugs used are Duphaston (in tablet form) or Utrozhestan (vaginal suppositories). Injections of progesterone or 17-OPG are also additionally prescribed. Progesterone dosages are prescribed by your doctor. Obstetricians and gynecologists even have a saying: “There is no such thing as too much progesterone.” Progesterone preparations can be used until 20-22 weeks of pregnancy.

If the threat of interruption is due to pathology of the blood coagulation system(thrombophilia), then the pregnant woman is prescribed blood thinning drugs (anticoagulants). Their use helps to avoid the formation of microthrombi in the placenta, which leads to a threat. The most commonly used are Fraxiparine (subcutaneous injections) and chimes (tablets).

If the cause of the threat of miscarriage is infection (if microflora is detected in a smear from the cervical canal), then the prescription of antibacterial drugs is mandatory. If treatment is not carried out in time, then later it will be almost impossible to get rid of total hypertonicity.

After 12 weeks of pregnancy, magnesium is prescribed intravenously (rarely intramuscularly). Magnesia improves placental blood flow and relaxes the muscles of the uterus. After completing the course of magnesium, further intake of magnesium preparations (Magnesium B6) is indicated.

Taking sedatives is mandatory, but not the main method of treatment. A woman’s anxiety about the emerging threat only increases the likelihood of progression of the pathology, so valerian and motherwort are prescribed.

The second trimester of pregnancy continues from 14 to 26 weeks of gestation.

List of dangerous conditions

Anemia in pregnant women (usually iron deficiency anemia) ranks first and its frequency is 21-80%, depending on the geographic location of the woman’s residence.

In second place is the threat of miscarriage or late miscarriage, although in the 2nd trimester of pregnancy the risk of this complication is slightly lower than in the first and reaches 5-10%.

Causes of dangerous conditions

Factors that cause the threat of late miscarriage include:

• development of isthmic-cervical insufficiency (both anatomical and functional);
• uterine defects (uterine malformations, tumors);
• Rhesus conflict pregnancy;
• infectious processes, including sexually transmitted infections;
• premature rupture of membranes, leakage of water.

Anemia in pregnant women is caused by:

• unsatisfactory living conditions;
• poor nutrition;
• chronic intoxication (harmful working conditions, disturbed ecology);
• chronic somatic pathology (kidney diseases, gastritis, diabetes mellitus, chronic infections, cardiovascular diseases);
• existing anemia before pregnancy;
• bleeding during pregnancy;
• multiple pregnancy;
• a large number of births;
• frequent childbirth;
• heredity.

The fairly high incidence of placenta previa in the 2nd trimester of pregnancy is explained by the rapid growth of the uterus, especially from 18 to 22 weeks. Predisposing factors include:

• burdened obstetric and gynecological history (abortion, curettage, complicated childbirth);
• surgical interventions on the uterus;
• genital infantilism;
• gynecological pathology (fibroids, endometriosis, chronic endometritis).

Symptoms

Signs of a threatened miscarriage in the 2nd trimester are:

• the appearance of nagging/aching pain in the lower abdomen;
• hypertonicity of the uterus, both constant and periodic (the uterus is like a “stone”);
• the appearance of dark bloody discharge;
• When examined, the cervix passes through the tip of the finger or the entire cervical canal is passable for the finger).

Anemia in pregnant women is characterized

• the occurrence of weakness, fatigue,
• change in taste
• low blood pressure, dizziness and tendency to faint,
• skin and hair are prone to dryness,
• hair and nails become brittle,
• The pregnant woman looks very pale, blueness appears under the eyes.

Placenta previa occurs against the background of frequently recurring bleeding from the genital tract, which leads to anemia in the pregnant woman. The intensity of bleeding depends on the duration of pregnancy and the nature of presentation (lateral or complete). Bleeding is painless, can occur at rest and is characterized by the appearance of scarlet blood from the vagina.

Complications

All of the listed threatened conditions in the 2nd trimester of pregnancy contribute to the development of the following complications:

• fetoplacental insufficiency;
• delay in the development of amnion and chorion;
• worsening anemia with placenta previa and the threat of miscarriage;
• intrauterine growth retardation;
• anemia contributes to the risk of miscarriage and low placentation;
• chronic fetal hypoxia;
• spontaneous termination of pregnancy;
• anomalies of generic forces;
• complicated course of the postpartum period;
• anemia increases the risk of gestosis by 1.5 times;
• incorrect position and presentation of the fetus with placenta previa.

Treatment and prevention

Treatment of anemia in pregnant women involves prescribing a diet rich in protein and iron, as well as iron supplements. In case of anemia of degrees 2 and 3, a woman is subject to hospitalization, where she is prescribed iron supplements orally (in tablet form, iron is better absorbed by the body). These drugs include: tardiferon, sorbifer-durules, fenyuls and others. The number of tablets taken depends on the iron content of the drug. In addition, preventive treatment of threatened abortion and fetoplacental insufficiency is indicated. In case of intolerance to oral iron-containing preparations or in case of impaired absorption of iron in the intestine, parenteral iron preparations (ferrum-lek, venofer, ectofer) are prescribed. In severe anemia (hemoglobin below 60 g/l), red blood cell transfusions are indicated.

If bleeding occurs during placenta previa, the pregnant woman must be hospitalized. In the hospital, she is prescribed strict bed rest and psycho-emotional rest. Therapy is carried out aimed at reducing the tone of the uterus and preventing the threat of miscarriage. Antispasmodics (no-spa, papaverine, magnesium sulfate) and tocolytics (ginipral, partusisten) are prescribed. Preventive treatment of iron deficiency anemia with iron supplements is also indicated. Blood transfusions of red blood cells and fresh frozen plasma are carried out according to indications (in case of severe and/or repeated bleeding, a sharp decrease in hemoglobin). In parallel, treatment is carried out to improve uteroplacental blood flow (Trental, Chimes, Actovegin, Magne-B6, vitamins E, C and group B). Termination of pregnancy is carried out according to vital indications on the part of the mother.

The threat of late miscarriage is also treated inpatiently, where bed rest, antispasmodics, tocolytics, vitamins and metabolic drugs (improving uteroplacental blood flow) are prescribed. In the case of isthmic-cervical insufficiency, surgical treatment is indicated - suturing the cervix (from 13 to 27 weeks).

In the prevention of anemia, special attention is paid to proper and balanced nutrition, preventive intake of multivitamins and minerals, and normalization of the rest day regimen.

To prevent bleeding during placenta previa or the threat of miscarriage, a woman is advised to refrain from heavy physical activity and heavy lifting, avoid stressful situations and undergo preventive courses of treatment.

Forecast

Iron deficiency anemia can be cured in almost 99% of cases, and the prognosis for this condition is favorable for the woman; delivery is carried out through the natural birth canal.

The prognosis for placenta previa is always serious, and the percentage of successful completion of pregnancy depends on the type of presentation (the prognosis is worse with complete presentation), the frequency of repeated bleeding, the development of accompanying complications of pregnancy (anemia, fetal growth retardation) and other factors. In 90% of cases with incomplete presentation, labor ends surgically, with complete presentation there is an absolute indication for cesarean section.

The percentage of successful completion of pregnancy with the threat of miscarriage in the second trimester depends on the cause that caused it, timely and adequate treatment. However, in most cases, the threat of interruption in the second trimester is successfully stopped and reaches 75-80%.

Some studies during pregnancy