Obstetrics and Gynecology - A.M. Hromova 2000

Miscarriage and Post-Term Pregnancy
Miscarriage
Diagnosis of Premature Termination of Pregnancy

The evaluation protocol for women experiencing recurrent Pregnancy loss is complex and depends on several circumstances: whether the assessment is conducted during or prior to pregnancy, whether it is a first-time pregnancy complicated by the threat of Miscarriage, or if the patient has a history of recurrent pregnancy loss. The Scope of the investigation also depends on The Nature of the primary underlying pathology triggering the miscarriage.

A meticulously taken medical history helps to hypothesize the cause of pregnancy loss. By clarifying the patient's Complaints, clinicians investigate potential occupational hazards, lifestyle factors, childhood, adolescent, and adult illnesses, extragenital and gynecological pathologies, and contributing hereditary factors. Both subtle and overt disruptions of ovarian and menstrual function are also identified.

A physical examination focuses on the patient's body build, height, and weight. It is generally observed that pregnancy loss is more prevalent among women with disproportionate body structures (infantile, asthenic, or intersexual body types), obesity, or an android Hair distribution pattern.

Assessment of the Endocrine Function of the Corpus Luteum and Placenta

The pronounced Clinical symptoms of an inevitable, complete, or incomplete Spontaneous Abortion typically obviate The Need for additional laboratory workups. However, diagnosing the regression of pathological symptoms (following effective Treatment) necessitates mandatory hormonal assays: measuring the levels of fetoplacental complex Hormones in the body, as well as specific hormones produced by the maternal endocrine Organs. The greatest prognostic value lies in the quantification of human chorionic gonadotropin, progesterone, estrogens (specifically estradiol and estriol), placental lactogen, and 17-ketosteroids (17-KS).

Functional diagnostic tests offer a more stable and equally informative approach for evaluating patients with pregnancy loss. A sustained or intermittent drop in basal body Temperature to 37°C or lower serves as an objective indicator of a threatened miscarriage. Determining the cellular composition of vaginal smears is another crucial tool in managing spontaneous abortion, as shifts in cytological patterns are most often associated with decreased progesterone production or an altered progesterone-to-estrogen ratio. A normal pregnancy is characterized by a "gestational" smear type, distinguished by a predominance of intermediate navicular-shaped vaginal epithelial Cells arranged in layers, alongside low karyopyknotic and eosinophilic indices.

Assessment of Uterine Contractile Activity

An increase in uterine contractility is a hallmark symptom of threatened preterm labor. It is identified through uterine Palpation, tocography, hysterography, and tonometry. In each individual case, it is essential to detect excessive labor activity promptly.

Because instrumental recording of uterine contractions can detect the Cytology/cytology/16.html">Early stages of a threatened miscarriage much earlier than the patient's subjective sensations, it is advisable for high-risk patients to undergo contraction monitoring in an antenatal clinic Setting. If four or more uterine contractions lasting 40–50 seconds or longer occur within a one-hour period, hospital admission is indicated. Timely initiation of treatment in these cases prevents preterm labor in 85% of women. The presence of 3 to 5 or more contractions per 10 minutes, accompanied by cervical effacement and 2–3 cm of dilation, indicates rapidly progressing preterm labor.

Fetal condition is evaluated through Auscultation of the fetal Heart rate, ultrasound assessment of the biophysical profile, dopplerimetry, and measurement of serum fetoplacental complex hormone levels.

Stress tests (such as the oxytocin challenge test, cold pressor test, or step test) should be avoided during cardiotocography (CTG). CTG is typically performed once a week, or more frequently in cases of combined pathology. During labor, CTG parameters are monitored continuously. The CTG signs of Hypoxia are identical for both preterm and term fetuses.

Assessment of fetal lung maturity is indicated when deciding on operative delivery via Cesarean Section in a preterm pregnancy, or when considering pregnancy prolongation following Premature Rupture of membranes in the third trimester, alongside the need to implement fetal respiratory distress syndrome prophylaxis. The simplest and most widely used METHOD FOR DETERMINING fetal lung maturity is the foam stability test (Clements ethanol test).

Ultrasound signs of a threatened miscarriage include: a decreased ratio of cervical length to its diameter at the level of the internal os, widening of the cervical canal in the region of the internal os, thinning of the anterior uterine wall in the lower uterine segment, herniation of the gestational sac into the cervical canal, and increased myometrial tone. Ultrasound also enables the evaluation of fetal lung tissue maturity.