In the outpatient clinic, patients often encounter patients holding blood lists or ultrasound lists to consult: "Doctor, can you help see it, is my baby not OK?" Did he or she stop developing? ”
How to judge that the fetus has stopped developing?
1. Calculate the true gestational age:
First of all, the doctor needs to know the number of days of conception, that is, the gestational age. What doctors call gestational weeks is based on standard menstruation, a 28- to 30-day menstrual cycle. For example, if your menstrual cycle is regular, then the number of menopause weeks is what the doctor calls gestational weeks; and if your menstrual cycle is 40 days, then the number of menopausal weeks minus 1.5 weeks is your gestational week. This is to calculate the gestational age through the menstrual cycle, which is convenient but also has a large deviation.
Nowadays, a considerable number of people are calculating pregnancy, for example, some people measure the basal body temperature, some people use ovulation test strips, and some people monitor ovulation in the hospital, then the calculation of gestational weeks is: the number of weeks of the same room day during ovulation + 2 weeks. In general, the assumption of gestational age is the basis for doctors to determine whether embryonic development is normal.
With this foundation, the doctor can roughly determine whether the fetus is developing normally. Usually the fetal sac appears at 5 weeks and the fetal heart rate appears at 7 weeks. Then the criterion for judging fetal stoppage must not be the average, but the worst case. The first thing to introduce is the gold standard for judging whether embryonic development is normal--- ultrasound.
2. The decline in blood progesterone does not indicate fetal death:
Progesterone is an important hormone to support pregnancy, in the early stages of pregnancy is produced by the ovaries, during which it will fluctuate upwards, to 8-9 weeks of pregnancy, with the appearance and enlargement of the placenta, the placenta secretion of progesterone gradually increases, then the ovaries have launched the historical stage, but in this task handover process there will be a small peak of blood progesterone decline. Even if the fetus is alive, progesterone will not last long, and slight fluctuations are possible.
Conversely, after the fetus dies, it speaks to the mother: "Don't give me nutrition!" I can't do it anymore. "Therefore, progesterone will be very low, generally below 5ng/dl, more prompt fetal stop." However, because many pregnant women now use progesterone to protect the fetus during early pregnancy, the significance of progesterone interpretation is greatly reduced.
3, blood hcg does not fall is not the fetus is still alive:
HCG, whose English name is human chorionic gonadotropin, doubles in 48 hours when HCG < 5000-6000 IU/L in early pregnancy, and then continues to grow, but never longer. However, the rise of HCG is also heady, generally around 100,000, and there are also as high as 200,000.
However, the rise in HCG indicates that the trophoblas of the vegetative embryo are still alive, not that the embryo is still alive. In most cases, HCG declines and the early pregnancy response disappears in the early stage of embryonic cessation, while a few cases that are not rare are that HCG continues to rise, the early pregnancy response remains the same, and ultrasound has indicated fetal cessation.
So don't think that HCG is still rising and the fetus is still alive.
4. The gold standard for diagnosing fetal arrest: ultrasound
The early embryos observed under ultrasound are divided into several parts: fetal sac, yolk sac, fetal bud. Among them, the one that really develops to the end of becoming a fetus is the fetal bud, and the others will either gradually atrophy (yolk sac) or become an accessory product of the fetus.
There are three conditions that suggest fetal arrest:
Growing fetal sac without fetal buds;
Fetal buds that no longer grow, never show the fetal heart;
The fetal bud appears in the fetal heart and then disappears again.
The presence of any of these three conditions indicates fetal arrest.
The most easily understood fetal stop in ultrasound reports is the fetal heartbeat from present to non-existent.
And how to judge that the fetal sac is long but not the fetal bud? If the average diameter of the gestational sac ≥ 2.5cm, and no fetal buds appear, it can be clearly diagnosed that the fetus has stopped, and it is very common to wait blindly in the clinic, and the gestational sac grows to 5cm and still waits obsessively, but it is not a minority.
How to make a judgment on the fetal heart that does not appear for a long time? If the fetal bud is larger than 7 mm without a fetal heartbeat, it indicates abnormal fetal development.
In addition, ultrasound also often mentions the yolk sac, it is actually a nutritious fetal bud of the east, if there is no fetal heart after 11 days after the yolk sac, then do not continue to wait.
In general, fetal arrest should be judged from the calculation of the gestational week, with ultrasound as the main line, and reference to blood HCG and progesterone.
The above is Professor Chen Weilin of Union Hospital's narration on the judgment of fetal stoppage. Why does fetal arrest occur? In addition to fetal cessation caused by problems with chromosomes themselves, some hidden dangers in the body of expectant mothers are also the culprits that lead to fetal cessation. Before preparing to become pregnant, expectant mothers can minimize these hidden dangers by adjusting their living habits, conditioning their bodies, and pre-pregnancy examinations.
For expectant mothers who have a history of fetal cessation, we must carefully investigate the causes of fetal cessation, actively treat symptomatically, and eliminate the physical hidden dangers that cause fetal cessation to ensure that re-pregnancy can be smooth.
There are several causes of fetal arrest
1. Insufficient function of the luteum:
Progesterone that supports embryonic development comes from the mother's ovaries during the first 8 weeks of pregnancy and from the placenta after 8 weeks. If the ovarian function of the mother-to-be is not good, the body cannot secrete enough progesterone to maintain the development of the embryo after pregnancy, which may lead to the problem of fetal cessation.
Therefore, for expectant mothers with irregular menstruation and poor corpus luteum function, it is best to adjust the body and improve the endocrine disorder before preparing for pregnancy. For expectant mothers who have stopped having a baby due to poor luteal function, it is best to supplement progesterone under the guidance of a doctor as soon as possible when pregnant again to maintain normal hormone levels.
2. Abnormal thyroid function:
In addition to the insufficiency of the luteal body, another important reason for fetal cessation due to endocrine disorders is abnormal thyroid function. Expectant mothers with hyperthyroidism or hypothyroidism can lead to embryonic abortives, miscarriages, or fetal malformations.
Because many people with thyroid dysfunction do not have obvious symptoms, it is recommended that expectant mothers have relevant tests to rule out during pre-pregnancy tests.
3. Uterine abnormalities:
There are many types of congenital or acquired uterine abnormalities, such as uterine mediastinum, uterine fibroids, uterine cavity adhesions, etc., all of which are at risk of fetal abortation. Fortunately, a large part of the uterine abnormalities can be found in time by specialized examinations such as ultrasound B ultrasound, and treated and improved before pregnancy.
Expectant mothers who have stopped having a fetus because of uterine abnormalities must first treat the relevant diseases of the uterus before preparing for the next pregnancy.
4. Infection:
Usually during preconception check-ups or first-trimester maternity check-ups, doctors will recommend that expectant mothers perform eugenic five tests, also known as teratogenic five (TORCH). Through the examination of virus antibodies, it is determined whether the mother-to-be's body is in the acute infection period of a certain virus. If the mother-to-be is in an acute period of infection with a virus such as rubella, giant cell, or toxoplasma, it can indeed lead to deformity or death of the embryo.
It is recommended that expectant mothers spend the acute infection period, and it is more appropriate to conceive again after the IgM antibody turns negative.
5. Advanced age:
As expectant mothers age, the chances of fetal cessation gradually increase. The latest data show that expectant mothers are between the ages of 20 and 30, and the probability of fetal cessation is only 9% to 17%; if they are 35 years old, the proportion rises to 20%; the proportion of 40 years old rises to 40%; by the age of 45, the proportion is as high as 80%.
6. Have a history of spontaneous abortion:
With a history of spontaneous abortion, the risk of fetal abortation increases. Therefore, once a spontaneous abortion occurs, it is necessary to find out the cause and actively treat it so as not to affect the second pregnancy.
7. Smoking and drinking:
This may result in embryo closure or teratogenicity. Therefore, throughout pregnancy, expectant mothers should try to maintain a healthy lifestyle.
8. Careless medication:
If the expectant mother takes aspirin, ibuprofen and other antipyretic analgesics in the early stages of pregnancy, there is a risk of fetal cessation. Therefore, if it is a mother-to-be who is planning to become pregnant, you should understand that the symptoms of drowsiness, headache, and even low-grade fever and other similar colds in the first trimester of pregnancy may be a manifestation of the reaction during pregnancy, and the medication must be cautious.
9. Low folic acid level:
If the concentration of folic acid in the mother-to-be is too low, it will increase the risk of fetal cessation at 6 to 12 weeks. Therefore, it is recommended that expectant mothers who are planning to become pregnant start supplementing with small doses of folic acid from the first 3 months of pregnancy.
10. Sperm abnormalities:
Studies have found that abnormal sperm from expectant fathers may lead to the appearance of vacuular eggs, that is, the gestational sac has developed to a large size, but there is no fetal bud.
Therefore, in the preparation stage of pregnancy, the father-to-be should try to work and rest regularly, quit smoking and alcohol, and maintain a healthy lifestyle, which is of great help to improve the quality of sperm.
Maintain a healthy lifestyle, actively eliminate the causes, prepare for pregnancy, and wish everyone a good pregnancy as soon as possible!