The story began for me a long time. Pregnant, my childhood friend. Once our parents were friends. We met on birthdays, went along for a vacation. She married a tall and handsome boy who grew up and was very competent and popular programmer. At the newlyweds had a spacious apartment, loving family, a good job, a very bright and warm relations. A year after the wedding, the guys are thinking about the child, and within a month or two on the test were two strips. What could be better?
I often think that there are couples who absolutely have to have children. It is in these pairs remains of the gene pool of our long-suffering country. It is a family where the parents are required to seriously deal with the upbringing and education of their children is the family, where parents deserve to be unattainable, or just elusive ideal. It is a pity that in such families seldom many children ...
The first months of pregnancy, consisting of a set of smiles, greetings and gifts. It was a tournament of the future grandparents - Young gave the book about the development of pregnancy and child-rearing with vivid illustrations and even began to repair children's future.
When it is time to get registered in the antenatal clinic, it was not even a shadow of a doubt. Whom to register? Of course, a childhood friend! My friend, however, was in a vacation on the seas and going back until the end of August, but who and when it stops. Especially since all feel fine, and they do not hurt. And do not even sick. And life was bright and beautiful.
She came to get registered at the 12th week of pregnancy. She was elated, radiant skin and a delicate blush on the cheeks slightly tanned. We got a blank history of pregnancy and started to fill the solemn columns. The point is not fast, and also want to be careful and knowing (what to do, youth!), So that for inspection at the chair we crawled forty minutes.
The uterus was sluggish, testovatoy slightly increased in size. I froze spin. I frantically thought, "What am I to say? And how? What if I'm wrong? And when there was menstruating? Make a mistake here, as well ... "confirmed the US - developing pregnancy . Embryo stopped in development in the period of 5-6 weeks ...
Of course, this story has a happy ending. Of course, nothing terrible has happened, and after a couple of years the boys was born a wonderful blue-eyed girl. In my opinion, she is in school. All had been ill, pereplakalos, survived. But for me this was the very first chapter in a long-predlinnoy book of human destinies and sorrow. Every year the "missed first trimester" pregnancies is becoming longer. According to official data, the frequency of developing pregnancy Among the cases of miscarriage in early pregnancy increased from 10-20% to 45-88%. According to the same official data, this is due to more widespread use of ultrasound in early pregnancy. No, it does not hurt US! Just got better equipment, ultrasound method has become more accessible - so often began to put such a diagnosis. Before a woman is admitted to the hospital with bloody discharge, and, with the diagnosis "in the course of an abortion" performed scraping. Who is it understood, whether the embryo is alive! The woman would be saved.
When genetic research abortions in the 60-80% found chromosomal abnormalities in embryos. Yes, these children were not viable. Yes, it's natural selection. Despite the fact that we invented antibiotics and djufaston Tranexam, nature is still trying to save Homo sapiens genetically intact: 46HH- girls, 46XY - boys. I wiped away many tears over the last 10 years of practice. I myself am always very painful and sick as if I'm guilty of something like this, I could not, failed, failed. I frowned and said very stern voice: "You want a healthy baby? Or anyone? "
One fetal loss - it really is not a tragedy. It found that the risk of pregnancy loss after the first miscarriage is about 16%. The same is likely to lose the pregnancy without any apparent reason any woman. But if it happens again - much worse prognosis. After two episodes of spontaneous abortion risk of loss of a wanted pregnancy increases by more than 2 times and amounts to 36-38%. In women with no living children, ie, with primary recurrent pregnancy loss, the likelihood of pregnancy loss as high as 40-45% after the third spontaneous abortion.
At the XVII FIGO Congress was asked to consider developing pregnancy combined with chronic endometritis in 100% of cases, regardless of the underlying cause of abortion. That is, in any case after developing pregnancy, we must treat chronic endometritis! In connection with this radically changed tactics emptying the uterus from the remnants of fetal eggs. Scraping, as adopted in our country, can greatly aggravate the inflammatory changes in the endometrium. Preference should be given gentle vacuum aspiration, or if time permits, medical exile.
Habitual miscarriage - a serious problem. We all are adults and smart, we had no hesitation to utter such a long and obscure words like "hyperhomocysteinemia", "antiphospholipid syndrome", "medium thrombophilia polymorphisms of genes." We're all right, we try to stay within the framework of evidence based medicine - «evidence-based medicine." So why get so bad? Why so many failures? This is a topic of turbulent scientific discussions. These are issues on which the future depends. The girls want a child so it is today. Boy. Or the girl, not the essence.
History № 1. Unhappy
She was 39 years old. She is a beautiful, successful business woman. In 2001, she gave birth to a girl without any problems. Then he married again and, of course, wanted to have another child from the new beloved husband. Pregnancy occurred quickly and easily. Bleeding at 12 weeks was a bolt from the blue. She had no time to recover, to look like doctors pronounced "spontaneous abortion in progress" and remove the remnants of the failed child sharp curette. It is quite strong and strong-willed woman. Having spent some time looking for a doctor, started to prepare for the next pregnancy. Again, the pregnancy is very easy. And everything was going well and not sick. She flew as on wings. Now all will definitely be good. In June 2010, a period of about 10 weeks, the embryo has ceased to evolve. No heartbeat, no perturbations - missed abortion She scraped again . But! She was determined to become a mother again . It was a course of rehabilitation, put the mountain of expensive tests . In the Hematology Research Center was found consultant - Professor, with which began a new cycle of training pregravid . Pregnancy come easily, but held very different . She desperately wanted to sleep, her terribly sick, she could not bear absolutely no odor, even irritated her beloved husband . We were happy that the typical manifestations of early preeclampsia . After all, if there are preeclampsia, then the pregnancy progresses . Several clouded our joy decidual polyp, which is sticking out of the cervical canal . We found it when registering . Such education is very dangerous to touch . Attempts to remove these polyps are fraught with heavy bleeding . After some deliberation, it was decided to do nothing . Intimacy was strictly prohibited, there is no bleeding, pregnancy progresses . How we rejoiced when the pregnancy has passed for 12 weeks! Analyses in the order, a consultant professor pleased with us . Ultrasound 12-13 weeks of gestation - wonderful! Biochemical screening - fine! We must give birth to this child .
At 16 weeks pregnant at 9 am call:
- I have something greasy ...
- How much volume?
- Quite a bit, with half a teaspoon ...
What is it? Polyp?
- Come and see.
She arrived in 5 minutes. Immediately take blood for the study, we put on the chair. I wear gloves.
Cap. Cap. Drip-drip. Drip-drip-drip-drip-drip. Tr-rr! I rotate - "teaspoon" confidently into a "trickle." Opens in a mirror - it looks like "born" a polyp. Ah, I was scared!
Frantically I think: first arrive in about 15 minutes, the ride is still about 15-20 minutes. While at the doctor propusknik descend until raise the department ... So, it will be necessary to save the mother already. Agree completely irresponsible decision - begin to drop immediately. Urgently. Right this second. Tranexam. And Tranexam. And Tranexam. After 30 minutes - dry. After 60 minutes - dry. Uz-control - the child is alive, there is placental abruption. LL-uh ... My hands are trembling largest coward. Lord, bless Tranexam!
By the way, in Russia for the year used about 2 tons traneksama, and in the US - 100 tons. Why is that?
Consultant Professor hematologist read an excerpt, squealing in surprise. Yeah, lucky. And the winners are known, do not judge. A 18-week child began to stir. And somehow quieter. And there is no selection. Dry. Dry!
22 weeks of pregnancy - Ultrasound - placenta previa. This is when the placenta completely covers the bottom and out of the uterus. Status terrible threatening bleeding. Earlier, in dostrahovuyu era, these patients were in the hospital before the birth. They are not even allowed to wash back home. They are not even allowed to take a walk in the courtyard of the hospital. It was believed that the bleeding may start at any moment. Inspection of the chair was allowed only in the expanded operating. Today, such a tactic considered inexpedient, is not economically profitable. I remember these unfortunate that months roamed the bleak corridors of pregnancy pathology department, collecting all nosocomial infections. Without the sun, without air, without her husband. They have always been very sorry. And we never yielded to persuasion and requests to release at least a half a day.
- Lie down! Wearing himself as a crystal vase! Sexual life can not live! Strongly!
23 weeks - swelling up to mid-thigh! The right leg 1 cm larger than the left. We have old-old-the operated varicose veins.
- Where ?! Where is your compression stockings ?
- Oh, I stopped wearing. I think I have because of the tights then started bleeding. I just bought a special tights for pregnant women, and that the very next day!
Vascular ultrasound of the lower extremities - phlebologist Consultation - Consultation Center of Obstetrics and Gynecology RAMS.
- You need a hospital. We must go and lie down. You can not run, ride, walk.
- I'm much better, so you will see me and be pleasantly surprised. Again I wear kompressionku and edema have virtually none. And I'm really more of a lie. Just once I began to gain weight and decided to be like ... more
24 weeks. 8 a.m.
- I'm bleeding.
- Call an ambulance. Urgently.
It was brought to 8-30, the doctors was shift change. Everyone rushed, rushed-seeing. Blood loss of about 1 liter. It was necessary to save the mother - a small cesarean section, the fruit of 400 g., Is unsustainable.
Then there was a lot of "if". Hospital doctors discussed, we discussed the medical center. Where is wrong? As could have been prevented? If she fell ... If it was taken over ... If you tried to remove a polyp even then ... If you did not listen to consultant professor and given another drug ... History does not know the subjunctive mood. We have not given birth to this child.
History № 2. Completed
She was always a little "donuts", with an increase in 165 cm weight hovered around 90 kg. It is a long time not pregnant. Not because there were some problems, but just somehow did not work - there was a man for whom I would like to get married and give birth. "His" she met in 36 years. She liked him just such a - soft and cozy. Pregnancy is very easy. In spring 2008 he got registered in the antenatal clinic in the community. Somehow it did not work out all right. The term of 15-16 weeks with the threat of lay there in the hospital. Find and treat any infection, for some reason, we were sent to the city center for toxoplasmosis.
- In the center of toxoplasmosis were not laughing at you?
- No, just very surprised: "Why do you sent here? "Here, help was given -" Clinical and immunological data toxoplasmosis no therapy is not indicated, general hospital. "
Results of prenatal screening anxiety - increased risk of Trisomy 21, a high risk of neural tube defects. Amniocentesis is not carried out, did ultrasound in MMA. Sechenov - 24-25 weeks of pregnancy, expressed oligohydramnios. Ultrasonic signs of congenital malformations and chromosomal abnormalities have been identified.
She came to our center Saturday for emergency diagnosis of amniotic fluid leakage. AmniSure test is rarely wrong. The term of 25-26 weeks occurred premature rupture of membranes. Ambulance, hospital, miscarriage later date. The fetus is not viable.
Preparing for the next pregnancy took 9 months. Restore normal biocenosis genital tract led to a state of euthyroidism thyroid, lost weight. In April 2009 - 2 strips. Delighted, began to be tested. May 9, a period of 6 weeks were spotting. First, gynecology, scraping. Histology - developing pregnancy. Karyotyping of the chorionic cells - 46, XX. We have not given birth to a girl.
- Why did not you call?
- So after all it's been a holiday off ...
- I do not get off. We would have at least tried to.
The new cycle of training. New analyzes. We have 2 fetal loss. And age. Age! Time melts. September 2010 - two strips. We're all right, we all know, we are in control. It starts coughing - exacerbation of chronic bronchitis. The therapist knocked down. Cough, the temperature up to 37, 5, and weakness. Antibiotics, antibiotics for a period of 7-8 weeks - missed abortion .
I hate this feeling of powerlessness. I do not know how to look them in the eye. They do believe. They believe that I can help that I know and can do. If she had gone, I probably would have rejoiced. She is gone. She wanted to have a baby.
The next training cycle. Everywhere were all consulted, the plan is approved and implemented. On the safe side, supplemented cycle training course plasmapheresis. In January 2011, "Customs has given good." Can. I think I just said, "can", as the bell rang, "Oxana, I'm in position." Nurses and administrators howled: "How! She is pregnant again ?! "
Pregnancy was perfect. I clenched my teeth and not "spied" by ultrasound before 10 weeks. At 13 weeks, call:
- I have something greasy ...
- Immediately come.
After 15 minutes, 5 obstetricians and one teravpevt rheumatologist who specializes in our problems we were at the ultrasound device.
- Show gasket.
- Here. There is little zheltovatenkoe, but it was more brown.
SPL doctor leans almost to the ear:
- Now Bogdashevskaya will kill you.
No. We did not kill anybody. We just smiled at her affectionately. We have all been very good. We went every month to consultants, time passed the tests properly fed, properly rested. She was a real beauty - skin glowed, her eyes burning. After 30 weeks we even pressure on admission was 120/80.
- What exactly has the fear of losing? Where is your "white coat syndrome? "
- Yeah, not bad. NOT FEAR!
I was scared. Highly. When she called me, she first said "all is well" and only then "hello". When she wrote to me on e-mail, in the subject line indicated "good".
We lacked some 10-14 days. On Saturday, at 17-00. Duration 34 weeks.
- I moved the water. Exactly. Yes I do the test right now, there is already the second strip. No, the stomach does not hurt. Yes, the child moves.
She never panicked. When it is necessary to act, it always works. An hour later she was in the hospital. Of course, I called. Of course, they were ready. After reviewing the contents of the card exchange, some colleagues nervous, and offered a caesarean. Fortunately began regular contractions, and by midnight we gave birth to a live boy. 2 kg 100 gr. Lungs are not ripe. Resuscitation, mechanical ventilation. The child's condition serious, stable.
Almost a month neonatologists nursed baby. It was not easy. Thank maternity hospital № 1. Thank department for nursing preterm infants Clinical Hospital № 13. Mother and son at home. They're great. They coped. Only I was still scared.
- And he hears? A otoacoustic emissions were carried out?
Rough neuropsychiatric disorders in the form of cerebral palsy, lower intelligence, hearing and visual impairment, seizures occur in 13-27% of premature infants.
This can not be considered a "happy ending." Miscarriage - a spontaneous abortion from conception to 37 weeks from the first day of last menstrual period. We only lasted 34 weeks. Nothing is over. For the boy's only the beginning.
We understand this story many times. Premature rupture of membranes in 2 cases - it's still an infection. We have not found anything that could be the cause. Maybe we're just not able to find it. Or do not know about its existence.
History № 3. Progressing
Young beautiful girl. She married at age 22. In January 2007, she became pregnant.
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Hooray!
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