RISKS, SCREENING AND DIAGNOSIS OF MISSED ABORTION / Шинэ санаа Шинэ нээлт

ABSTRACT

Missed abortion refers to clinical situation in abnormality of early stage of pregnancy. According to WHO study, abnormality of early stage of pregnancy accounts for 15-20% of total pregnancy disorders, moreover missed abortion is about 10-20% of abnormality of early stage of pregnancy. Missed abortion is one of the obstetrical complication, which is caused by several risks and causes, resulting fetal movements stop and aborted in uterus causing clotting defects and bleeding. Under the cases and statistics in capital maternity hospitals during 5 years, 168781 births was registered but 8887 of them were diagnosed with IUGR and were hospitalized, meaning frequency of missed abortion is increasing.470 mothers whom were diagnosed missed abortion at department of “Treatment of preterm pregnancy” and 1000 mothers whom were hospitalized in department of “Treatment of pregnancy disorders” of First Maternity Hospital were included in our study. Retrospective study was used. In prospective study, 50 mothers whom were hospitalizing with diagnosis of missed abortion at department of “Treatment of preterm pregnancy” and 50 mothers whom were going to go under abortion when they had normally developing baby, total 100 mothers were participated in our study.Participants’ age was among 18-43. Average age of case group participants’ was 30.5. Differentiating by age, 31.9% were age of 30-34, and 25.7% were at age of above 35. According to pregnancy frequency, above 4 pregnancy was 34.3% in case group, аabove 6 pregnancy 13% in case group (p=0.01). Defining the duration between pregnancies, the duration of 1 year was 27.7% in case group (p=0.01). Previous abortion accounts for 147 (31.3%) in case group and 116 (11.6%) in control group, meaning there is statistical value in both groups (p>0.05). In case group study, 228 (48.5%) participants had previous abortion, 101 (21.4%) had miscarriage, and 47 (10%) mentioned about missed abortion before. Comparing ultrasound finding in 6-7 weeks of gestational age with last menstruation period, had difference of 2-3 weeks. Moreover, 56% were with-fetus type and it was diagnosed at the 7 weeks of gestational age, and 44% were anembrionic types which were diagnosed in 6 weeks of gestational age. In blood coagulation laboratory test finding; prothrombin time was 32 (8.4%), ACT 60(15.6%), thrombin time was 39(10,2%), fibrinogen 34(8.9%)resulting elongated duration change accounts for most of the cases. Comparing “TORCH” test result in type 1 acute infection, it increase the risk of missed abortion by 3 times (OR=3.579,P=0.005), and type 2 both acute and chronic infection affects the missed abortion occurrence (OR=3.807, P=0.001). In uterus swab test, foam cellinflammation (OR=0.431, P=0.001) and villous destructive change (OR=0.276 P=0.002) had difference of statistical value. The risks of missed abortion are including mothers’ age, pregnancy frequency, duration between pregnancies (P<0.05), previous missed abortion affected pregnancy (OR=5.444, p=0.028) and abortion (OR=1.93,p=0.005). In ultrasound finding 2-3 weeks were delayed. And with-fetus type was 56%, and 44% was non- fetus type. If duration of missed abortion lasts long coagulation factors such as prothrombin time, ACTand thrombin time is elongated making it risky for bleeding. Herpes simplex virus infection and its type and 2, acute and chronic infections are high in case group. In uterus swab test, foam cell inflammation (P=0.001) and chorionic villi inflammation (P=0.002) affects growth restriction.