Repeated cleaning of the uterus: when it is needed. Recovery and new pregnancy after curettage with a frozen pregnancy Repeated cleaning after a frozen one

Sometimes it happens that the fetus, instead of growing and developing normally in the mother's womb, dies. Pregnancy freezes. It is already impossible to save a child, but such a condition is dangerous for a woman, and in order to prevent negative consequences, cleaning is carried out after a frozen pregnancy. After this procedure, a certain time is needed to restore the health of a woman - as a rule, at least 3 months.

What is cleaning and how does it work

Medical cleaning is carried out in order to remove the dead embryo from the uterus. If this is not done, then the decomposition of the tissues of the deceased fetus will cause a local inflammatory reaction, and also provoke a general intoxication of the body. Depending on the period at which developmental fading occurred, doctors may choose one of the removal methods.

Medical cleaning

In this case, special drugs are used that provoke a miscarriage. This treatment is the least traumatic for the reproductive system, but this method can only be used for up to 5 weeks.

Vacuum aspiration

With the help of a special tool, the cervix is slightly opened, an extractor is inserted into the organ and its contents are sucked off. The operation is performed under local or general anesthesia. The uterine epithelium is minimally damaged during the procedure, and spotting after such an intervention does not last long (1-3 days). Vacuum aspiration is done when freezing for up to 8 weeks.

Scraping

Therapeutic curettage is performed under local or general anesthesia (the type of anesthesia is determined by the doctor after clinical and laboratory studies in preparation for the operation). The uterine endometrium is cleaned using special tools.

This surgical intervention, even carefully performed by an experienced doctor, is traumatic for the female reproductive system. The recovery process after it will take long time, and spotting with this type of treatment can last 2-3 weeks.

Artificial childbirth

At a period of 18-28 weeks, with the help of medications, labor is artificially stimulated, and after the dead fetus comes out, curettage is carried out, as described above.

The dead embryo, after being removed from the uterus, is sent for a histological examination to identify the reasons for stopping development.

After the removal of the frozen fetus, the woman must undergo a control ultrasound.

Possible Complications

Despite the fact that surgical treatment is carried out in a hospital and in compliance with all the rules of asepsis and antisepsis, after removing a frozen embryo from a woman, the following complications may occur:

Endometritis (acute inflammatory process of damaged uterine mucosa).
Rupture of the uterine neck. Such breaks heal on their own for a long time, they can suppurate. To prevent the attachment of a secondary infection, immediate suturing of such traumatic cracks on the neck is necessary.
Incomplete removal of pieces gestational sac, which begin to be rejected by the woman's immune system, causing hyperthermia and severe pain. In severe cases, with untimely seeking medical help, sepsis may develop.

In order to notice signs of developing complications in time, in the first days after surgical treatment, it is necessary to carefully monitor such moments.

Body temperature

The presence of even a slight hyperthermia, even if there are signs of a cold, should serve as a reason for an additional examination.

The inflammatory process may begin in reproductive system, and a cold will occur already due to a weakened immune system.

Allocations

Normally, the discharge will be scanty and bloody, resembling a menstrual "daub". The presence of strong spotting or discharge with an unpleasant odor and with additional impurities to the blood will indicate the presence of a pathological process.

Pain syndrome

In the first 2 days after the extraction of the embryo, due to instrumental intervention, slight pains in the lower abdomen are possible.

But a prolonged or intense pain syndrome is a sign of the development of postoperative gynecological pathology.

Any deviation from the normal course of the recovery period should be immediately examined and treated. Timely treatment will help reduce the consequences of complications, such as the development of chronic diseases or even infertility.

Recovery of the body

To recover from a frozen pregnancy and subsequent extraction of a dead embryo, the female body will need about 3 months. It is during this time that normal menstrual flow will be established, the cycle will normalize, hCG (pregnancy hormone) will be excreted from the body. Despite the fact that 3 months are enough for recovery, doctors recommend planning a pregnancy after curettage of a missed pregnancy no earlier than 6-12 months later, to reduce the risk of re-development of this pathology.

In order to minimize the risk of fetal death in subsequent pregnancies, the following treatment is prescribed after cleaning.

Antibacterial therapy

As a prophylaxis of a secondary infection after curettage, especially if the fetal fading was not detected immediately, broad-spectrum antibiotics are prescribed.

If the patient has purulent discharge or discharge with an unpleasant odor, her drugs are selected individually, taking into account the data of clinical and laboratory studies. During this period, it is better to avoid sexual intercourse or use barrier contraceptives (condom).

Hormonal remedies

To quickly bring the female hormonal background to the pre-pregnancy state, hormones are prescribed.

More often, these are hormonal contraceptives, which not only stabilize the menstrual cycle, but also prevent unplanned pregnancy.

Psychological help

For the female psyche, which is already set for the upcoming motherhood, the loss of an unborn child is a great stress. Sometimes women need the help of a psychologist to stop feeling guilty about what happened and get rid of the fear of subsequent failures. In severe cases, on initial stage psychological treatment, in combination with hormonal and antibacterial therapy, antidepressants or tranquilizers are prescribed.

The risk of recurrence of pathology

There is a chance that the fetus will die in the womb with every conception. But even if this happened, the risk of repeating this situation is small. To bear and give birth to a healthy child, you must:

Plan pregnancy not earlier than six months after the previous unsuccessful attempt.
During the recovery period, pay attention own health Because, as a rule, a healthy child is born to a healthy mother. Perhaps the body was weakened due to a chronic illness and could not provide the embryo with the substances necessary for development.
Psychologically tune in and believe that this time everything will go well, and enjoy the feeling of upcoming motherhood. You should not plan conception if the fear of losing a child persists.

A frozen pregnancy is not a sentence, and the risk of a recurrence of the situation is minimal. It is only necessary during the recovery period after cleansing to pay careful attention to your health and psychological mood, and then there will be good chances to give birth to a healthy child.

Frozen pregnancy is a tragedy and a difficult test. And not only from a physical, but also from a moral point of view. But you should not despair. after scraping a frozen pregnancy is possible. Naturally, efforts will have to be made, but they will be absolutely justified by the safe birth of the baby.

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What is fading

Freezing is a pathological phenomenon in which the fetus in the womb stops developing(dies).

Calling the curettage procedure an abortion in this situation is a mistake. Abortion is a term that implies the deprivation of the life of the fetus by removal from the uterus.

In case of fading, the doctor removes the already dead fetus.

The dead fetus decomposes, toxins penetrate the bloodstream through the umbilical cord, after the placenta is damaged, the risk of suppuration of the female reproductive organs and the abdominal cavity increases significantly.

Decay spreads through the tissues and the only way out is removal. A complete transfusion sometimes saves from blood poisoning.

Important! To save the life of a woman and her childbearing function, doctors have no more than 7 days after fading.

The timing of the cleansing affects when you can get pregnant after a missed pregnancy. If the diagnosis was made late, the rehabilitation process is significantly delayed, not to mention cases of infertility.

In the first trimester, toxicosis is confused with symptoms of fading and late in seeking help. In severe physical condition, it is recommended to do a simple blood analysis, which will show the fade.

Consequences

In the early stages, scraping is replaced vacuum cleaning. A tube is inserted into the uterus, which, like a vacuum cleaner, sucks the embryo into itself. The method is safe up to 11 weeks of pregnancy.

After 11 weeks, curettage is used - the entire layer of the endometrium, with the attached fetus, is torn off from the wall of the uterus.

After scraping during a frozen pregnancy, a woman will observe a number of typical symptoms:

vaginal bleeding;
lower abdominal pain;
pain in the mammary glands;
temperature increase;
depression.

Curettage is a wound in the uterine cavity. Until upper layer won't drag on bleeding do not arouse suspicion. Normally, not too heavy bleeding, without additional aggravating symptoms, lasts up to 4 days.

Vaginal discharge is Brown and yellow. Brown for up to 2 weeks after scraping is considered to be the norm. It may be clotted blood coming out of the healing uterus.

After 14 days, such discharge is not considered the norm. Yellow discharge is a sign inflammatory process.

Pain in the lower abdomen is caused by a wound and contraction of the uterus to its natural size.

Contraction is painful because hormonal background broken and the process is not as smooth as after childbirth.

Hormonal fluctuations also affect the condition of the breast. It has already started the process of preparing for feeding, and a sharp reverse stroke causes natural pain in the tissues.

Temperature increase normal in the early days, but its growth must be monitored and controlled for the appearance of additional symptoms. There could be inflammation.

The emotional state of a woman who has lost a child is difficult to describe in words and convey. It's terrible.

Complications

Complications after curettage not news. Most often found:

endometritis;
ovarian cyst;
depression.

Endometritis - inflammatory process uterine endometrium. During the operation, or because the woman does not follow the rules of the postoperative period, foreign particles enter the uterus and the tissues become inflamed. The disease is accompanied by fever, discharge and pain. The chronic stage of the disease is characterized by infertility, since the egg cell cannot penetrate into the inflamed endometrium and cannot securely attach.

An ovarian cyst is a cavity in the ovary filled with fluid. This is the reaction of the hormonal system to a sharp one.

Depression is a very complex disease. It can lead to mental disorders, destroy a marriage, lead a woman to self-destruction. Impressive persons and ladies who have been waiting for a baby for a long time are especially susceptible to deterioration. It is very important to undergo trainings and consult with specialists. You can't start the state in any case! Launched depression is very common leads to suicide!

Analyzes

Examination after a frozen pregnancy is very important.

Firstly, it allows you to control the state of a woman's health and does not allow possible diseases to develop to a critical stage.

Secondly, establishing the causes of the tragedy will help in the future to successfully become pregnant after a missed pregnancy and bear the baby.

List main studies:

hormone analysis;
analysis for STDs;
immunogram;
histological examination;
smear for microflora.

Ultrasound is performed on the 10th day after cleaning to confirm that there are no particles of the fetal egg left in the uterus. If there are particles, re-cleaning is prescribed, otherwise it will start inflammation and suppuration.

An analysis of hormones is necessary for 2 reasons: to determine the current state, and to prescribe a course of hormones to maintain the body, because not every woman's hormonal background levels off by itself. In the future, the hormonal background will show whether the deviation in his work caused the fading. The second analysis is done later, when the body is restored, and the woman begins to think about re-conception.

STDs are sexually transmitted diseases. They cause pathologies in both the mother and the fetus, which leads to freezing.

An immunogram is an analysis of the functioning of the immune system. Failures in its work lead to fading. The analysis is carried out in the late period of rehabilitation.

If a woman is not recovering well, an immunogram may be needed to determine her current condition and prescribe the correct treatment.

Histological examination - fetal examination for developmental pathologies. The result in the future will help to bear the child.

A smear on the microflora determines the current state of the woman and allows you to find out a number of diseases that provoke fading. This knowledge is necessary for successful treatment and preparation for a new conception.

Treatment

Treatment after a frozen pregnancy involves 3 points:

scraping;
taking antibiotics;
hormone therapy.

Antibiotics are always prescribed do not allow inflammation. As a rule, broad-spectrum antibiotics are prescribed. Reception of hormones is prescribed not always, but in those cases when female body can't handle on its own. It is impossible to choose medicines on your own - it is easy to earn complications, because the female body is greatly weakened.

Recovery

Recovery after scraping a missed pregnancy long process passing in 3 stages:

bring the body back to normal after the procedure;
undergo a course of treatment to eliminate the problem that provoked the fading;
accumulate strength for re-conception.

Recovery of the endometrium after curettage may be delayed for 2 months.

It depends on individual characteristics, hormonal background, immune system and presence/absence of complications.

One of the signs of a successful recovery is menstruation. They show that the hormones are working "as intended" and their quantity is sufficient.

The very fact of menstruation shows that the endometrium has grown and naturally moved away. Full recovery may take up to 2 menstrual cycles.

After scraping delay of menstruation normally up to 45 days, if it is not accompanied by additional symptoms:

pain;
strange discharge;
bad smell;
heat.

Additional symptoms, or delay more than 45 days signals deviations. in the hormonal background, inflammatory processes or the remains of the fetal egg.

New pregnancy

Pregnancy after a frozen pregnancy must be approached with all responsibility! Necessary:

fully recover after the procedure;
find out the reason the occurrence of pathology;
undergo a course of treatment;
prepare the body for a new conception.

The first question that arises in a woman after scraping is whether it is possible to get pregnant after being frozen? The answer is yes, but there are conditions:

curettage should be carried out in time so that suppuration does not have time to affect the uterus and all reproductive organs remain healthy;
to establish and eliminate the cause of fading;
hormonal background must comply with the norms;
endure the course of rehabilitation and not become pregnant until its completion;
undergo a course of rehabilitation after psychological trauma, if necessary. Morale is very important and can cause a miscarriage or fading.

Important point When can you get pregnant after a missed pregnancy? Suggested timeframe is to wait from a year to two depending on individual characteristics.

During this period, the body will surely recover from all bad habits get rid of, the diet will improve, and the hormonal background will return to normal.

The second significant aspect is how long it takes to prepare for re-fertilization? After half a year - not earlier.

In 6 months, most of the pathologies leading to fading are cured, or most of the course for their treatment is completed. The imposition of courses of therapeutic and preparatory therapy can lead to undesirable consequences.

Preparing for pregnancy after frozen suggests:

quit bad habits;
get out of depression;
take vitamins;
lead a healthy lifestyle;
watch your diet.

From general advice temporary (until the permission of the gynecologist) bans are allocated for:

sexual contact;
use of hygienic tampons;
douching;
taking baths and visiting the pool;
hypothermia;
heavy physical activity and weight lifting;
pregnancy in the first six months after cleaning.

The penetration of any foreign object, including water, into the vagina, and hypothermia is fraught with inflammation. Physical exercise bring the uterus into tone - this is pain and possible bleeding. early pregnancy you won’t be able to endure it, and the body will “remember” the reaction even better.

Pregnancy after curettage of a dead woman is feasible and occurs in 9 out of 10 cases. It is very important to allow your body to fully restore its strength, and not to rush things. you can find out from the link.

Useful video: is a new pregnancy possible after scraping a frozen

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Joyful excitement at the sight of two cherished stripes, anticipation of the search for a dowry for the crumbs, careful planning of the future life, inexplicable fear, malaise, a visit to the gynecologist, ultrasound, a verdict, a curtain.

And now, along with the unfulfilled dream, obsessive thoughts are swarming in my head: “What if I don’t get pregnant anymore? And I won't be able to have children? Our marriage will become “empty” and collapse…”

In support of these experiences, the stomach ached again. Again, an ambulance and already familiar doctor advises to relive the recent horror ...

Cleaning after cleaning a frozen pregnancy: is it necessary?

Depending on how the failed pregnancy was detected (miscarriage or anembryony / frozen without rejection), the doctor will be able to give direction for further manipulations.

This may include repeated cleaning after a short time after curettage. That is, two surgeries one after the other.

First scraping most likely performed under general anesthesia. Especially if the miscarriage did not occur, although the pregnancy stopped a few weeks ago and symptoms of general intoxication have already begun to appear.

It is very important to carry out this procedure flawlessly: remove all dead tissue without touching the myometrium and bottom layer endometrium. After all, if the cleaning is done poorly and particles of the fetal egg / placenta remain in the uterus, the health and life of the woman is threatened by a serious danger: inflammation - intoxication - blood poisoning - surgery - infertility.

It is good that such a course of events takes place no more often than a favorable one, in which the patient is informed about the further reaction of the body and can notice something was wrong in time. Basically, this is the absence of any discharge, abdominal discomfort and cramping pain a few days after cleaning. In such cases, you should urgently contact the doctor, explain everything clearly and ... endure repeated curettage. Only this time without anesthesia.

And local anesthesia, as practice suggests, does not really relieve the terrible sensations. After all, you will have to open the cervix again, squeeze out / clean out everything that should have come out on its own (blood, clots and the remains of the fetal egg remained in the uterus, provoking false contractions). And again, pain, rehabilitation, fear ... The main thing is that at least life is saved.

But in such a situation, you often don’t know what is better / more dangerous: a second curettage in a row or the remains of the results of cleaning in the uterus with the hope of self-expulsion from the body?

And what about the discharge and why are they considered the main guideline for the success of the operation?

But the fact is that the female body perceives curettage / cleaning / childbirth like another menstruation: The endometrial layer is an open wound that bleeds. And this mixture of blood, mucous and dead tissues must find a way out, otherwise stagnation will result with further infection / intoxication of the genitourinary system.

Such discharges also last no more than a week, accompanied by slight malaise and aching pain in the lower abdomen.

If there is nothing of the kind, then there is a suspicion that the cervix has closed prematurely and all the secretions are collected in the cavity of the reproductive organ. Waiting for everything to work out by itself is too big a risk. Exit: only repeated cleaning.

If first scraping occurred under short-term general anesthesia, and the patient asked about, for example, the absence of toxicosis, then she most likely will not experience pain. This procedure, or rather the female body during it, does not “remember” the pain, which also passes quickly.

What, unfortunately, can not be said about spasms, which notify of the overcrowding of the uterus with blood. Since this is very similar to contractions, the ladies giving birth will understand the scale of the sensations.

And the most severe pain syndrome can be called repeated cleaning with minimal anesthetics. Some women even lose consciousness, but after the procedure is completed, they may well move independently and even do household chores.

What to do after?

And after the woman is expected to return home, where, perhaps, preparations have already begun for the reception of a new family member.

She does not worry about pain, two cleanings and well-being .... Only suffering, emotional and unbearable. After all, everything was fine, the tests showed a positive trend. It's hard to even imagine how mothers feel when they experience something like this in the second or third trimester of pregnancy.

The strongest cope even with such a disaster. But often their endurance is not so strong, the psyche suffers greatly, without specialist help not enough. After all, the future baby needs a happy mother. Only then will he choose her among a million others and appear as a bright ray in her life.

The consequences of repeated cleansing for the body

Will they be, and if so, which ones? Almost every patient is interested in this question (if she has already recovered from the shock), wanting to hear words of reassurance and support from her interlocutor.

But first what she must understand is that since she needed repeated curettage, it means that life and women's health were in danger. That is, it was a measure of necessity and hopelessness.

On the other side, the question of the cause of the current situation remains open. Who was to blame for the fact that the uterus was not cleansed and inflammation began?

A doctor who did not perform the operation qualitatively?
Features of the body?
Elasticity of the neck of the reproductive organ?
Woman's careless attitude/ignoring her first symptoms?

Although ... It is unlikely that anyone will look for a reason when neither the feelings nor the body have yet come to their senses ...

What treatment is required?

Frozen pregnancy- it's not a cold. You can’t cure her with hot tea and raspberry jam ...

In almost all cases, surgical intervention cannot be avoided, since expectant tactics is chosen rather as an exception, with ideal examination results.

But no one does curettage blindly:

examination on a gynecological chair.

Only after this preparation for surgery and the procedure itself. As for repeated cleaning, there is often not enough time for a long-term study due to severe pain that cannot be removed with the help of medications.

Only when the uterus is cleaned again, then the pain will subside and the spasms will disappear. After the operation, it is recommended to lie on your stomach for a short time, drink an anesthetic and ... walk around.

Your reproductive system needs blood flow, so movement is the best way out.

If everything went well, the woman is not bothered by anything (slight discomfort, no more), the results of the ultrasound examination confirmed the impeccability of the performed curettage, the patient has nothing to do in the hospital.

And this is not frivolity. In any case, at least it’s hard for a woman at heart and it will be unbearable to be in the same department with happy pregnant women. And at home, relatives who will support and help unwind. Or they will be involved in household chores away from sad thoughts.

In the case of any kind complications inpatient treatment will last until full recovery.

Women undergo the procedure of curettage of the uterus either at their own request to terminate the pregnancy or as prescribed by a doctor for any pathology for diagnostic and therapeutic purposes.

Unfortunately, in some cases, it is prescribed to undergo a second cleaning of the uterus. The cause may be bleeding from the genital tract as a result of insufficient contraction of the uterus, the accumulation of blood clots or the remains of a fetal egg in the uterine cavity, the presence of a placental polyp. All this can occur after:

miscarriage (spontaneous abortion);
(failed abortion), when the fetus stops developing and dies;
medical abortion or after, carried out at an early stage up to 6 weeks of pregnancy;
unsuccessful abortion in early dates up to 12 weeks or at a later date from 13 to 27 weeks strictly for medical reasons;
artificially induced premature birth, when termination of pregnancy is required in terms of more than 28 weeks and urgent delivery.

In addition, there are gynecological indications:

recurrent postmenopausal bleeding;
rarely, but still there is a repeated curettage after removal of the neoplasm.

If endometrial hyperplasia is detected, a separate diagnostic curettage of the uterus and cervical canal is normally performed, then a second cleaning is prescribed:

after 3 months if atypia is detected for control;
if in the background hormone therapy there is a relapse;

How is the cleaning process going?

The procedure for curettage of the uterus is an operation lasting about 20 minutes under the influence of general intravenous anesthesia. The patient falls asleep and feels nothing. Epidural (spinal) anesthesia can also be used when the woman is conscious and does not feel the lower half of the body, but this type of anesthesia is used much less frequently. In other cases, they may be limited to local anesthesia, but the pain still remains.

Before and after the operation, the external genital organs and the vagina must be treated.
Then, using special tools, the cervix is fixed, the length of the uterus is checked and the cervical canal is expanded.
The contents of the cavity and the surface layer of the uterine mucosa are removed using a curette, hence the name - curettage; or carry out vacuum cleaning with aspiration.

Reminder to the patient after repeated cleaning of the uterus

After repeated curettage, it is important to follow the doctor's recommendations so that there are no complications and recover faster:

continue and complete the prescribed treatment (antibacterial, hormonal, hemostatic, uterine contractions and other groups of drugs);
watch for secretions from the genital tract. Normally, after the procedure, spotting gradually decreases in volume and lasts no more than 10 days;
sexual rest for at least 2 weeks, and preferably up to a month and after a follow-up examination;
do not use tampons or douche;
exclude physical activity;
you can not go to the sauna, take a hot bath.

If you experience the following complaints, you should consult a doctor to exclude or identify pathology, and carry out appropriate treatment:

body temperature above 37 degrees, general weakness, dizziness;
after a few days, pains appeared in the lower abdomen and lower back;
vaginal discharge with an unpleasant odor;
the amount of bloody discharge does not decrease or they suddenly stop;
after 1-1.5 months, the discharge did not begin, and the first menstruation may be scarce.

Consequences of repeated cleaning

Curettage of the uterus is a surgical intervention, so there may be negative consequences that occur immediately after the procedure or after some time:

inflammation of the lining of the uterus (endometritis);
perforation of the walls of the uterus during the procedure;
stenosis (narrowing) of the cervical canal of the cervix;
the formation of adhesions in the uterine cavity;
violations menstrual cycle;
due to damage to the deeper layers of the uterine mucosa, which prevents the implantation of a fertilized egg in the future.

In any case, after discharge, a follow-up examination by a doctor is necessary, ultrasonography in dynamics and, if necessary, colposcopy.

For better recovery, you can take a course of physiotherapy (electrophoresis, mud therapy, acupuncture). Eat more liquids and healthy food, drink.

Vladlena Razmeritsa, obstetrician-gynecologist, specially for the site