embryo arrest
Introduction
Introduction to Embryo Stopping Embryo stoppage refers to the death of embryos to a stage where they stop and continue to develop. A fertilized egg is like a seed. It takes a series of complicated and wonderful processes to eventually grow into a healthy baby. If the fertilized egg does not have a good bud at the initial stage, it is likely to stop growing healthy. This phenomenon of abnormal embryonic development occurring in the first trimester is called "fetal stopover". basic knowledge The proportion of illness: 0.003% Susceptible population: pregnant women Mode of infection: non-infectious Complications: intrauterine distress
Cause
Cause of embryonic arrest
Embryo stoppage refers to the developmental stop of an embryo in early pregnancy due to some reason. B-ultrasound examination showed fetal buds in the gestational sac or fetal form irregularities, no fetal heartbeat, or manifested as gestational sac. Clinical is a category of abortion or stillbirth. There are many reasons for embryonic cessation.
Endocrine disorders (20%)
Embryo implantation and continued development rely on complex endocrine systems to coordinate with each other, and any one of the links can cause miscarriage. When the embryo develops early, three important hormone levels are needed. One is estrogen, the other is progesterone, and the other is human chorionic gonadotropin. As a mother, if the endogenous hormone is insufficient, it will not satisfy the embryo. If necessary, it may cause embryonic suspension and abortion. The most common of these is luteal dysfunction, luteal insufficiency can cause endometrial growth retardation and short luteal phase, which affects the implantation of fertilized eggs, or early pregnancy abortion. Luteal dysfunction is often accompanied by other gland dysfunction, such as hyperthyroidism or hypothyroidism, diabetes, androgen relative hyperplasia and hyperprolactinemia, these factors are not conducive to embryonic development, and closely related to abortion.
Immunity factor (15%)
Embryos or fetuses in the uterus are allogeneic, because the combination of the fetus's parental genetic material and the mother may not be identical. Maternal-to-fetal immunity does not adapt to the mother's rejection of the fetus. Common autoimmune diseases are systemic lupus erythematosus, scleroderma, mixed connective tissue disease, dermatomyositis and the like. The second is the problem of reproductive immunity. If we bring some kind of antibody, it may affect the development of the embryo. In fact, the detection of antibodies is not the same in every hospital. The doctors' opinions are not the same. From the perspective of our research, there are four factors influencing the factors, one is anti-sperm antibody, if there is, there is May be resistant to sperm-egg binding; second, anti-endometrial antibodies, if there is anti-endometrial antibodies, it may affect the development of the embryo, resist the development of the embryo; the third is anti-ovarian antibodies, if you want, Will affect the quality of the egg; the fourth is called anti-chorionic gonadotropin antibody, this hormone is actually an important hormone to be secreted seven days after the combination of sperm, but if you have this antibody, it will resist hormones Secretion may cause the embryo to stop.
Uterine abnormalities (18%)
The internal environment of the uterus and the overall environment of the uterus may have an effect on the embryo. The internal environment is the endometrium. If it is too thin and too thick, it will affect the implantation. Due to uterine defects caused by abortion accounted for about 10% to 15%, common (1) congenital mullerian tube abnormalities including single-horned uterus, double uterus and double-horned uterus caused by narrow uterine cavity, blood supply is limited. Abnormal uterine artery development can lead to dysplasia and abnormal planting. (2) intrauterine adhesions, mainly caused by intrauterine trauma, infection or placental tissue residue caused by intrauterine adhesions and fibrosis. It hinders normal aponeurosis and placenta planting. (3) uterine fibroids and endometriosis caused by decreased blood supply leading to ischemia and venous dilatation, decidualization is not synchronized, abnormal implants and hormonal changes caused by fibroids can also cause pregnancy failure. (4) Congenital Sexual or traumatic cervix sinus relaxation and intrauterine treatment with diethylstilbestrol cause cervical dysplasia often cause mid-term pregnancy abortion.
Chromosome problem (20%)
If the chromosome is abnormal, it will cause the embryo to not develop and cause early abortion. Chromosomal abnormalities include quantitative and structural abnormalities. The quantitative abnormalities can be divided into aneuploidy and polyploid. The most common abnormal karyotype is triploid, while the 16 trisomy accounts for 1/3, often fatal. There are 25 to 67% of the 21 trisomy, 4 to 50% of the 13 trisomy, and 6 to 33% of the 18 trisomy are inevitable abortion. Others have haploid (4SX), and the tetraploid is not developed due to abnormal cleavage. There are missing structural anomalies, such as balanced translocation, inversion, and overlap. Balanced translocation is the most common chromosomal abnormality. On the chromosomal problem, current research suggests that pairing, interchange and separation between chromosomes form gametes, and gametes combine to form zygotes. If the zygote is abnormal, it will not develop normally, which may lead to miscarriage, stillbirth, stillbirth, and deformed children. Therefore, prenatal diagnosis is needed to prevent the birth of chromosomal children. There is no effective treatment for abortion, fetal arrest, etc. caused by chromosomal abnormality. Only prenatal genetic counseling and diagnosis can be performed. For chromosomal abnormalities, it is theoretically possible to give birth to normal karyotypes and carriers of infants, and to make prenatal diagnosis for these couples to ensure normal babies. Of course, the current study also shows that the chromosomes of both couples are normal, but chromosomal abnormalities occur during gamete formation and embryo development. If a woman is older than 35 years old, the egg is aging, prone to chromosome segregation, leading to chromosomal abnormalities; semen abnormalities, such as macrocephaly, are mostly diploid, and polyploid embryos after fertilization lead to miscarriage. Adverse environmental effects such as toxic chemicals, radiation, high temperatures, etc. can also cause embryonic chromosomal abnormalities. Therefore, the key to prevent fetal cessation due to chromosomal abnormalities is to regulate both husband and wife's body, so that the functions of the organs are normal and coordinated, yin and yang are balanced, and the pregnancy is preferred and away from the adverse environment.
Reproductive tract infection (16%)
In addition to the above various factors, the early pregnancy abortion caused by infection has been paid more and more attention by scholars at home and abroad. Severe TDRCH infection in early pregnancy can cause embryo death or miscarriage, and mild infection can also cause embryo malformation. Studies have shown that cytomegalovirus can cause expired abortion, fetal death and so on. After the mother's infection, the pathogen can pass the placenta infection through blood, causing damage to the chorion and capillary endothelium, destroying the placental barrier, and causing the abortion, embryo development, and fetal malformation. In recent years, many studies have shown that mycoplasma infection is related to the cessation of embryonic development. The positive rate of mycoplasma infection in cervical secretions of women with embryonic development is significantly higher than that of normal women, and there are significant differences.
Environmental factors (10%)
Changes in the physiological state during pregnancy, the mother's absorption, distribution and excretion of therapeutic drugs and various environmentally harmful substances have undergone major changes. At the early stage of development, embryos are extremely sensitive to the effects of therapeutic drugs and environmental factors. All kinds of harmful factors can cause damage or even loss of the embryo. Many pharmaceutical and environmental factors are important factors in causing early embryonic death or fetal malformation. Environmental hormones can directly act on the central nervous system of endocrine regulation, causing reproductive hormone secretion disorders, decreased reproductive rate and abnormal embryonic development. There are many environmental factors that cause miscarriage, including X-ray, microwave, noise, ultrasound, high temperature and other physical factors, as well as heavy metals such as aluminum, lead, mercury, and zinc, which affect the implantation of fertilized eggs or directly damage embryos, leading to miscarriage. Various chemical drugs such as dichloropropane, carbon disulfide, anesthetic gas, oral antidiabetic drugs, etc. can interfere with and impair reproductive function, causing embryo abortion, stillbirth, deformity, stunting and dysfunction. And bad habits such as smoking, alcohol, coffee, drugs, certain drugs, etc. all affect early embryo development.
Prevention
Embryo arrest prevention
1, chromosomal abnormalities: pre-pregnancy, need to conduct pre-pregnancy examination and medical diagnosis, if there is a familial genetic history, you can consider not pregnant or take effective care measures.
2, quit harmful substances: fruit engaged in the work of related industries, in the months before conception, can be transferred to other departments. For those who have just renovated the family room, it is recommended not to move in too early and check in after passing the test. Choose a clean, non-polluting food for your diet.
3, radioactive light: X-ray inspection before pregnancy, microwave oven should be kept at a certain distance, about one meter or more. Don't carry your phone with you for a long time, and use your phone if necessary.
4, the impact of drugs: If there is no intention of gestation, contraceptive measures should be done well. When preparing for pregnancy, if you have a condition, first make sure you are pregnant. If you have one, you should take it with caution. It is best to consult a doctor and choose a drug that is good for your condition and has no effect on your baby.
5, smoking and drinking : Both husband and wife should quit smoking and alcohol during a period of time before pregnancy and during pregnancy, in order to avoid the impact of tobacco and alcohol on the fetus in the abdomen.
6, infected with the virus: in rubella, pregnant women should be injected with rubella vaccine in advance. In the first three months of pregnancy, avoid staying in public places for too long, and exercise properly to enhance physical fitness and self-satisfaction. Maintain a balanced diet.
7, chronic serious diseases: drugs for the treatment of chronic diseases will have a great impact on the fetus, if the patient needs to be pregnant, it should be discontinued for a period of time, and when the condition is stable, it is suitable for pregnancy.
8, abnormal immune system: in women with abnormal immune system, should be able to become pregnant after the condition is fully recovered. More exercise is needed in life to maintain a balanced diet and enhance immunity.
Complication
Embryo stop complications Complications of the fetus
May be complicated by fetal distress.
Symptom
Embryo Stopping Symptoms Common Symptoms Vaginal Excretion Fragment Tissue Lower Abdominal Pain Vaginal Hemorrhagic Abortion
If embryonic cessation occurs, all pregnancy reactions in the pregnant mother will gradually disappear. The first is that there is no longer a reaction to early pregnancy such as nausea and vomiting, and the feeling of breast swelling will also weaken. Then there will be bleeding in the vagina, often dark red bloody vaginal discharge. Finally, there may be lower abdominal pain and discharge of the embryo. The above performance varies from person to person, and some even have no signs at all, and there is direct abdominal pain, and then abortion, or asymptomatic after embryonic arrest by conventional B-ultrasound.
Most pregnant women have no obvious symptoms after they stop developing. Some pregnant women may see red and generally have no abdominal pain, which is different from threatened abortion.
Examine
Embryo arrest
Male inspection project
1. Semen exfoliative cytology: determine sperm motility and presence of abnormal sperm.
2, male prostate examination: prostatitis can cause abnormalities in semen.
3. Chromosome examination: Chromosomal abnormalities are an important cause of fetal cessation.
Female inspection project
1, female sex hormones six tests: female hormone levels determine the quality of follicle development, the quality of follicles directly affect the quality of the embryo, when the quality of the embryo is not good, it is easy to cause fetal suspension. The test of six hormones (ie, ovarian reserve function) is usually checked on the third day of menstrual cramps.
2, female prenatal and postnatal four: including rubella virus, cytomegalovirus, toxoplasma and herpes simplex virus, pregnant women and women planning to become pregnant due to low immunity, the chance of contracting the fetus will be high, these infections will not only lead to fetal cessation It can also make the baby born abnormal.
3, immune antibody test: including anti-sperm antibody, blocking antibody, anti-embryonic antibody, anti-ovarian antibody, anti-nuclear antibody, anti-endometrial antibody, anti-human chorionic gonadotropin antibody, anti-cardiolipin antibody, etc., immunity The clinical manifestation of infertility is fetal stop.
4, thyroid function test: abnormal thyroid function is a factor leading to fetal stop.
5, leucorrhea routine screening: check for trichomoniasis, mold, mycoplasma, chlamydia infection, bacterial vaginal inflammation.
6, detection of sexually transmitted diseases such as gonorrhea, syphilis.
7, cervical mycoplasma, chlamydia determination.
8, hysteroscopy: to determine whether the uterine cavity adhesions, uterine fibroids, uterine deformities and other issues.
9, the uterus, accessories B super.
10, ABO hemolysis, Rh blood group antigen system check subjects: female blood type is O type, husband is type A, type B, or unexplained abortion history.
11, chromosome examination.
Diagnosis
Diagnosis and identification of embryonic stop
(1) Symptoms:
Most pregnant women have no obvious symptoms after they stop developing. Some pregnant women may see red and generally have no abdominal pain, which is different from threatened abortion.
(2) Diagnosis:
The patient has a history of menopause, whether or not there is redness, B-ultrasound should be performed in the first trimester to avoid missed diagnosis of embryos. B-ultrasound monitoring of embryos, fetal development, such as 6 weeks without gestational sac, or although there is a gestational sac but deformed and shrunk, when the gestational sac has 4cm but can not see the fetal bud, the length of the head bud of the fetal bud is 1.5cm but no fetal heart Bog can determine abnormal embryo or fetal development. The latter three cases can be diagnosed as embryonic cessation. In addition, blood -hcG assay also contributes to the diagnosis of embryonic cessation. For example, 5 weeks, blood -hcG<100IU/L; 6 weeks, blood -hcG<2000IU/L, m indicates insufficient chorionic gonadotropin secretion, and dynamic observation of the value is no longer rising, then the fluff can be determined Epithelial decline, abnormal embryos.
