Habitual abortion
Introduction
Introduction to habitual abortion Habitual abortion is a spontaneous abortion for more than 3 consecutive times, and each abortion often occurs in the same pregnancy month. Chinese medicine is called "slipper". Most of the causes of habitual abortion are luteal insufficiency, hypothyroidism, congenital uterine malformation, uterine dysplasia, intrauterine adhesions, uterine fibroids, chromosomal abnormalities, and autoimmunity. Habitual late abortion is often caused by relaxation of the internal cervix. Due to cervical rupture caused by curettage or dilation of the cervix, a small number may be congenital dysplasia. After the mid-pregnancy, due to the growth of amniotic fluid, the fetus grows up, the intrauterine pressure increases, and the fetal sac can protrude from the internal cervix. When the intrauterine pressure increases to a certain extent, it will rupture the membrane and abort, so the abortion There are often no symptoms before. basic knowledge Probability ratio: 0.5% of women with gestational age Susceptible population: pregnant women Mode of infection: non-infectious Complications: endometritis, salpingitis, spontaneous abortion, infertility, abdominal pain
Cause
Habitual abortion cause
Environmental factors (20%):
Excessive exposure to certain harmful chemicals (such as arsenic, lead, benzene, formaldehyde, chloroprene, ethylene oxide, etc.) and physical factors (such as radiation, noise and high temperatures) can cause miscarriage.
Maternal factor (15%):
Acute disease, high fever, bacterial toxins or viruses during pregnancy (herpes simplex virus, cytomegalovirus, etc.), severe anemia or heart failure, chronic nephritis or hypertension, genital diseases (such as uterine malformations, double uterus, mediastinal uterus and uterus development) Poor, etc., pelvic tumors (such as uterine fibroids, etc.), hypothyroidism, severe control of severe diabetes, and insufficient endocrine function of the placenta can lead to miscarriage.
Maternal and child blood group incompatibility (10%):
Maternal and child blood group incompatibility is a cause of habitual abortion. Maternal and child blood types are different, mainly in the ABO type and Rh type. Once pregnant, the husband and wife should have a blood type test before giving birth. If the husband is type A, type B or type AB, and the pregnant woman is type O, there is a possibility of ABO blood group incompatibility. If the husband is Rh positive and the pregnant woman is Rh negative, there is a possibility of Rh blood group incompatibility. Childbirth allows the mother to produce antibodies to the blood of the fetus. The first pregnancy has little effect on the fetus. The more the number of births, the greater the possibility of fetal and neonatal morbidity. Therefore, it often occurs after the second child. Such blood type is incompatible with severe illness, which can be common in miscarriage, stillbirth, and severe neonatal hemolytic jaundice.
Genetic defects (25%):
The majority of embryos with chromosomal abnormalities are aborted, and very few may continue to develop into fetuses, but some functional abnormalities or malformations may occur after birth.
Prevention
Habitual abortion prevention
1, based on prevention, before the conception, both men and women should go to the hospital for careful examination, including genital examination and necessary tests. Conditional chromosomal examination, if the cause can be found, for the cause of treatment. Those who have already been pregnant should also follow the doctor's instructions for different reasons for the treatment of the fetus.
2, Chinese medicine believes that this disease is mostly due to lack of kidney, Chong Ren is not solid, it is appropriate to kidney and spleen before the pregnancy, solid qi and nourishing, for treatment. Zishen Yutai Pills for kidney and spleen, Yiqi Peiyuan, nourishing blood and fetus, strong body, prevent habitual abortion and threatened abortion. Stop the menstrual period, take 2 months as a course of treatment, can take 1-3 courses.
3. For habitual abortion in the third trimester of pregnancy caused by relaxation of the uterus, the intrauterine suture is usually performed in the 16-22 weeks of pregnancy to maintain the pregnancy to the late stage or even the full term.
4. Women who suffer from habitual abortion and cause infertility usually receive social pressure from family ethics and local customs. Therefore, they are always seeking diagnosis and treatment nationwide.
Complication
Habitual abortion complications Complications endometritis salpingitis spontaneous abortion infertility abdominal pain
1, easy to cause infection: multiple occurrences can be due to expansion is too convenient for the invasion of bacteria, light can lead to endometritis or salpingitis. Even if the implantation of the pregnant egg will cause the endometrium to be frequently sucked and damaged, which will affect the implantation of the placenta and cause obstacles in the blood circulation of the placenta, resulting in hypoxia and growth retardation, which will increase the mortality of premature infants and neonates.
2, easy to form spontaneous abortion: multiple artificial abortions have the risk of causing spontaneous abortion. The multiple endocytosis has a great impact on the neuroendocrine and reproductive function of women, especially for unmarried women, which can increase the spontaneous abortion rate in the early and middle stages of pregnancy. It also increases the incidence of ectopic pregnancy, placenta previa and postpartum hemorrhage.
3, easy to damage the endometrium: multiple artificial abortion is easy to damage the endometrium, because the most vulnerable to damage to the basal layer of the endometrium when sucking, so there are many uterine perforation. After the normal tissue between the endometrium and the basal layer of the functional layer is destroyed, the endometrium can easily grow into the basal or muscular layer, producing adenomyosis or adenomyoma, causing excessive and infertility. Abdominal pain and other symptoms.
Symptom
Habitual abortion symptoms Common symptoms Vaginal irregular bleeding lower abdomen pain is inevitable abortion or not ... Cervical dilatation completely abortion vaginal discharge fragment tissue spontaneous abortion threatened abortion
The clinical manifestations of habitual abortion are the same as those of general abortion, and it is also a stage of experiencing threatened abortion, inevitable abortion, incomplete or complete abortion.
Early symptoms
1. A little vaginal bleeding: The early symptoms of a woman with a habitual abortion are the same as those of a general abortion. The vaginal bleeding may last for a few days, or it may last for several weeks, but the blood volume is generally less. If female friends have increased blood volume, then it means that women will have a miscarriage, and it is impossible to avoid miscarriage.
2. Lower abdominal pain: Female friends have a faint pain in the lower abdomen after suffering from habitual abortion, usually accompanied by a small amount of bleeding in the female vagina. If female friends have a feeling of faint pain in the lower abdomen, There are symptoms of intravaginal bleeding, then you need to pay attention.
3. Pregnancy exclusion: When female friends discharge a part of the pregnancy in the uterus, then it is said that some of the residual in the uterus is an incomplete abortion; if the pregnancy inside the uterus is completely excluded from the female, then It is called a complete abortion phenomenon. When women have this kind of situation, they should go to the hospital in time to do the corresponding uterus treatment to avoid the pregnancy infection in women.
Late symptoms
The amount of bleeding in the vagina increases, and the pain in the abdomen is aggravated: At this time, the cervix is examined, and the expansion can be found, or the fetal sac is blocked in the cervix, so habitual abortion is inevitable.
Examine
Habitual abortion check
Laboratory inspection:
1. Genetic examination
(1) For those suspected of having hereditary diseases, both husband and wife should do karyotype examination, or further do family genetic survey and pedigree mapping.
(2) Pedigree analysis: Through the family survey, analyze the impact of hereditary diseases on future pregnancy.
(3) Karyotype analysis: Simultaneously detect the chromosomes of peripheral blood lymphocytes of both couples, observe whether there are any number and structural aberrations and types of distortion, and speculate on the probability of recurrence.
(4) Molecular genetic diagnosis
2, endocrine diagnosis
(1) Basal body temperature measurement (BBT): The basal body temperature can reflect the functional status of the ovary and can be used to screen for luteal insufficiency. Because luteal insufficiency can cause habitual abortion, the basal body temperature of luteal dysfunction is: high temperature phase is less than 11 days; high temperature phase body temperature rise is less than 0.3 degrees.
(2) Endometrial biopsy: The length of the menstrual cycle varies greatly among individuals, mainly due to the different lengths of the follicular phase, while the luteal phase and endometrial changes are basically the same. Endometrial biopsy at the end of the luteal phase, such as poor endometrial maturity, can diagnose corpus luteum insufficiency. Endometrial biopsy In addition to routine histological testing, it is best to do estrogen receptor measurements at the same time. The endometrial estrogen and progesterone receptors are low in content. Even if the corpus luteum function is normal, the progesterone is sufficient, and the endometrial maturity is still behind the normal level, which is a pseudo-luteal dysfunction.
(3) Hormone determination, including quantitative detection of estrogen and progesterone, chorionic gonadotropin, and the like. Determination of serum progesterone: Progesterone in peripheral blood in the menstrual cycle mainly comes from the menstrual corpus luteum formed after ovulation, and its content gradually increases with the development of the corpus luteum, until the corpus luteum matures, that is, the middle part of the corpus luteum, the progesterone content in the blood reaches The peak, then falling, reached the lowest level before the menstrual period. The progesterone content of peripheral blood in the whole luteal phase was parabolic. When the corpus luteum is insufficiency, the amount of progesterone secretion decreases, so the determination of progesterone levels in the peripheral blood can reflect the functional status of the corpus luteum. Serum progesterone levels greater than 3 micrograms per milliliter (ie 3 ng / ml), indicating that the ovary has ovulation, luteal phase progesterone levels greater than 15 micrograms per milliliter (ie 15 ng / ml) indicating normal luteal function, less than this is luteal insufficiency.
(4) Determination of serum prolactin (PRL): serum prolactin is secreted by the anterior pituitary gland, and its main function is to promote milk secretion after childbirth. At the same time, serum prolactin also plays an important role in maintaining normal corpus luteum function. Too low or too high can lead to luteal insufficiency. Common in clinical practice is hyperprolactinemia, which is excessively secreted by serum prolactin. The normal value of serum prolactin in serum is 4-20 micrograms per ml, which is higher than 20 micrograms. The mild elevation of serum serum prolactin is closely related to repeated abortion. Excessive levels of serum prolactin severely interfere with the function of the glandular axis, leading to anovulation and infertility.
3, immunological examination
(1) Firstly, mixed lymphocyte culture reaction (MLR) and lymphocyte toxicity antibody assay were used to identify primary and secondary abortions. Primary abortion occurs more than 20 weeks after pregnancy. Husband and wife have more human leukocyte proic (HLA) than normal spouses. Wife does not have sputum immunization, and her husband shows a weak mixed lymphocyte culture reaction. Serum does not contain mixed lymphocyte culture blockers, and leukocyte therapy is effective. There is no human leukocyte prostaglandin (HLA) between the secondary abortion spouses, and the wife has complement-dependent or complement-independent anti-spouse lymphocyte toxic cells, and shows a multi-antibody antibody to a group of cells, and heparin treatment is effective. The woman compared the male single-phase mixed lymphocyte culture and compared it with the antigen of the third party. If the woman shows weak or lack of mixed lymphocyte reaction to her husband, it suggests that her wife has no anti-parental antibodies in her blood and has the same human leukocyte progenitor as her husband.
(2) Determination of anti-sperm antibodies: such as anti-sperm antibody positive, suggesting low fertility. High anti-sperm antibody titers and anti-sperm antibodies in cervical mucus have a great impact on fertility. Sperm agglutination antibodies can be detected by sperm agglutination test, sperm brake antibodies can be detected by sperm braking test, and sperm-binding antibodies can be detected by immunobead test.
(3) Determination of antiphospholipid antibody (APA): Anti-phospholipid antibodies are detected in patients suspected of having autoimmune diseases, and the antiphospholipid antibodies and their titers in the serum of females can be directly determined by enzyme-linked immunosorbent assay.
(4) Determination of natural killer cell activity: High activity of natural killer cells before pregnancy indicates a high possibility of abortion in the next pregnancy.
(5) Determination of maternal anti-parental lymphocyte cytotoxicity: the couple's lymphocytes plus complement are incubated together, and then count the percentage of dead cells, such as more than 90% of dead cells, normal pregnancy, less than 20%, repeated abortion .
(6) Determination of blood type and blood type antibody: husband's blood type is A or B, or AB type, the wife is O type and has a history of abortion, and then should check whether the husband is O type when pregnant, O type does not cause ABO blood type Not in harmony. On the contrary, when the husband is A or B or AB type, he should consider whether his wife has anti-A, anti-B or anti-AB antibodies, and do pregnancy monitoring to prevent miscarriage and stillbirth.
There are more than forty causes of habitual abortion or fetal suspension. The diagnosis and treatment is the specialty of Antai Hospital. Antai = a fetus. It takes a day to find the cause, to do anti-embryo antibody + four-dimensional color ultrasound + electrochemiluminescence endocrine + dynamic digital hysterosalpingography. About 3,000 or so, after diagnosis and treatment, if it is genetic vaccine immunotherapy and cervical embedding, it is 30,000, invalid after the treatment of the full refund; other reasons vary from one to 30,000, with international patents.
4, the inspection of internal genital malformations
(1) Hysterosalpingography (HSG): Hysterosalpingography is a sensitive and specific method for diagnosing uterine malformations. According to whether there is abnormality or filling defect in the uterine cavity, it can be judged whether there is uterine malformation. If the angiography shows that the diameter of the internal cervix is greater than 6 mm, it can help to diagnose cervical insufficiency.
(2) Ultrasound examination: Ultrasound is not as good as hysterosalpingography in the diagnosis of uterine cavity abnormalities, but it is of great significance in the diagnosis of uterine external morphological abnormalities. For example, ultrasound examination combined with hysterosalpingography can help the differential diagnosis of mediastinal uterus and double-horned uterus; ultrasound examination can determine the number, size and location of uterine fibroids.
(3) Magnetic resonance imaging: Although the cost is high, it plays a significant role in judging the internal genital malformation.
(4) Laparoscopy and hysteroscopy: Both can directly observe the external morphology of the uterus and the intrauterine condition, and can identify the uterine malformation and its type. Hysteroscopy can also confirm intrauterine adhesions and can be treated to a certain extent. Laparoscopy can also diagnose and treat pelvic lesions, such as pelvic adhesions, endometriosis, and the like.
(5) Cervical dilator examination: Cervical dysfunction is indicated when there is no difficulty in extending the cervical dilator into the cervix.
5, the detection of pathogen infection urine, cervical mucus culture to understand whether there is microbial infection. Pathogen infection is also the cause of repeated abortion, and should be cultured by cervical secretions of mycoplasma, chlamydia, and -hemolytic streptococcus. In general, TORCH testing (toxoplasma, rubella virus, cytomegalovirus, herpes virus immunoassay) and other pathogenic microbial antibodies are of little significance unless the history suggests chronic infection. Postpartum pregnancy should be pathologically examined.
Diagnosis
Habitual abortion diagnosis
It is recommended that a full-term, sequential assessment be initiated after a spontaneous abortion of a second-term pregnancy or two abortions of an early pregnancy. Should pay attention to the medical history and physical examination of both couples, this is the first step to initiate the diagnosis and treatment of infertility. Including: blood, urine routine, erythrocyte sedimentation rate, urine sugar, chest penetration and so on. Abortion must be differentiated from functional uterine bleeding, tubal pregnancy, hydatidiform mole, uterine fibroids, and chorionic epithelial cancer. In addition, various types of abortion should be identified in order to clarify the diagnosis and choose different treatments depending on the type.
