complete miscarriage
Introduction
Introduction Complete abortion: It means that the pregnancy has been completely discharged, the amount of vaginal bleeding is reduced, gradually stopped, abdominal pain disappears, the cervix is closed during gynecological examination, the uterus is quickly revived, and the size of the uterus is close to normal. Through the aura and dystocia abortion process, the embryonic tissue is completely discharged in a short time, and bleeding and abdominal pain are stopped. Spontaneous abortion is a misfortune for pregnant women, but in a sense, spontaneous abortion is a way for human beings to continually optimize themselves. It is also a choice for gestating new life. The survival of the fittest is the law of nature, accounting for more than 50% of abortion. Chromosomal abnormalities Early abortion of the fetus will reduce the birth of the deformed child. Therefore, the cause should be ascertained as possible before the miscarriage, and blind fetus should not be blinded.
Cause
Cause
Reasons for complete abortion:
The causes of miscarriage are complex and diverse. The most common causes of early abortion are chromosomal abnormalities, endocrine abnormalities, uterine dysplasia or deformities.
I. Chromosomal abnormalities Chromosomal abnormalities include abnormal chromosome numbers, such as monomer, trisomy, and polyploid. Structural abnormalities, such as breaks, deletions, and translocations, can cause miscarriage. Chromosomal studies of spontaneous abortions and therapeutic abortions have found that 60% of karyotype abnormalities occur in spontaneous abortions. A karyotype abnormality is accompanied by a structural abnormality such as a fetus or a placenta. The fetuses with abortion in normal karyotype are more normal.
Second, endocrine disorders excessive estrogen and progesterone deficiency is also the cause of early abortion. Because it is in the period of placenta formation instead of pregnancy luteal function in the 12-14 weeks of pregnancy, it is easy to have endocrine disorders, especially the luteal function. In addition, the lack of thyroxine, the cell's oxidation process is impeded, and hyperthyroidism and diabetes are prone to miscarriage.
Third, placental abnormalities and endocrine insufficiency in the early pregnancy, decidual inflammation can cause decidual hemorrhage or hyperplasia, villus epithelial cells and decidual cells are dissolved, vascular obstruction in the villi, affecting the absorption and transport of nutrients, resulting in pregnant eggs Isolation from the attachment, bleeding and abortion. In addition, a large infarction in the placenta can reduce the function of the placenta and affect the survival of the fetus. It is not uncommon for the placenta previa, placental villus edema and degeneration to become abortion. In the maternal blood after pregnancy, -hCG, hPL, P, E2, estrone, if these hormone values decrease in early pregnancy, 50% abortion.
IV. Incompatibility of blood type Due to previous pregnancy or blood transfusion, Rh factor and inconsistent ABO blood group factor produce antibodies in the mother. This pregnancy enters the fetus from the placenta and agglutinates with red blood cells to cause hemorrhage.
Fifth, mental and neurological factors such as fright, severe mental stimulation can also cause miscarriage. In recent years, through research, noise and vibration have a certain impact on human reproduction.
6. Maternal systemic diseases
(1) Severe acute infectious diseases and infectious diseases: such as lobar pneumonia, many with high fever leading to uterine contraction, or embryo death can cause miscarriage.
(B) chronic diseases: severe anemia, heart disease, heart failure can cause fetal hypoxia, suffocation and death. Chronic nephritis, severe hypertension can cause infarction or early dissection of the placenta and cause miscarriage.
(3) Malnutrition or drug poisoning: such as vitamin deficiency, especially the lack of vitamin E-tocopherol, chronic poisoning such as mercury, lead, alcohol and morphine, can cause miscarriage.
Seven, reproductive organs diseases
Uterine malformations, such as the double-horned uterus, the uterine cavity mediastinum, are often the cause of miscarriage. But uterine dysplasia is often the cause of infertility. In addition, such as uterine fibroids, especially submucosal fibroids that develop into the uterine cavity or ovarian cysts that are embedded in the bone cavity, can affect the development of the fetus and cause miscarriage. Relaxation of the uterus is one of the common causes of habitual abortion. In recent years, about 14% of patients with intrauterine adhesions have developed after abortion. Adhesion causes uterine contraction, deformation, and reduction of endometrial area, and hardening, affecting embryonic development.
Eight, immune factors
For those whose causes are unknown, recent studies have found that most of them are closely related to immune factors.
(1) Histocompatibility locus antigen (HLA): The HLA complex is located on a segment of the short arm of the sixth pair of chromosomes of humans, including at least 4 gene loci associated with transplantation: HLA-A, B, C, D/DR, etc. HLA incompatibility in normal pregnancy can maintain genetic diversity and prevent the production of lethal homozygotes. The frequency of HLA antigen compatibility between habitual abortion couples is greater than that of normal pregnancy, and the chance of DR antigen is the same. Excessive consensus antigens prevent the mother from recognizing the pregnancy as an allogeneic antigen, and cannot stimulate the mother to produce antibodies required for maintenance of pregnancy, and lack the regulation of antibodies. The maternal immune system is susceptible to an immunological attack on the fetus, leading to miscarriage.
(B) anti-phospholipid antibodies: a group of autoimmune antibodies, including lupus anti-coagulant antibody (LA) and anti-cardiolipin antibodies (acl). In recent years, studies have found that in autoimmune diseases, certain infections, drugs, or unexplained diseases, such as antiphospholipid antibodies, the incidence of habitual abortion is extremely high. Patients often have arteriovenous thrombosis, thrombocytopenia, and the cause of abortion is due to thrombosis, which causes dysfunction of the diaphragm or placenta. Antiphospholipid antibodies do not act on abortion in the early pregnancy, but in the middle and late pregnancy to cause fetal death. Antiphospholipid antibodies may be a factor in the middle and late abortion.
(3) Anti-sperm antibodies: In couples of recurent spontaneous abortion (RSA), studies have found anti-sperm antibodies in the serum of both sides or men. Animal experiments have shown that anti-sperm antibodies have the effect of killing embryos. This suggests that the presence of this antibody is associated with RSA. Domestically, it has been reported that the female anti-sperm antibody is more common, indicating that the woman's allogeneic immunity to sperm and her husband's autoimmunity are related to RSA.
Abortion caused by anti-sperm antibodies occurs in early abortions within 3 months, that is, sperm agglutination antibodies in the mother continue to act on the lesions of early embryonic tissues, causing embryo damage and miscarriage.
Examine
an examination
Related inspection
Obstetric B-ultrasound system fetal ultrasound examination blood routine urine routine gynecological routine examination
Complete abortion check and diagnosis:
Complete abortion: ultrasound image: 1 normal size of the uterus or slightly larger. 2 see the regular intrauterine wave in the uterine cavity, no irregular light group.
For couples who have had a history of abortion, they should go to the hospital for examination in time to find out the cause of the abortion. No matter which side of the couple has problems, they should be treated promptly.
Diagnosis
Differential diagnosis
Differential diagnosis of complete abortion:
(1) Threatened abortion: The performance of abortion, but after the treatment of miscarriage, may continue to pregnancy to full-term. Often occurring in early pregnancy, only a small amount of vaginal bleeding, accompanied by a slight intermittent uterine contractions. At the time of examination, the uterine cervix did not open, the amniotic sac did not rupture, the uterus was in line with the menopause month, and the pregnancy test was positive.
(2) Inevitable abortion or inevitable abortion (inevitable abortion): There are the above processes, but the embryo continues to separate from the uterine wall, bleeding for a long time, increased bleeding, more than normal menstrual flow, and blood clots, paroxysmal lower abdominal pain Intensified, for a sloppy or swell. Check the uterus mouth gradually open, the pregnancy month is larger, and some amniotic sac has bulged or ruptured. Some embryonic tissues are blocked in the cervical canal and even exposed to the external cervix. Abortion is bound to occur, and pregnancy cannot continue.
(3) Incomplete abortion: often occurs in later pregnancy (after 10 weeks), the placenta is developing or has formed, the fetus and part of the placenta are discharged during abortion, the entire placenta or part of the placenta is still attached to the uterine wall, the uterus Can not shrink very well, so that the vaginal bleeding is very much. Residual placenta can form placental polyps for a long time, repeated bleeding, and easy to induce infection.
(4) Missed abortion: also known as expired abortion or stillbirth. Refers to the embryo death and still stay in the uterine cavity, and the pregnancy products are generally discharged within 1 to 2 months after the symptoms are produced. Therefore, it is stipulated that the embryos have not been naturally discharged 2 months after the embryo ceases to develop, which is called missed abortion. Pregnant women often have a threatened abortion in early pregnancy, after which the uterus no longer grows up, but gradually shrinks, and is not as soft as normal pregnancy. The pregnancy test changed from positive to negative, and the placenta was mechanically adhered to the uterine wall and was not easily separated. On the other hand, due to insufficient sex hormones, the uterine contractility is reduced, and it is difficult to discharge and the uterine cavity is reserved. After the embryo dies, the placenta dissolves, and the lysozyme is produced into the maternal blood circulation, causing blood coagulation in the microvessels, consuming a large amount of clotting factors, and the longer the period of the uterine cavity is, the greater the possibility of causing coagulation dysfunction. In recent years, B-ultrasound has been widely used in clinical practice. It can be used to detect fetal sac and fetal buds after 6 to 7 weeks of menopause. If you suspect that the embryo has stopped developing, you can use B-ultrasound to make a diagnosis and treatment in time. Therefore, it is suggested that the term "missing abortion" should be used again, but the clinical symptoms are not obvious, and the patient's attention is not noticed. The embryonic death of the embryo is longer in the diagnosis.
(5) Habitual abortion: spontaneous abortion for more than 3 consecutive times is called habitual abortion, and abortion often occurs in the same month, and the process of abortion can undergo the aforementioned clinical classification.
