Habitual abortion
Introduction
Introduction 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.
Cause
Cause
The causes of habitual abortion are complex and often caused by a combination of factors.
The more obvious causes are:
1, genetic factors: about 4.5% -25% of habitual abortion, such as embryonic chromosome abnormalities, abortion occurred within 8 weeks of pregnancy.
2, endocrine factors: about 13% - 20%, such as ovarian corpus luteum insufficiency, is also a common cause of early abortion.
3, reproductive organs abnormalities: about 12% - 15%, such as uterine dysplasia, cervical internal dysfunction, etc., causing late abortion.
4, infection factors: accounted for 2%, such as viral or bacterial infections, on the one hand can lead to abnormal development of the embryo, on the other hand can cause inflammation of the reproductive organs, is not conducive to implantation of pregnant eggs.
Examine
an examination
Related inspection
Obstetrics B-ultrasound gynecological ultrasound examination of closed antibodies to check anti-cardiolipin antibodies infertility blood group examination
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: At present, some genetic diseases can be diagnosed by molecular genetic examination.
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 as follows: the high temperature phase is less than 11 days, and the 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. Mild elevation of 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 within 20 weeks of gestation. The husband and wife share more human leukocyte antigen (HLA) than the normal spouse. The wife does not have anti-spouse immunity, and the husband shows a weak mixed lymphocyte culture reaction, serum. Does not contain mixed lymphocyte culture blocking factor, leukocyte therapy is effective. There is no human leukocyte antigen (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, which is effective for heparin treatment. 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, she suggests that her wife has no anti-parental antibodies in her blood and has the same human leukocyte antigen 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 anti-blood type antibody: husband's blood type is A or B, or AB type, his wife is O type and has a history of abortion. When pregnant, he should further check whether her husband is O type, 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.
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: When there is no difficulty in extending the cervical dilator into the cervix of the cervix, the cervical dysfunction is indicated.
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
Differential diagnosis
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.
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: At present, some genetic diseases can be diagnosed by molecular genetic examination.
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. Mild elevation of 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 within 20 weeks of gestation. The husband and wife share more human leukocyte antigen (HLA) than the normal spouse. The wife does not have anti-spouse immunity, and the husband shows a weak mixed lymphocyte culture reaction, serum. Does not contain mixed lymphocyte culture blocking factor, leukocyte therapy is effective. There is no human leukocyte antigen (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, which is effective for heparin treatment. 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, she suggests that her wife has no anti-parental antibodies in her blood and has the same human leukocyte antigen 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 anti-blood type antibody: husband's blood type is A or B, or AB type, his wife is O type and has a history of abortion. When pregnant, he should further check whether her husband is O type, 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.
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.
