I. Definition
Repeat miscarriage refers to 3 or more consecutive miscarriages in women of childbearing age before 28 weeks of gestation, when the fetus weighs less than 1000g, and the embryo stops developing automatically.
Etiology
The etiology and pathological mechanism of recurrent miscarriage are very complicated, and a comprehensive examination is needed to find the cause. 50% of them have no clear cause and belong to recurrent miscarriage of unknown origin, and immune factors play an important role in the pathological mechanism of recurrent miscarriage of unknown origin. The common causes are as follows: Wang Xiaoli, Department of Obstetrics and Gynecology, People’s Hospital of Yangshan County
1, uterine factors: uterine malformation, uterine adhesions, benign and malignant tumors of the uterus can lead to endometrial dysplasia, insufficient blood supply to the uterus affecting the development of the fetal placenta and leading to miscarriage. Cervical insufficiency, i.e. cervical endocervical insufficiency or endocervical relaxation, is the main cause of recurrent miscarriage in the middle of pregnancy.
Genetic factors: The rate of chromosomal abnormalities in couples with recurrent miscarriage is about 3.2% to 4.9%, mainly manifested as embryonic abortion and recurrent miscarriage in early pregnancy. Karyotype analysis of miscarried embryo tissue found that 22%-61% of miscarried embryos have chromosomal abnormalities, and spontaneous miscarriage due to chromosomal abnormalities or genetic abnormalities is a form of natural selection in human evolution.
3, immune factors: the relationship between immune factors and recurrent miscarriages is attracting more and more attention. In the past, it was thought that the cause of recurrent miscarriage was unknown, but now it is believed that it is related to immune factors, and about 20% of recurrent miscarriages are caused by immune factors. The examination mainly includes anti-cardiolipin antibody, anti-nuclear antibody, lupus anticoagulant, β2-glycoprotein I antibody, anti-thyroglobulin antibody, anti-thyroid peroxidase antibody, etc.
4, endocrine factors: common endocrine abnormalities mainly include luteal insufficiency, hyperprolactinemia, hypothyroidism, polycystic ovary syndrome, severe diabetes mellitus, etc.
5, infection: Infection during pregnancy not only harms the mother, but certain infections can also have serious effects on the fetus and newborn. In addition to causing miscarriage, premature birth or stillbirth, it can also lead to various malformations and mental retardation, thus affecting the quality of the population. The main tests include TORCH, the four eugenic tests (toxoplasmosis, cytomegalovirus, rubella virus, herpes simplex virus), chlamydia, gonococcus, etc.
6, mother and child ABO + RH blood type incompatibility: blood type incompatibility between the pregnant woman and the fetus, will produce the same immune disease, which will cause miscarriage.
7.Insufficient immunosuppression: abnormal immune response to the paternal antigen of the embryo, maternal rejection of the fetus, manifested as closed antibody negativity.
8, systemic diseases: severe anemia or heart failure, diabetes, hypertension, liver and kidney diseases, poor coagulation function, etc.
9, bad habits: excessive smoking, alcoholism, excessive coffee, drug and medicine dependence, exposure to toxic substances.
10, male factors: poor semen quality, or sperm DNA damage.
Third, treatment: treatment for the cause, if the cause of miscarriage is not found, a comprehensive treatment based on clinical experience is required.
1. Etiological treatment: If the cause of miscarriage is found according to the above examination, the cause should be treated.
(1) Give heparin sodium and aspirin if the relevant antibody is positive.
②Immunotherapy, such as closed antibody negative: clinically, lymphocyte immunotherapy is used to induce the mother to produce an alloimmune response, resulting in closed antibodies and microlymphocytotoxic antibodies,
This makes the maternal immune system less susceptible to immune attack on the fetus and allows the pregnancy to continue.
(3) Uterine insufficiency: cervical cerclage is given at 12-17 weeks of gestation.
④Uterine malformations can be treated by surgical correction, large uterine fibroids can be removed, and uterine adhesions can be treated by surgery and estrogen therapy;
⑤ Patients with hyperprolactinemia can be given bromocriptine to control prolactin at normal level by excluding pituitary adenoma.
(6) Supplementary therapy such as eugenol should be given to patients with hypothyroidism.
(7) Patients with abortion due to infection are given anti-infection treatment until the relevant indexes turn negative.
(8) Patients with systemic diseases such as diabetes mellitus and hypertension should be given glucose-lowering and antihypertensive treatment;
2.Fetal preservation treatment: for patients with preterm miscarriage and previous history of spontaneous abortion, perform fetal preservation treatment as soon as possible after pregnancy.
3.Regular testing, such as blood HCG (chorionic gonadotropin), prolactin, progesterone, etc. If the test result is abnormal, it indicates the possibility of miscarriage and can be treated in advance.
4. Pay attention to rest, strengthen nutrition, and avoid all stimulating factors that can cause uterine contraction as much as possible.
5. Monitor the antibody potency of the mother and child with blood group incompatibility during pregnancy, monitor closely during pregnancy, if the antibody potency increases, terminate the pregnancy in time after fetal maturity.
6. Treatment is required for male partner with abnormal semen.
Patients with repeat miscarriage should take contraceptive measures first, and then get pregnant after comprehensive examination and targeted treatment to avoid recurrence of spontaneous miscarriage.