Currently, the incidence of spontaneous abortion is about 10-15%, with a gradual increase. Women who have experienced spontaneous abortion are often nervous when planning to get pregnant again, and often visit the clinic for advice on how to prepare for pregnancy in order to avoid another miscarriage. For this reason, the Center for Reproductive Medicine at Ruijin Hospital has established a special clinic for recurrent spontaneous miscarriages to provide professional consultation and treatment for such patients.
First of all, let’s clarify the concept: miscarriage refers to the termination of pregnancy before 28 weeks of gestation, when the fetus weighs less than 1000g. Miscarriage before 12 weeks of gestation is called early miscarriage, while miscarriage between 12 and 28 weeks is called late miscarriage.
What are the causes of spontaneous miscarriage? What can we do to prevent and treat it? The causes of spontaneous abortion are very complex and diverse, including fetal chromosomal abnormalities, maternal reproductive tract malformations, lesions, infections, endocrine diseases, immune abnormalities, parental blood type incompatibility and many other factors.
1, embryonic chromosomal abnormalities, accounting for more than 50% of the causes of early spontaneous abortion.
Some couples are carriers of chromosomal abnormalities such as balanced ectopic and roentgenographic ectopic. Although there is no abnormality in appearance, the embryos they conceive will have a high chance of chromosomal abnormalities and eventually develop disorders and end up in miscarriage. In addition, gametes and congeners are extremely sensitive to the external environment during development. Teratogenic factors in the environment, including radiation, viruses and drugs, may cause chromosomal abnormalities. For this part of the embryo, abortion plays the role of “survival of the fittest”, natural selection, elimination of abnormal embryos, in fact, it is important to maintain the stability of the species.
2. Abnormal sperm quality
Men who have been in high temperature and radiation environment for a long time, or alcohol and smoking, may change the quality of sperm, leading to abnormal fertilized eggs and miscarriage.
3.Maternal factors
Maternal factors include: endocrine abnormalities, such as luteal insufficiency, polycystic ovary syndrome, diabetes, hypothyroidism, hyperthyroidism, obesity, etc.; abnormalities or organic lesions of the reproductive organs of pregnant women: uterine fibroids, uterine diaphragm, uterine cavity adhesions, relaxation of the endocervical opening, etc. Women with fibroids are three times more likely to have a spontaneous abortion than normal people. This is because fibroids can compress the local tissues of the uterus and deform the uterine cavity, which is not conducive to the development of the embryo and leads to miscarriage. Loose inner cervical opening tends to lead to miscarriage in the middle of pregnancy (around 5 months). This is because as the fetus grows, the amniotic fluid gradually increases, the pressure in the uterine cavity increases, and the cervical opening protrudes and causes rupture of the fetal membranes. Adhesions in the uterine cavity lead to adhesions due to severe damage to the endometrium, which shrinks and deforms the uterine cavity and hardens the endometrium and affects embryonic development. Pregnant women infected with viruses, bacteria, parasites, etc. before or during pregnancy may also easily lead to miscarriage.
4.Environmental factors
Such as excessive exposure to benzene, formaldehyde, lead, ionizing radiation, etc., causing abnormal embryo development and termination.
5. Abnormal immune function
Many miscarriages that were originally thought to be “unexplained” are now found to be closely related to immune factors and may be an important cause of recurrent miscarriages. After pregnancy, the fertilized egg must grow in the uterus, which is equivalent to a homozygous transfer from an immune point of view, and metaphorically speaking, there are certain antibodies in the uterus that can act as a “seal” to protect the embryo. In the absence of such antibodies, the uterus will think that the embryo is a “bad thing” and will use its immune system to “attack” the embryo, expelling it as a foreign body. So far, obstetricians and gynecologists believe that it is difficult to find objective evidence of the cause of miscarriage caused by closed antibody deficiency, and the treatment method cannot be unified, and the effect of the treatment varies, but we have found some efficacy after targeted treatment.
6.Pregnant women suffering from systemic diseases during pregnancy
When pregnant women suffer from acute infectious diseases such as influenza, typhoid and pneumonia, bacterial toxins or viruses enter the fetus through the placenta and can cause fetal death by poisoning. High fever can promote uterine contraction and cause miscarriage. When a pregnant woman suffers from chronic diseases such as severe anemia, heart failure, chronic nephritis and hypertension, the fetus can be disabled due to placental infarction and lack of oxygen in the uterus, resulting in miscarriage. Malnutrition of pregnant women, especially vitamin deficiency, as well as mercury, lead and alcohol poisoning can cause miscarriage.
What should I do after a spontaneous miscarriage?
If only one spontaneous miscarriage occurs, the couple need not be apprehensive, they can actively exercise, strengthen sports, quit smoking and alcohol, and take folic acid and multivitamins for the female partner and vitamins and zinc and selenium for the male partner in moderation 3 months before the planned pregnancy, and prepare for pregnancy after 3 to 6 normal menstrual periods. If the woman has no reproductive organ abnormalities or diseases, no special tests are necessary. It is safer to actively keep the fetus after another pregnancy until 12 weeks until the placenta is formed. If a woman has genital diseases, she should be treated before pregnancy.
Daily prevention methods of miscarriage during early pregnancy
(1) Do not do heavy physical labor, do not lift heavy objects, do not climb high, do not travel far and avoid fatigue during the third month of pregnancy;
(2) Keep your mood relaxed, avoid all kinds of mental stimulation, eliminate tension, boredom and fear, and harmonize your emotions;
(3) prevent trauma, avoid falls and abdominal impact and extrusion by external forces;
(4) Avoid sexual intercourse in early pregnancy;
(5) prevent cold and keep warm, prevent colds;
(6) Prohibit drugs that are contraindicated in pregnancy;
(7) strengthen nutrition, food should be easy to digest, avoid spicy and hot products; pay attention to dietary hygiene, to prevent intestinal infections, so as not to cause abortion due to diarrhea.
What should I do if I have two or three spontaneous abortions in a row?
If spontaneous abortion occurs 3 times or more in a row, it is called “recurrent miscarriage” and needs to be treated actively. Studies have found that the more miscarriages there are, the lower the rate of live births again. Early recurrent miscarriages are often caused by maternal luteal insufficiency, hypothyroidism and chromosomal abnormalities of the embryo. The most common causes of late recurrent miscarriage are endocervical relaxation, uterine malformation, and uterine fibroids.
There are many factors that lead to recurrent miscarriage. In general, contraception should be used within six months after the occurrence of miscarriage to reduce the occurrence of recurrent miscarriage. During this period both spouses should undergo a comprehensive physical examination especially genetic chromosomal examination. In addition the following should be done.
(1) Pay attention to rest, emotional stability, and regular and disciplined life.
(2) For women with short luteal phase or insufficient secretion, it is better to supplement luteinizing hormone in the middle of menstruation and early pregnancy. The medication for luteal insufficiency treatment should be used for a period longer than the gestational period of the last miscarriage (if the last miscarriage was in the third trimester, the treatment should not be shorter than the third trimester).
(3) Do blood group identification including Rh blood group system.
(4) Have hypothyroidism, keep thyroid function normal before pregnancy, and also take anti-low thyroid medication during pregnancy.
(5) Those with loose endometrium can have cervical cerclage at 13 to 20 weeks of pregnancy.
(6) The male partner should have a reproductive system examination. Those who have bacteriospermia should be treated thoroughly before conceiving the wife, and if the DNA fragmentation rate is high, they also need to be treated to return to normal.
(7) Avoid exposure to toxic substances and radioactive materials.
Content of physical examination for couples with recurrent spontaneous abortion: male partner: semen routine, morphology, DFI; blood type, chromosomes, etc. Female partner: vaginal cell smear, cervical score, basal body temperature, blood type, chromosomes, ultrasound to check uterine development, etc. If necessary, check closed antibody and coagulation complete set, fasting blood sugar, thyroid function.
Biochemical pregnancy miscarriage, pregnancy after next normal menstruation
If the HCG is elevated, if the bleeding is the same as menstruation after a few days of delayed menstruation or on time, and the gestational sac is very small or invisible on ultrasound, and the blood HCG decreases, biochemical pregnancy abortion is considered. After a biochemical pregnancy miscarriage, it has little effect on the woman and she can get pregnant after her next normal period. Biochemical pregnancy miscarriage was previously unnoticed, but now it is considered that the incidence of such miscarriage is high and just not taken seriously.
The chances of a successful pregnancy after an occasional miscarriage are high, so couples should not be particularly nervous, but should pay attention to their lifestyle and proper nutrition and maintain a good attitude. The causes of recurrent miscarriage are complex and need to be diagnosed and treated according to each of the mentioned articles to rule out the causes one by one.