The incidence of female infertility is increasing year by year due to a variety of complex factors, and currently has a prevalence of nearly 20% among women of childbearing age. A woman who cannot conceive normally is called infertile, and if she can conceive normally but the fetus does not eventually give birth is called infertile. One important cause of infertility is miscarriage. The high incidence of recurrent miscarriage and fetal loss causes great suffering to young couples and families. What is recurrent miscarriage? Why is the incidence so high? How can it be prevented and treated appropriately? It is more and more necessary to sort out these questions systematically and scientifically at the public level.
What is recurrent miscarriage?
A recurrent miscarriage is usually referred to as a termination of pregnancy at less than 28 weeks and a fetus weighing less than 1000g. The incidence of spontaneous abortion is about 11% to 13%. The incidence of recurrent miscarriage is about 1% to 5% among couples of childbearing age, and it refers to 2 or more consecutive spontaneous abortions. The classical theory used to define 3 or more consecutive spontaneous abortions as habitual abortion.
Those who have a history of spontaneous abortion face a much higher risk of spontaneous abortion when they get pregnant again, about three times more than women without a history of spontaneous abortion, and the risk of recurrence of spontaneous abortion increases as the number of abortions increases, with a risk of recurrence of abortion up to 80% or more after three abortions. Therefore, early detection of the problem, early prevention and treatment are very crucial.
Why do recurrent miscarriages occur?
The more common causes of recurrent miscarriage include chromosomal abnormalities in the couple, maternal reproductive tract infection, anatomical abnormalities, maternal endocrine abnormalities, immune factors, blood hypercoagulability and fetal factors, male factors, etc.
1. Chromosomal abnormalities in couples: about 3-8% of recurrent miscarriages are due to chromosomal abnormalities in one or both spouses, and their offspring will have spontaneous miscarriage due to more or less of a chromosome or a gene segment.
2. Maternal reproductive tract infections and anatomical abnormalities: Reproductive tract infections include various bacterial pathogens (chlamydia, mycoplasma, gonococcus), viruses, toxoplasma, etc. Reproductive tract anatomical abnormalities include maternal uterine malformations such as unicornuate uterus, bicornuate uterus, double uterus, longitudinal uterus, etc.; uterine adhesions, uterine polyps, etc.; cervical insufficiency; large uterine fibroids, etc.
3, maternal endocrine abnormalities: the more common causes are luteal insufficiency, polycystic ovary syndrome, hyperprolactinemia, etc. About 60% of patients with habitual miscarriage suffer from polycystic ovary syndrome, in addition to abnormal thyroid function, diabetes mellitus also easily lead to recurrent miscarriage. In recent years, clinical experience, thyroid function abnormalities in women of childbearing age in the high trend.
4, immune factors: about 50% to 60% of patients with recurrent miscarriage are related to immune problems, one type of autoantibodies related to autoimmune recurrent miscarriage, the incidence is about 27%, most of these patients are suffering from antiphospholipid antibody syndrome, the rest are also related to systemic lupus erythematosus, dry syndrome and other autoimmune diseases; another type may be related to low reactivity to fetal paternal antigens Another group may be related to hyporeactivity to fetal paternal antigens, called alloimmune recurrent miscarriage, and related studies have shown that these patients may have a lack of closed antibodies in their bodies. The diagnosis and treatment of closed antibody is controversial in academic circles.
5. Blood hypercoagulable state: There are two types: hereditary and acquired. Acquired (acquired) is common in our patients, such as thrombophilia due to antiphospholipid antibody syndrome.
6, fetal factors: embryonic chromosomal abnormalities are also an important cause of recurrent miscarriage. Some fetuses have chromosomal abnormalities because one or both parents have problems with their chromosomes, while some couples do not have chromosomal abnormalities, but the embryo has chromosomal combination errors during development. Studies have shown that the older the couple, the higher the incidence of chromosomal abnormalities in the embryo.
7. Male factor: The direct result of high sperm malformation rate is infertility or loss of early embryos.
How to scientifically screen for the causes of recurrent miscarriage?
As mentioned above, the etiology of recurrent miscarriage is complex. If the etiology can be clarified and treated symptomatically, the incidence of recurrent miscarriage can be effectively reduced. The items to be examined include.
1. chromosome examination of both spouses.
2, determination of blood hypercoagulable state and autoimmune antibodies.
3.Infection indicators.
4. examination of the uterus and reproductive tract.
5. ovulation monitoring and luteal function examination.
6. examination of endocrine indicators, such as thyroid and pituitary lactogen.
7, male semen, especially the determination of malformation rate.
8.Closure antibody determination if necessary.
Based on the results of the examination, a treatment plan is formulated. If the cause is clear and the miscarriage occurs again even after the treatment has improved, it is recommended to check the fetal chorionic chromosome. All of the above recommended tests do not need to be performed on every item, but should be done according to the individual situation, and to oppose excessive screening.
Attention! Attention! There are still about one third of patients for whom the existing conventional diagnostic methods do not detect the cause of miscarriage.
How to avoid recurrent miscarriage?
1.For patients with chromosomal abnormalities leading to recurrent miscarriage, pre-implantation genetic diagnosis or screening (PGD/PGS), sperm donor or egg donor IVF should be used to reject or avoid abnormal embryos based on early diagnosis; or try to conceive first and then do prenatal fetal chromosome examination, and once fatal or teratogenic chromosomal abnormalities are detected, termination of pregnancy is an option.
2.For patients with maternal reproductive tract causes, if it is a uterine problem, it can be clearly diagnosed by vaginal ultrasound, hysterosalpingography, hysteroscopy, magnetic resonance and other examinations, and can be effectively treated by hysteroscopic surgery and plastic surgery; cervical function problems can be corrected by early cervical cerclage surgery.
Endocrine abnormalities can be improved by medication and adjustment, including adjustment of blood glucose, lactogen and methotrexate, and patients with polycystic ovary syndrome can try to conceive after normal endocrine regulation; progesterone can be applied to compensate for luteal insufficiency, etc. The success rate of pregnancy again after treatment can be over 90%.
4, blood hypercoagulation and immunosuppression, special immunosuppression and anticoagulation therapy can be used; at present, the clinical application of aspirin and low-molecular heparin and other anticoagulant drugs to improve coagulation function and prevent the formation of blood clots.
5, male factors, moderate supplementation of vitamins and zinc, through moderate exercise, regular work and rest can be improved appropriately.
Attention, attention! After the etiological treatment or patients with unknown etiology, in the practice of clinical treatment, there are still more than 20% of patients will be unsuccessful to preserve the fetus.
Therefore the principles I consistently follow in the treatment of recurrent miscarriage :
1. opposing bed rest in the first trimester of pregnancy, i.e. before placenta formation, and encouraging appropriate walking, even if there is a small amount of bleeding or coffee-colored discharge.
2.Advocate monitoring ovulation, and start luteal health immediately after ovulation to make up for the lack of luteal function.
3, advocate moderate fetal preservation, regular monitoring of pregnancy indicators, and oppose excessive use of drugs without regard to the safety of mother and child.
4.Advocate etiological treatment and oppose the role of mythical birth control.
5.The use of birth control drugs is not recommended for first pregnancies without a history of miscarriage, even if there are symptoms of pre-eclampsia.
6. advocate the use of western medicine with clear composition and oppose the use of fetus-preserving Chinese medicine with unclear composition.
7. recommending active immunotherapy when no other etiology can be clarified and closed antibody is negative
8.Encourage relaxation and physical and mental pleasure.