1.What is spontaneous miscarriage?
If the pregnancy is less than 28, or if the fetus weighs less than 1000g and is terminated, it is called abortion. If the pregnancy is terminated by artificial factors such as surgery or medication, it is considered an induced abortion; while a miscarriage caused by natural factors is called a spontaneous abortion.
2.What should I do if I had one spontaneous abortion in the past?
The probability of spontaneous abortion is about 20% for normal couples. Couples with only one history of spontaneous abortion need not be nervous, and it is recommended to take a six-month break and prepare for pregnancy again after a preconception health check. If you are pregnant, it is best to have early checkups and if necessary, treatment to preserve the pregnancy. Yang Xuezhou, Department of Obstetrics and Gynecology, Xiangyang Central Hospital
3.What should I do if I have had 2-3 spontaneous miscarriages in the past?
Those who have had 2 consecutive spontaneous miscarriages are called recurrent miscarriages, and those who have had 3 or more consecutive spontaneous miscarriages are called habitual miscarriages or recurrent miscarriages. In this case, the couple should do the examination of the cause of spontaneous miscarriage and treat the cause to avoid another miscarriage.
4.What is the cause of recurrent miscarriage?
There are many factors that cause spontaneous abortion, including anatomical factors, endocrine factors, genetic factors, infection factors and immunological factors. Other factors include male factor, maternal combined internal diseases, bad living habits and environmental factors. If the cause cannot be found with the current medical methods, it is called unexplained recurrent miscarriage.
5.How to treat and prevent recurrent miscarriage?
Couples with recurrent miscarriage should have a comprehensive examination of the cause of miscarriage, and if a clear cause is found, pregnancy can be treated for the cause; if there is no clear cause and it is recurrent miscarriage of unknown origin, pregnancy can be treated with lymphocyte immunotherapy. If pregnancy is planned, it is recommended to monitor ovulation by ultrasound, estimate the time of ovulation and guide intercourse, and start luteal support treatment immediately after ovulation.
6.What type of miscarriage is suitable for lymphocyte immunotherapy?
For couples with 2 or more consecutive spontaneous miscarriages and no clear cause after detailed screening for the cause of miscarriage, lymphocyte immunotherapy with husband’s blood is recommended.
7.What does the screening for the cause of spontaneous miscarriage include?
Reproductive tract anatomical abnormalities: ultrasound, hysterosalpingography or hysteroscopy to exclude endometrial polyps, submucosal fibroids, saddle-shaped uterus, longitudinal uterus, and double uterus.
Endocrine examination: sex hormone 6, luteal phase progesterone, thyroid function, oral glucose tolerance and insulin release test.
Chromosome examination: karyotype examination of both spouses, karyotype examination of aborted embryos
Infectious factors examination: virus (toxoplasmosis, rubella, herpes) examination, cervical chlamydia, gonococcal examination
Immunological factors examination: blood group of the couple (ABO and RH blood group), reproductive immune antibodies (anti-endometrial antibodies, anti-cardiolipin antibodies, anti-sperm antibodies, etc.)
Male partner semen routine and malformation rate examination.
8.What is lymphocyte immunotherapy about?
30-50ml of the husband’s blood is drawn and the lymphocytes (i.e. immune cells) from it are extracted and injected under the skin of the wife’s forearm.
9.Does the husband’s blood have to be used for lymphocyte immunotherapy?
If the husband has a blood-borne disease, etc., the blood of an unrelated man can be used for lymphocyte immunotherapy.
10.What are the precautions for lymphocyte immunotherapy?
Before the operation, both partners need to be checked for infectious diseases, eat a light diet for 1-2 days before the blood is drawn, and avoid eating too oily food. The treatment time should avoid the female partner’s menstrual period.
11.Mechanism of lymphocyte immunotherapy for recurrent miscarriage
The mechanism of lymphocyte immunotherapy is still unclear. Some scholars believe that the embryo can survive in the mother as a maternal hemizygote (half of the embryo’s genes come from the father), and there must be an immune balance locally in the mother’s uterus. If this immune balance is disturbed, maternal immune attack on the embryo may occur and induce spontaneous abortion. If the mother is stimulated several times with small amount of immune cells from the husband, it may cause immune tolerance of the mother to the embryo, maintain the local immune balance of the uterus and avoid the recurrence of miscarriage.
12.How many times do I need to do lymphocyte immunotherapy before trying to conceive, and do I need to do it after I get pregnant? Can I get pregnant right after the surgery?
It is recommended to do 2-3 times of immunotherapy before trying to conceive, with an interval of 3-4 weeks each time, and then 2-3 times after pregnancy.
13.How long can the efficacy of lymphocyte immunotherapy be maintained?
It is effective within six months after immunotherapy. If it is more than six months, it is recommended to try to conceive after immunotherapy again.
14.How should I treat spontaneous abortion caused by Chlamydia infection?
You can apply erythromycin, azithromycin and other medications, or treat according to the drug sensitivity test, and then prepare for pregnancy after the chlamydia turns negative.
15.How should I treat spontaneous abortion caused by anti-sperm antibody?
You can apply glucocorticoids such as dexamethasone and prednisone for 1-3 months, while condom contraception, and try to conceive after the anti-sperm antibodies turn negative. You can also choose artificial insemination treatment, where sperm are washed and optimized for direct injection into the uterine cavity, which can exclude the interference of anti-sperm antibodies.
16.How should I treat spontaneous abortion caused by anti-cardiolipin antibodies?
You can apply aspirin – anti-platelet coagulation drugs for 1-3 months, and try to conceive after the anti-cardiolipin antibodies turn negative. Low molecular heparin treatment can be chosen if necessary.
17.What is luteal insufficiency?
The corpus luteum forms in the ovary after ovulation, and the corpus luteum secretes enough progesterone in the second half of menstruation to facilitate embryo implantation and growth. If the progesterone level is insufficient, luteal insufficiency is considered to exist.
18.How should I treat spontaneous abortion caused by luteal insufficiency?
Luteinizing support drugs such as progesterone injection, oral progesterone capsules, progesterone vaginal gel can be given at ovulation.
19.How should cervical insufficiency be treated?
In the middle of pregnancy, cervical cerclage should be performed promptly to avoid cervical relaxation leading to fetal abortion.
20.Can aspirin and prednisone be used during pregnancy and will they affect the development of the fetus?
The pharmacopoeia describes aspirin and prednisone as having a risk of fetal malformation, but the use of only a small amount of these drugs in the treatment of fetal preservation, from domestic and foreign data reported that the rate of malformation of newborns born after treatment with the drugs was not found to increase compared with babies born under normal conditions.