Embryonic abortion is known as spontaneous miscarriage or miscarriage, which means that the embryo or fetus stops developing before the 7th month of conception for some reason and is expelled naturally or artificially forced out of the mother. Incidence: 10%-15%.
Two or more consecutive spontaneous abortions are called recurrent spontaneous abortions; early abortion: occurs before 12 weeks of pregnancy, late abortion: refers to 13-27 weeks of pregnancy; three or more consecutive spontaneous abortions are called habitual abortions.
Risk of recurrence
The risk of recurrence of spontaneous abortion increases with the number of miscarriages. In the first pregnancy, the incidence is about 11-13%; the miscarriage rate is about 13.5% in those with a history of one spontaneous miscarriage; the risk of recurrence after two miscarriages is 24%; in those with a history of four or more miscarriages, most miscarriages occur again if they are not treated appropriately.
Causes of spontaneous abortion
①Endocrine disorders: polycystic ovary syndrome, hyperprolactinemia, luteal insufficiency, endometriosis, diabetes mellitus, thyroid disease, etc., accounting for about 20% of the causes of spontaneous abortion.
②Anatomical factors: accounting for 16%. Uterine uterine malformation.
The most common is mediastinum ;
Cervical insufficiency: 3-5% of RSA patients;
Uterine adhesions: about 50% of the incidence after abortion;
Uterine fibroids ;
Endometrial defects.
(iii) Genetic factors: about 3-8% of RSA patients. Chromosomal abnormalities: including parental and fetal chromosomal abnormalities.
④Immune factors: about 40-80% of RSA patients are immune-related, autoimmune diseases and autoimmune hyperactivity.
⑤ Infectious factors: about 5% of ERSA is caused by infections: mycoplasma, chlamydia, bacteria, TORCH (giant cell, rubella, toxoplasma, herpes simplex)
⑥Other causes: hyperhomocysteinemia
Etiological examination.
Depending on the patient’s specific situation, screening is selectively performed from common to rare causes, and thus the cost is relatively variable, such as the occurrence of 2 or more times, the examination costs roughly about 2,000 yuan.
①Endocrinological examination: including sex hormone six, insulin, thyroid hormone and blood glucose measurement. Note that you should come to the hospital in the morning of the 2nd-4th day of menstruation on an empty stomach for blood sampling.
②Genital anatomical examination: vaginal ultrasound, hysterosalpingography (HSG), hysteroscopy, combined hysteroscopy and laparoscopy
③Genetic factors: karyotype analysis of both spouses, karyotype and genetic analysis of aborted fetus.
④Immune factors: about 40% to 80% of RSA patients are immune-related, autoimmune diseases and autoimmune hyperactivity.
Thus, autoantibodies need to be checked. Such as antiphospholipid antibodies, anti-nuclear antibodies, anti-thyroid antibodies; anti-endometrial antibodies, anti-sperm antibodies, anti-ovarian antibodies, anti-hyaline antibodies, anti-trophoblast antibodies, anti-chorionic gland proliferative, blood group antibodies, etc. Sequestering antibody deficiency detection.
⑤ Examination of infectious factors
TORCH (toxoplasma, rubella virus, cytomegalovirus, herpes virus) and mycoplasma and chlamydia tests are usually performed.
Treatment.
1. Those with clear causes through screening are treated for the causes, such as endocrine regulation, correction of uterine malformations, separation of adhesions, passive immunotherapy for abnormal autoimmune function; anticoagulation therapy for those with hypercoagulable blood. Anti-infection treatment for those with pathogenic microbial infection.
2.Active immunotherapy.
What is meant by active immunotherapy
In 1981, Beer and Taylor treated wives with RSA with lymphocytes from husbands or third parties with success.
In 1993, Lin Qide et al. reported that immunotherapy of 22 cases of RSA patients resulted in a success rate of 86.4% in re-pregnancy and 19 full-term deliveries. That is, wives with RSA were treated with lymphocytes from the husband or a third party to produce closed antibodies and protect the fetus from maternal rejection.
Who is suitable for active immunotherapy?
Those with recurrent spontaneous abortion of the same immune type, who have not been found to have significant abnormalities after the etiological examination mentioned above, or who are negative for closed antibodies
Procedure of active immunotherapy
1.Both husband and wife have normal 8 items and liver function before transfusion.
2.Collection of husband’s blood and collection of lymphocytes.
3.Intradermal injection into the forearm of the female partner.
4, once every 3 weeks, 3 times as a course of treatment, after 3 times you can try to conceive, aim to conceive within 3 months, after conception, then 3 times active immunotherapy, if not conceive within 3 months, need additional times of treatment before trying to conceive.
5. Contraception during treatment.