Those with 2 or more consecutive spontaneous miscarriages (embryonic abortions) are called habitual miscarriages.
Common factors.
1, chromosomal (both spouses; embryonic villi are more common) ;
2, anatomical factors: reproductive tract abnormalities ;
3, infection factors: cytomegalovirus; Toxoplasma gondii;
4, abnormalities caused by various endocrine diseases; 5 unknown causes were found in the mid to late 80s with immunological factors, accounting for 40-50%.
Mainly immune-related: divided into autoimmune type (immune hyperresponsive type), isoimmune type (immune bottom reactive type);
Difficult clinical treatment factors.
1.Etiological screening is not systematic and comprehensive;
2. Imperfect diagnosis of immune-related recurrent miscarriages;
3. unclear immune mechanism;
4. Lack of targeted treatment;
5. Unsatisfactory therapeutic efficacy.
Autoimmune-related mechanism: It is related to the presence of antiphospholipid antibodies (APA) in the patient’s body, often accompanied by a decrease in platelets and thromboembolic phenomenon called antiphospholipid antibody syndrome.
Mechanisms related to alloimmunity: anatomical barrier between mother and fetus; enhanced protective immune response during pregnancy; presence of closed antibodies, specific or non-specific serum inhibitory factors in the peripheral blood of pregnant women; lack of specific factors on the surface of embryonic tissues; local immunity in the reproductive tract.
Etiological screening methods for RSA.
1.General examination: detailed medical history; careful gynecological examination; auxiliary examinations (ultrasound: check for the presence of anatomical malformations of the reproductive tract, uterine fibroids affecting the morphology of the uterine cavity);
2.Special examination
(1) chromosome ;
(2) Endocrine examination: sex hormones (early value-added, ovulation, mid-luteal phase); thyroid function; insulin function;
(3) Infection examination in small proportion: Toxoplasma gigantocellum, with chronic pelvic inflammatory disease to strengthen the exclusion of infectious factors.
(4) immune examination: autoantibody detection: IFANA, ENA antibody, LAC, etc;
(5) systemic immune status examination: including IgM, IgA, IgG, C3, CH50; micro lymphocytotoxic test for both spouses.
(6) Coagulation mechanism examination: blood clotting series, D-dimer, platelet aggregation test.
(3) Newly discovered special types: blood hypercoagulable state (hereditary, acquired); early embryo implantation position is too low.
Treatment principle of autoimmune type: immunosuppression + anticoagulation therapy (adrenocorticotropic hormone + aspirin/heparin) Main protocols
(1) Aspirin alone or combined with prednisone;
(2) Heparin alone or in combination with prednisone;
(3) High-dose immunoglobulin. Monitoring indicators: autoantibody titers; blood coagulation status indicators + D-dimer.
Principles of treatment for RSA of alloimmune type.
(1) Active immunotherapy: immunization with intradermal injection of lymphocytes from husband or unrelated third party (2 cycles to avoid blood-borne infection efficacy 70%-90%); small amount of whole blood infusion method; seminal plasma immunization;
(2) intravenous infusion of human albumin; 3CD4+, CD25+, RT.
Monitoring indicators: cytotoxicity test; serum inhibition test.