Spontaneous miscarriage refers to those who stop the development of the embryo before 28 weeks of gestation or expel it from the uterus automatically; miscarriage that occurs before 12 weeks of gestation is early miscarriage, while those who occur after 12 weeks of gestation are late miscarriage; if two spontaneous miscarriages occur, it is called recurrent miscarriage; those who occur three times or more are called habitual miscarriage.
The causes of spontaneous miscarriage are complex, mainly including: anatomical abnormalities of the female reproductive tract, chromosomal abnormalities, endocrine disorders, infectious factors, immune factors, blood clotting status of the body, etc.; chromosomal abnormalities and sperm problems of the male partner, etc. Studies have shown that with the increase in the number of miscarriages, all aspects of the body’s condition will be damaged, and the condition will be aggravated, so that the risk of miscarriage again after pregnancy will be higher and higher. In order to find the cause, we need to ask a detailed medical history, menstrual history, reproductive history, family history, past history, and a series of tests to identify the cause and carry out targeted treatment.
I. Chromosomal abnormalities —- No treatment countermeasures
Fetal chromosomal abnormalities are a major cause of spontaneous abortion, and there is no effective treatment, the causes of fetal chromosomal abnormalities are the following 2 points.
1, congenital genetics: chromosomal abnormalities in both spouses, chromosomal abnormalities in both spouses, although accounting for a small percentage of habitual miscarriages, but there is no effective treatment, half of the offspring of successful pregnancies with abnormal chromosomes of their parents, and will have an impact on their next generation, common chromosomal abnormalities are balanced translocation, inversion, etc. It should be noted that couples with chromosomal abnormalities are often combined with immune disorders at the same time, to It should be noted that couples with chromosomal abnormalities are often combined with immune disorders and should be examined and treated at the same time so that a normal fetus is not preserved.
2, acquired mutation: after the sperm-egg union, the fertilized egg chromosomes or chromosomes on some important genes in the process of division by a variety of adverse factors, the incorrect encoding caused by these fetal developmental abnormalities and stop development is a natural elimination process, through the abortion of the chorionic villus culture can confirm the diagnosis of chromosomal abnormalities, but the diagnosis of genetic abnormalities is currently more difficult, can be carried out embryonic SNP The diagnosis of genetic abnormalities is difficult, but SNP testing of embryos can be performed, but the cost is high.
Second, endocrine disorders —- can be targeted treatment
Endocrine abnormalities are an important cause of spontaneous abortions, including gynecological endocrine disorders and endocrine abnormalities in internal medicine.
1, gynecological endocrine abnormalities: common ones are luteal insufficiency, hyperprolactinemia (PRL), polycystic ovary syndrome (PCOS), etc. After pregnancy in women with luteal insufficiency, the ovaries cannot produce enough progesterone to support the normal development of placental cells, and the embryo does not get enough nutrients and dies, which is manifested by a slow rise in basal body temperature after ovulation, fluctuations, or insufficient height, time limit Short, low progesterone level, treatment is relatively simple, progesterone supplementation is the most effective method, the dosage and course of treatment can be adjusted according to the level of progesterone in the blood after conception, high prolactin and PCOS serious condition can lead to amenorrhea, non-ovulation and infertility, even after conception, it is easy to miscarriage, therefore, these patients must be given targeted treatment before conception, and after pregnancy, fetal preservation, and
2, endocrine abnormalities: mainly diabetic women and patients with abnormal thyroid function (including hyperthyroidism and hypothyroidism) should be treated until the condition is stable before considering pregnancy to avoid miscarriage, on the other hand, patients with recurrent miscarriages should have relevant examinations in this regard to avoid missing the diagnosis.
Immunomodulatory factors
In recent years, with the rapid development of reproductive immunology, it has been found that the majority of patients with unexplained habitual miscarriage have immune regulation disorders.
1.Low alloimmune type: Because of the high compatibility of leukocyte antigens of the couple, the mother cannot produce protective “closed antibodies” to the embryo after conception, and the embryo is attacked by the mother’s immune cells and stops, the husband’s lymphocytes can be used for active immunization to make the wife produce closed antibodies, and our treatment team is working on On the basis of this, the male lymphocytes isolated from the husband are stimulated to fully express their surface antigens, which greatly improves the effect of active immunotherapy.
2, autoimmune hyperactivity: due to the disorder of the patient’s own immune system, a variety of antibodies against their own tissues and organs, these antibodies can also destroy the embryonic tissue and the placental cells that nourish the embryo, resulting in the death of the embryo, including endometrial antibodies, anti-sperm antibodies, zona pellucida antibodies, etc. Western medicine treatment is mainly based on corticosteroids and immunoglobulins, our treatment team also summed up the previous treatment experience, combined with Chinese medicine Our treatment team also sums up the past treatment experience, combined with Chinese medicine to identify the evidence, the combination of Chinese and Western medicine treatment, the efficiency of more than 90%.
3.Immune disorder type: Patients with both of the above two immune subtypes can be treated with immunomodulators, currently, our treatment team uses low-dose cyclosporine A treatment, the success rate of fetal preservation is more than 85%.
IV. Blood coagulation status
Recent studies have found that some patients with unexplained recurrent miscarriages are due to hypercoagulable state of the body, and anticoagulation therapy has also shown good results.
V. Infection factors
There is no direct correlation between infectious factors and spontaneous abortion, but the detection rate of infectious factors is high in these patients, reaching about 50%, such as TORCH (cytomegalovirus, toxoplasma, rubella virus, herpes virus, mycoplasma, chlamydia, candida infection, bacterial vaginosis, etc.), and it is recommended that tests should be performed to exclude and treat the infection before conception again.
Anatomical factors
Common causes of recurrent miscarriage due to anatomical abnormalities include cervical insufficiency, uterine developmental abnormalities (such as longitudinal uterus, unicornuate uterus, bicornuate uterus, saddle-shaped uterus, etc.), uterine fibroids or adenomyoma, uterine adhesions, etc. Diagnosis mainly relies on ultrasound, hysteroscopy, laparoscopy, etc. Treatment depends on the specific cause of surgical correction, hysteroscopic surgery, laparoscopic surgery or cervical cerclage in mid-pregnancy.