Termination of pregnancy at less than 28 weeks and fetal weight less than 1000g is called abortion. If it occurs before 12 weeks of gestation, it is called early abortion, and if it occurs between 12 and 28 weeks of gestation, it is late abortion. Spontaneous abortion occurs in 31% of cases after embryo implantation, 80% of which are early abortions. Among early miscarriages, about 2/3 of them are occult miscarriages, i.e. miscarriages that occur before menstruation, also called biochemical pregnancies.
Etiology
1.Embryonic factors
Embryonic or fetal chromosomal abnormalities are the most common cause of early miscarriage, accounting for about 50% to 60%. In addition to genetic factors, infections, drugs, etc. can also cause. Therefore, miscarriage is a natural elimination, most of them are empty gestational sacs or degenerated embryos. Even if the fetus is forcibly preserved, a few of them may be deformed or have metabolic and functional defects when they reach full term.
2.Maternal factors
(1) Pregnant women suffer from systemic diseases, such as high fever, serious infection, severe anemia, heart disease, chronic liver and kidney disease, high blood pressure, etc. TORCH infection can infect the fetus and lead to miscarriage, so before pregnancy, blood should be drawn to check the seven items of eugenics, IgG (+) means that there has been an infection and antibodies have been produced, so it is possible to conceive normally; IgM (+) means that the infection is ongoing and must be treated before conception.
(2) Abnormalities of reproductive organs, such as uterine malformations, uterine fibroids, especially submucosal fibroids, uterine adenosis, uterine adhesions, endometrial polyps, etc., can affect the embryo’s implantation and development and lead to miscarriage, so it is recommended to have an ultrasound examination before conception to confirm the diagnosis and treat the problem before conception. In addition, cervical insufficiency can lead to premature rupture of fetal membranes and late spontaneous abortion, so it is recommended to perform cervical cerclage at 14 to 18 weeks of pregnancy.
(3 ) Endocrine abnormalities such as luteal insufficiency, hyperprolactinemia, polycystic ovary syndrome, abnormal thyroid function, diabetes mellitus, etc. can be treated symptomatically.
(4 ) Surgery, external impact on the abdomen, too frequent sexual intercourse; anxiety, excessive tension, and smoking, alcohol and drug abuse, etc.
(5 ) Positive antiphospholipid antibodies, etc., and abnormal immune function such as closed antibody factor deficiency.
3.Father factor
Chromosomal abnormalities of the sperm.
4.Environmental factors
Exposure to excessive radioactivity and chemical substances such as lead and arsenic.
Diagnosis
1.History of menopause, small amount of vaginal bleeding, vague or paroxysmal pain in the lower abdomen.
2.B ultrasound examination: it can determine the size and shape of the gestational sac, the presence or absence of fetal heartbeat, and the survival of the embryo to guide the correct treatment method.
3.Blood HCG: at 6-8 weeks of normal pregnancy, the HCG value should increase at a rate of 66% daily, if the growth rate is <66% in 48 hours, it indicates a poor prognosis of pregnancy.
4, blood progesterone determination: can assist in determining the prognosis of preterm abortion.
5.Thyroid function: it can check whether the thyroid function is normal.
Treatment
1.Bed rest and prohibition of sexual intercourse.
2.Progesterone is available for those with luteal insufficiency.
3, vitamin E gel pills taken orally.
4, oral small doses of thyroid tablets for hypothyroidism.
5, to pay attention to psychological guidance, so that their emotional stability, enhance confidence.
What are the misunderstandings to be avoided in birth control?
The following are a few common misconceptions that doctors and patients should be aware of.
1. Bed rest. A clinical study has confirmed that bed rest is not beneficial and is purely a psychological comfort. So it is recommended to rest, not always bedridden, can be normal activities.
2, for a normal pregnancy there is no need to repeatedly draw blood to check HCG and progesterone, even if the patient is on birth control, there is no need for frequent checks, although HCG can help determine the development of the embryo, but the ultimate gold standard to determine whether the embryo is good or bad, intrauterine or ectopic is ultrasound.
Let’s understand that progesterone is mainly produced by the ovarian corpus luteum before 10 weeks of pregnancy, completely relies on the corpus luteum to secrete progesterone before 7 weeks of pregnancy, after 10 weeks it is mainly secreted by the placenta, and at 12 weeks the corpus luteum degenerates and is completely replaced by the placenta. The secretion of progesterone in early pregnancy is pulsatile and the level fluctuates greatly, sometimes as low as 5 ng/ml. progesterone is basically at a plateau in the range of 6-10 weeks of pregnancy, with a physiological drop in 7-9 weeks of pregnancy and then a rebound. So even if a low progesterone level is measured, it does not indicate abnormal embryo development. Therefore, it is not recommended to check the progesterone level to determine the development of the embryo.
3. If the embryo itself is stunted, progesterone is definitely useless. If it is caused by luteal insufficiency, progesterone should be used to preserve the fetus.
4. The most reliable means is ultrasound, which can clearly see the size of the gestational sac, the size of the embryonic bud and heartbeat, as well as the condition of the yolk sac. It is not necessary to check too early, it is recommended to do ultrasound around 7 weeks after menopause, it is not necessary to check repeatedly, if necessary, you can review ultrasound once in 1 to 2 weeks.
5, Pre-eclampsia does not need to be hospitalized to keep the fetus, it is enough to keep the fetus at home and outpatient follow-up treatment.
6.The food you eat when you are on birth control should be the same as usual, in moderation, with a small number of meals, balanced nutrition and diversity.
7. Indications for progesterone application: early preterm miscarriage, late preterm miscarriage, recurrent miscarriage and re-pregnancy, and assisted pregnancy cycle.
Early Pre-eclampsia Miscarriage
Usage: The route of progestin administration can be divided into oral, intramuscular injection, local application (vaginal medication), etc., which can be combined with medication as appropriate.
(1) Preferred oral medication: dydrogesterone, 20-40 mg daily, or other oral progesterone preparations; should be used with caution in patients with severe pregnancy vomiting.
(2) Intramuscular injection of progesterone: 20 mg daily; attention should be paid to local skin and muscle adverse reactions of patients.
(3) Vaginal progesterone: micronized progesterone, 200-300 mg daily, or progesterone vaginal extended-release gel, 90 mg daily; should be used with caution in patients with vaginal bleeding.
Timing of discontinuation: After the drug is administered, clinical symptoms improve until they disappear, and ultrasound examination indicates the survival of embryo can be discontinued after 1 to 2 weeks of use; or continue to use the drug until 8 to 10 weeks of pregnancy. If clinical symptoms worsen during treatment, β-hCG level continues not to rise or fall, and ultrasound examination suggests inevitable miscarriage, consider miscarriage inevitable, stop the drug and terminate the pregnancy.
Late Pre-eclampsia Miscarriage
Usage: The usage and dosage are the same as those for early preterm abortion.
Timing of discontinuation: 1 to 2 weeks after the disappearance of signs and symptoms of pre-eclampsia miscarriage, applied to pregnant women with a history of late recurrent miscarriage until 28 weeks of pregnancy.
Recurrent miscarriage and re-pregnancy
Usage: The usage and dosage are the same as those for early preterm abortion.
Timing of discontinuation: Use until 12-16 weeks of pregnancy, or 1-2 weeks after the gestational week of the previous miscarriage, and discontinue if there is no manifestation of pre-eclampsia and the ultrasound examination is normal.
Cycle of assisted conception
The use of progesterone for assisted reproduction is complicated and needs to be performed under the guidance of a specialist.
I advise you to keep the pregnancy correctly and not to do unnecessary tests, which will cost more money and suffer. Remember that the most important monitoring tools for fetus preservation are: clinical symptoms, beta-hCG level and ultrasound examination.