Two spontaneous miscarriages occurring in the same gestational week or with similar tutorials are called recurrent miscarriages, and three or more occurrences are called habitual miscarriages.
There are many reasons for multiple spontaneous miscarriages, the common ones are.
1, genetic factors mainly chromosomal number and structure abnormalities, accounting for 50% to 60% of miscarriages, often leading to early embryonic development stoppage, degeneration and shrinkage of pregnant eggs, a way to eliminate undesirable offspring.
2. exposure to external toxic substances such as lead, organic mercury, DDT, radiation, etc.
3. endocrine abnormalities such as luteal insufficiency, hyper- or hypothyroidism, diabetes affecting the development of the meconium, placenta and fetus leading to miscarriage
4. genital malformations or tumors such as bicornuate uterus, uterine longitudinal septum, uterine fibroids, ovarian tumors, etc.
5, abnormal cervical function manifested by relaxation of the endocervix.
6, mechanical stimulation during pregnancy such as abdominal surgery or trauma easily cause uterine contractions resulting in miscarriage.
7, immune factors: recent studies on reproductive immunity have shown that about 50-60% of habitual miscarriages are related to immunity. 1/3 of them are related to autoantibodies, especially antiphospholipid antibodies, antiphospholipid antibodies are mainly lupus anticoagulation factor (LAC) and anti-cardiolipin antibodies (ACL)) are common, as well as anti-nuclear antibodies (ANA) and anti-nuclear extractable antigen antibodies (anti-ENA antibodies). The other 2/3 are unexplained abortions, which are thought to be related to maternal low recognition and/or low response to fetal paternal antigens during pregnancy, resulting in the inability to produce sufficient protective or confining antibodies and fetal rejection.
8, maternal systemic diseases, especially acute infectious diseases, can lead to fetal abortion.
9. Fetal hemolysis due to parental blood group incompatibility can lead to late miscarriage.
10.After miscarriage, don’t be overly sad and worried, adjust your mind in time, keep a cheerful mood and positive attitude towards life, don’t have intercourse too early and use contraception for six months, during this period, consult an experienced physician to actively search for the cause of the disease, and generally need to conduct the following examinations.
11. chromosome examination of both spouses, semen examination of the male partner, and preferably retention of the aborted embryo for chromosome examination.
12. ultrasound, hysterosalpingography or hysteroscopy to understand the anatomy of the genitalia such as the presence of uterine fibroids, uterine malformations, uterine adhesions, etc.
13.Some viral infections during early pregnancy can lead to miscarriage and fetal malformation, so serum anti-cytomegalovirus antibodies and anti-rubella virus antibodies should be examined.
14. Examination of luteal function: basal body temperature measurement, progesterone measurement, ultrasound examination and endometrial biopsy are applied to understand luteal function.
15. Examination of autoantibodies such as lupus anticoagulation factor (LAC), anti-cardiolipin antibody (ACL), anti-nuclear antibody (ANA) and anti-nuclear extractable antigen antibody (anti-ENA antibody). Given that the level of antiphospholipid antibodies fluctuates in the body, false positives can occur, and false positives can occur in cases of fever and infection, so clinical confirmation of the diagnosis can require that the results of three consecutive tests are positive and that the time interval is 3 months.
16, the presence of hypercoagulable state, easy embolism tendency.
17. thyroid function tests, testing of blood glucose to exclude thyroid disease and diabetes, etc.
Endocervical examination, if the habitual abortion caused by cervical insufficiency often occurs in the middle or even late pregnancy, manifested as painless early water breakage followed by paroxysmal abdominal pain fetal abortion, some of these patients can show wide endocervical opening after abortion on ultrasound examination, while some of them show normal, and only when they are pregnant again, they show abnormal, so they need to be monitored closely when they are pregnant again.
18. More than half of the patients can find the cause of miscarriage after the above examination, but in some patients the exact cause cannot be found. It is currently believed that pregnancy is a successful semi-identical transfer process, and because 1/2 of the fetus genes are from the paternal line and the couple HLA antigens are incompatible, the maternal immune system is subject to a series of regulation, no immune rejection of intrauterine embryo grafts occurs, and the continuation of pregnancy is maintained, in this HLA antigens play a very important role in this immune regulation process. The paternal HLA antigens (on the surface of trophoblast cells) carried by the embryo stimulate the body’s immune system and produce a class of IgG-type antibodies, called the closure factors or closure antibodies. If the pregnant woman has low recognition and reactivity to the embryonic semi-identical antigens and fails to produce the appropriate containment and protective antibodies during pregnancy, the embryo may be rejected and miscarried. This type of unexplained habitual miscarriage, also known as alloimmune habitual miscarriage, mainly refers to patients with a history of three or more consecutive miscarriages without a history of live births, stillbirths, or stillbirths, and with no chromosomal or anatomical abnormalities detected by routine etiologic screening, and no infectious, endocrine, or autoimmune diseases.
After finding the exact etiology, symptomatic treatment should be given for.
1, if it is a chromosomal abnormality of the couple, if it is a sex chromosome dominant inheritance, then pregnancy should not be carried out, if it is a sex chromosome recessive inheritance or autosomal inheritance disease, at present, third generation IVF i.e. pre-laying diagnosis after artificial insemination can be performed to obtain a normal embryo to be transferred into the uterus.
2. If it is a deformity or tumor of the reproductive tract can be corrected by surgical treatment.
3, Luteal insufficiency can be corrected by medication to improve luteal function.
4.If it is a viral infection, it should be distinguished whether it is a current infection or a permanent antibody produced after a previous infection, if it is the former, antiviral treatment can be given, while the latter can be left untreated.
5, combined with thyroid disease and diabetes mellitus should be actively treated medical disease, and after the condition is stabilized, the internal medicine physician and obstetrician will decide whether pregnancy is possible.
6. If there is no clinical symptom of cervical insufficiency during the non-pregnancy period, ultrasonic endocervical measurement should be performed at about 12 weeks after pregnancy, and endocervical suture should be performed if abnormal birth is found.
7, autoimmune type habitual abortion can be used immunosuppressive methods, generally apply adrenocorticosteroids and aspirin combined treatment, since the pregnancy is determined to start taking until the end of pregnancy.
8. Hypercoagulable state and embolism-prone tendency can be treated with aspirin alone. Platelet agglutination (PagT) tests were performed regularly during the course of medication to adjust the aspirin dose. No adverse effects of the drug on the offspring were found through follow-up.
9. Habitual abortion of unknown origin can be treated with active immunotherapy, using lymphocytes, monocytes or trophoblast syncytium membranes from the husband or unrelated individuals, of which lymphocytes are more commonly used. The course of treatment starts before conception with 2 sessions at 3-week intervals, with a pregnancy success rate of 87%. At the end of the course, patients are encouraged to become pregnant within 3 months, and if pregnancy is obtained, a further 1-month course of treatment is performed. If pregnancy is not achieved, tubal lavage should be performed and 1 course of active immunotherapy should be repeated if infertility is ruled out.
Patients with habitual miscarriage should not carry a heavy psychological burden, as with the progress of medical science, most patients can have a successful pregnancy through treatment, so be confident and actively cooperate with your physician to achieve a successful pregnancy as soon as possible.