Women are anxious about miscarriage, and it is possible for a woman of childbearing age to have one or two miscarriages. However, recurrent miscarriages should be treated with caution. What is recurrent miscarriage? It is generally defined as the occurrence of two or more spontaneous miscarriages. The etiology of recurrent miscarriage (RSA) is complicated, mainly including five major causes, such as genetic factors, endocrine disorders, abnormal uterine anatomy, infection, and immune factors.
1. Genetic abnormalities.
Recurrent miscarriage, especially early recurrent miscarriage, is mainly related to chromosomal abnormalities. Parents with chromosomal abnormalities can have chromosomal abnormalities in 50-70% of the sperm or eggs they produce, resulting in recurrent miscarriages. Embryonic chromosomal abnormalities, which include abnormal chromosome numbers and abnormal chromosome structures, can also lead to recurrent miscarriages. The proportion of miscarriages due to chromosomal abnormalities increases with the age of the mother. There is no way to correct recurrent miscarriages caused by chromosomal abnormalities. The only way is to conduct pre-implantation genetic diagnosis or screening to select normal embryos for transfer to the mother’s uterus to obtain a normal pregnancy.
2. Endocrine factors.
The normal function of endocrine regulation is closely related to recurrent miscarriage, such as luteal insufficiency, polycystic ovary syndrome, diabetes mellitus, hyperprolactinemia, thyroid disease and other endocrine diseases can also lead to recurrent miscarriage. Treatment can be achieved by controlling endocrine diseases.
3. Abnormalities of reproductive organs.
Such as congenital malformation of uterus can cause recurrent miscarriage, abnormal uterine cavity and cervical insufficiency can lead to miscarriage. Uterine cavity abnormalities include uterine malformation, uterine cavity adhesions and submucosal fibroids, polyps, etc. Surgery can improve recurrent miscarriage caused by some uterine abnormalities.
4.Infection factors.
Various inflammatory diseases of the vagina such as mycoplasma and chlamydia infection, cytomegalovirus, rubella virus, herpes simplex virus and toxoplasma infection can lead to miscarriage. Therefore, relevant examination should be conducted before pregnancy.
5, immune factors.
Recurrent miscarriage is also closely related to the abnormal immune system of pregnant women, mainly including autoimmune type and isoimmune type. Autoimmune patients can be found with a variety of antibodies in their bodies, while homoimmune patients show a lack of closed antibodies. Currently, the autoimmune antibodies associated with miscarriage are thought to include antiphospholipid antibodies, anti-nuclear antibodies, anti-sperm antibodies, anti-endometrial antibodies and anti-embryonic antibodies. About 15% of women with recurrent miscarriages have antiphospholipid antibody syndrome. If left untreated, the risk of miscarriage in the next pregnancy can be as high as 90%. Antiphospholipid antibody syndrome can be treated, such as our clinical use of aspirin, steroid hormone drugs (such as prednisone, methylprednisolone, prednisone or Medrol, etc. are such drugs), heparin, etc., are effective measures for the treatment of this condition.
6. Pregnancy itself tends to lead to hypercoagulable state in pregnant women, and thrombosis-prone body is more likely to cause maternal pre-thrombotic state, which in turn tends to lead to recurrent miscarriage.
The genetic abnormalities associated with thrombogenic predisposition have been found to include factor V (Leiden), factor II (prothrombin), and methyltetrahydrofolate reductase mutations. The prethrombotic state can be prevented by low molecular heparin to prevent the occurrence of miscarriage.
In addition, recurrent miscarriages are influenced by many factors.
1, adverse factors in the environment, such as excessive exposure to harmful chemicals, overexposure to radiation, severe noise and vibration, etc.
2, adverse psychological factors, such as women’s mental tension, high degree of depression, serious negative emotions, low emotional control, fear of re-pregnancy, tension, fear, sadness and other adverse psychological stimuli through the neuroendocrine hormone system, so that the internal environment changes, which can affect the normal development of the embryo.
3, excessive physical labor, alcoholism, smoking, drug addiction and other bad habits.
4, Age factor: pregnant women or their husbands are younger than 18 years old or older than 35 years old, resulting in aging of eggs and chromosomal abnormalities of sperm.
For women who come to the hospital, what tests are generally needed to diagnose recurrent miscarriage?
1. chromosome examination of both parties.
2, anatomical examination of the reproductive tract: ultrasound, hysteroscopy, laparoscopy.
3, reproductive endocrine examination: sex hormones, endometrial biopsy, thyroid function, blood glucose, glucose tolerance test, insulin determination.
4, reproductive tract infection examination: chlamydia, mycoplasma, gonorrhea, syphilis serology, AIDS antibody, eugenics 5.
5. immune factor tests: such as anticardiolipin antibody, antinuclear antibody, lupus anticoagulation factor, D-dimer.
Patients with recurrent miscarriage should first take contraceptive measures, undergo a comprehensive examination to understand the cause, and get pregnant again after comprehensive and systematic targeted treatment to avoid recurrence of spontaneous miscarriage.