Pregnancy, pregnancy, there are always some expectant mothers for various reasons can not retain the fetus in the abdomen, thus falling into self-blame and pain, in fact, there are many reasons for repeated abortion during pregnancy, several of which are particularly hidden, pregnant mothers should pay more attention to ~
What is miscarriage?
Spontaneous abortion is one of the common pregnancy complications in obstetrics and gynecology, which refers to the failure of the pregnancy process before a certain gestational week, mainly including empty gestational sac, biochemical pregnancy, gradual cessation of embryonic development, embryonic or fetal death, and excretion of embryos and their appendages. Studies have shown that for women of childbearing age, the risk of a spontaneous abortion is about 10%. Of course, if there is only 1 spontaneous abortion, the expectant mother does not need to worry too much, nor does she need to carry out special screening and treatment, and relax her mood and do a good pre-pregnancy examination before the next pregnancy. If it is a recurrent, repeated spontaneous abortion (recurrent abortion), it needs to be paid full attention.
For recurrent miscarriage (RSA), the previous definition in China was that the fetal loss occurred 3 or more times with the same spouse before 28 weeks of pregnancy, but due to the increase in the reproductive age and the increase in the number of pregnant women at an advanced age, it is currently believed that 2 or more consecutive occurrences should be made, and the fetal loss before 28 weeks of pregnancy should be defined as RSA.
Data show that for women of childbearing age, the incidence of recurrent miscarriage is 1%-5%, and with the increase in the number of miscarriages, the incidence gradually increases, and the embryo loss rate after re-pregnancy in patients with more than 3 consecutive spontaneous abortions is as high as 40%-80%.
What tests must be done after repeated abortions?
01. Ask a detailed medical history
For patients with recurrent miscarriage, consultation and consultation are recommended at a specialized fertility centre or prenatal diagnostic centre. At the time of the first visit, both husband and wife need to visit the doctor at the same time and actively explain the medical history and family history, including the age of both husband and wife, the patient's menstrual history, marriage and childbirth history, family history, surgical history, whether there is internal medicine comorbidities, whether there is a history of infectious diseases, and other past history, living habits (smoking, drinking, etc.), adverse environmental exposure, body mass index, etc. Psychological factors need to be assessed.
02. Immunological factor screening
Studies have shown that autoimmune abnormalities are closely related to recurrent miscarriage, therefore, for patients with recurrent miscarriage, routine autoimmune screening is required, mainly including rheumatoid factor, antiphospholipid antibodies, anti-neutrophil antibodies, anti-thyroglobulin antibodies, etc., to exclude common autoimmune diseases such as antiphospholipid syndrome, systemic lupus erythematosus, rheumatoid arthritis and systemic sclerosis.
03. Thrombophilia screening
The normal development of the fetus depends on the placental circulation has sufficient blood supply, and if the blood vessels of the placenta form small blood clots, it is similar to the blockage of the water tube, the outflow of water must be reduced, and the formation of thrombosis will also lead to a decrease in the blood supply to the placenta, thereby affecting the growth and development of the fetus, leading to the occurrence of miscarriage in severe cases, therefore, for patients with recurrent miscarriage, it is recommended to carry out routine thrombosis screening, including: thrombin time, activated part of the thromboplastin time, thrombin antithrombin complex, thrombomodulatory protein, anticardiolidin antibodies and the like , check whether the miscarriage is due to the formation of small placental thrombosis.
04. Chromosomal examination
According to statistics, 3%-8% of couples with recurrent miscarriage have chromosomal abnormalities in at least one of them, and with the increase of maternal age, especially women of childbearing age > 35 years old, the detection rate of embryonic chromosomal abnormalities is as high as 78%, based on this, it is recommended that both couples with recurrent miscarriages (especially women) conduct chromosomal karyotype analysis of peripheral blood and miscarriage tissue.
05. Anatomical factors
Embryos need to grow and develop within the uterine cavity, so once the shape or development of the uterus is abnormal, it can also lead to miscarriage. Data show that up to 8.4% to 12.6% of patients with recurrent miscarriage have uterine abnormalities, such as: mediastinal uterus, bicornal uterus, arched uterus, uncornuated uterus, uterine dysplasia and cervical insufficiency. Therefore, it is recommended that women with a history of RSA should have genital ultrasound, if necessary, imaging tests such as MRI can be performed to evaluate uterine anatomy, and for those with suspected abnormalities, the diagnosis should be further confirmed by uterine/laparoscopy, and cervical morphological monitoring should be strengthened during pregnancy in order to detect cervical insufficiency in time.
06. Miscellaneous
Miscarriage can also occur if the thyroid gland is abnormal or if there is an endocrine disorder. Therefore, in patients with RSA, routine basic reproductive endocrine testing (follicle-stimulating hormone, luteinizing hormone, estradiol, progesterone, testosterone, and prolactin), thyroid function, and blood glucose screening is recommended.