Foreword: Having children is a happy life that every family yearns for, but in outpatient clinics, doctors often encounter some "family (pregnancy) disasters" - fetal cessation, which is a double blow mentally and physically for expectant fathers and expectant mothers who are looking forward to a better future. So how should expectant mothers correctly understand fetal cessation, and how to prevent and treat it scientifically? Today, we invited Professor Sun Zixue, Professor Mengbo and Professor Wang Chunxia of the Reproductive and Andrology Diagnosis and Treatment Center (Department of Reproductive Medicine) of Henan Provincial Hospital of Traditional Chinese Medicine to be guests in the studio and asked them to talk about the topic of fetal cessation.
Highlights of this issue:
Question 1: "Fetal cessation" for a newborn family, is undoubtedly a thunderbolt on a sunny day, the program began to ask Professor Sun to introduce to you what is "fetal cessation", right?
Sun self-study: pregnancy is a complex physiological process, just like the growth of plants, it is necessary to choose good seeds, fertile soil, suitable seasons, while timely watering, fertilization, seeds can be smoothly germinated, grown, and grown into a good plant. The same is true for human beings, the conception and growth of life first require high-quality sperm and eggs to obtain high-quality embryos, and at the same time require a good uterine cavity environment, a series of physiological changes in the mother's body, and the embryo or fetus can develop and grow smoothly until it is successfully delivered.
Fetal cessation is a name that is more grounded in order to facilitate the public's understanding. Medically it is commonly referred to as "miscarriage". Fetal cessation, which includes embryo arrest and fetal cessation (or stillbirth). If, at the initial stage, the fertilized egg develops into the embryonic stage (i.e., within 8 weeks of pregnancy) there is a development abnormality and the development is automatically terminated called "embryonic abortment"; If the embryo develops into a fetus and then stops developing it is called fetal cessation or stillbirth in the womb or stillbirth. Both spontaneous abortion and stillbirth should fall under the category of fetal cessation. It is more common in those who occur within 12 weeks of pregnancy.
Spontaneous abortion is often divided into: threatened miscarriage, inevitable miscarriage (inevitable abortion), incomplete abortion and complete miscarriage, residual abortion, recurrent miscarriage and stillbirth.
Threatened miscarriage: a small amount of vaginal bleeding after menopause, or accompanied by lower abdominal pain or low back pain; The cervical orifice is not opened, and no pregnancy is excreted; The size of the uterus corresponds to the time of menopause. After rest and treatment, the symptoms disappear and the pregnancy can continue.
Inevitable miscarriage: also known as inevitable miscarriage, on the basis of threatened miscarriage, if the amount of vaginal bleeding increases or lower abdominal pain increases, or the fetal membrane ruptures, the cervical opening is checked to have dilated. B-ultrasound examination only sees the blastocyst, and no embryo or fetus, or no fetal tube beat, also falls into this type.
Incomplete abortion: it is inevitable that the miscarriage will continue to develop, and some of the pregnancy will be excreted from the uterine cavity, or the placenta will remain in the uterine cavity or incarcerated with the cervical opening after the fetus is excreted, affecting the contraction of the uterus, causing heavy bleeding, and even shock. Check that the cervical opening is dilated and the uterus is less than the number of menopausal weeks.
Complete miscarriage: there are symptoms of miscarriage, the pregnancy is completely excreted, and then the bleeding gradually stops and the abdominal pain gradually disappears. Check that the cervical opening is closed and the uterus size is basically normal.
Surviving miscarriage: Also known as expired abortion, refers to those who are not excreted in time after the death of an intrauterine embryo or fetus. Typically presents with a normal course of early pregnancy, with symptoms of threatened miscarriage or no symptoms; As menopause prolongs, the uterus no longer enlarges or shrinks, and the uterus is smaller than the number of menopausal weeks. Or on a B ultrasound examination is the appearance of an embryo that has stopped developing.
Habitual miscarriage: refers to 2 or more consecutive spontaneous abortions.
Stillbirth: Refers to the death of the fetus in the womb after 20 weeks of pregnancy. If the fetus dies during childbirth, it is called stillbirth, and one is a type of stillbirth
Question 2: There are many expectant parents who are very confused, why do they stop having a fetus? Can you ask Professor Men to briefly introduce the common causes of abortion and non-fertility?
Monpo: Okay. We know that there are many reasons for fetal cessation, the mechanism of occurrence is very complicated, and there are many problems that are not yet clear and need to be explored. At present, there are mainly the following reasons for everyone's recognition:
Today we use a seed to grow into a tree as a metaphor to give you a brief introduction: 1. First of all, chromosomal abnormalities, which is what we call birth defects. We know that good varieties, high-quality seeds are more likely to grow well, and so are embryos. Congenitally, if there are chromosomal abnormalities, especially if there are malformed children born in the family, familial genetic diseases, and there have been multiple histories of embryonic cessation, such patients are more likely to have embryonic cessation.
The second is the maternal disease factor: the sapling grows better in a suitable environment. The same is true of embryos, which are more conducive to development in a good endometrial environment and a normal endocrine environment. If the uterine development is deformed, the endometrium is defective, and the endocrine disorders are all likely to affect the development of the embryo.
There are also some infectious factors: small saplings that are thriving, after encountering harsh environments, may also be harmed, or even stop breeding, our small embryos are the same, severe TORCH infection in the first trimester of pregnancy can cause embryonic death or miscarriage, and mild infections can also cause embryonic malformations. In recent years, studies have shown that mycoplasma infection is also related to embryonic cessation.
Finally, there are some factors, such as abnormal coagulation function, which is what we call prethrombotic state thrombosis and abnormal immune factors. In addition, in clinical work, people often ask, "So many reasons, which of these reasons do I cause?" In fact, not all embryos can be particularly clear in terms of specific causes, and there are still a considerable number of patients with fetal anterogenesis whose cause is unknown.
Problem three: Expectant mothers need special attention after pregnancy to avoid fetal cessation. So please ask Professor Wang to introduce us to the common types of fetal cessation in the first trimester of pregnancy?
1. Wang Chunxia: According to the relevant testing indicators, there are 4 common types of fetal cessation in the first trimester of pregnancy
2. 1. Biochemical pregnancy: it is a kind of early miscarriage, which generally occurs within 5 weeks of pregnancy, refers to the combination of sperm and egg, but there is no implantation to the uterus, menstruation is delayed, the HCG in the blood is detected and elevated, B ultrasound can not see the gestational sac, probably in more than a month there will be bleeding phenomenon, due to the small embryo, the general amount of bleeding will be relatively small, slightly more than the usual menstrual volume, and the trauma caused by miscarriage is also small. It generally does not affect the next month's pregnancy test.
3. 2. Empty pregnancy sac: Normally, if the woman's menstrual cycle is regular, do pelvic three-dimensional color ultrasound about seven weeks after menopause, you can find that there is a pregnancy sac in the uterine cavity, and the fetal heart and fetal buds can be seen in the gestational sac. If menopause is seven weeks, ultrasound shows only one empty sac in the uterine cavity, but no yolk sac and fetal bud echo are consistently seen.
4. 3. There is a fetal bud without fetal heart: for normal intrauterine pregnancy, the general B ultrasound examination can clearly see the embryo in the uterus and the fetal heart canal beating at 42 days of menopause. Some women who ovulate late or fertilize eggs implant late, their intrauterine germ, fetal heart canal beat time will be relatively delayed, but most will not exceed 49 days of menopause, no later than 56 days, if more than 56 days B ultrasound suggests that fetal bud echo, sustained no original blood vessel beat.
5. 4. After there is a fetal heart rate, it stops: B ultrasound prompts that the fetal buds and primitive blood vessels are pulsating, and after a period of time, the original heart canal beat is checked.
Question 4: Many people believe that the occurrence of fetal abortation is all caused by female reasons, is this really the case? Doesn't it have anything to do with men? Please ask Professor Men to answer it for you.
Monbo: Of course not. However, it can be seen that there are more studies on women and are more in-depth. However, in recent years, the attention to male factors has begun to be paid attention to, and there have been more researchers. We know that women in the early stage of pregnancy in the embryo stop development, spontaneous abortion situation occurs from time to time, so fetal abortion patients couples in our reproductive clinic is very common, many women have not been able to find obvious problems after multiple examinations, which is currently a thorny problem in the clinic. When the woman can't find the problem, maybe we can see if there is a problem with the man's sperm, after all, half of the embryo's genetic material comes from the man's sperm. So what factors can cause fetal arrest in men?
It mainly includes chromosomal abnormalities, abnormal sperm quality, and male homosexual cysteine abnormalities, as well as bad living habits and reproductive tract infections.
Question 5: For a pregnant mother, there will be some signs of fetal cessation, Professor Wang, how can a novice pregnant mother judge whether fetal cessation occurs?
Wang Chunxia: Judging mainly from the following two aspects
One is the change of the patient's self-conscious symptoms When the embryo is stopped, all pregnancy reactions of the mother will gradually disappear, for example, the body temperature drops, and the early pregnancy test strip cannot test positive; If the reaction to early pregnancy is weakened, such as nausea, vomiting, or sudden disappearance, the feeling of breast swelling will also weaken or disappear. Vaginal bleeding, more or less in amount, accompanied by pain in the lower abdomen (like menstrual cramps), lumbosacral aches and discomfort.
The second is laboratory indicators and B-ultrasound examination.
Criteria for the diagnosis of fetal cessation in ultrasound B: head-hip length ≥7 mm and no original fetal heart canal beat. The average diameter of the gestational sac ≥ 25 mm without the fetal heartbeat of the embryo. No embryos with primitive tube beats were detected after 2 weeks of gestational sac without yolk sacs. After 11 days of examination, the gestational sac with the yolk sac is not seen in embryos with primitive heart canal beats.
There are also 8 situations that require high vigilance against fetal cessation, which will not be repeated because it is more professional.
The above are all indicators of the diagnosis of fetal cessation, but the clinical situation is complex, coupled with the reliability of the test and the level of the doctor, the diagnosis of fetal cessation often requires a combination of multiple examination indicators to prevent and control misdiagnosis and avoid blind fetal preservation.
Question 6: When is fetal cessation generally prone to occur? Who is susceptible to fetal abortation? Please ask Professor Sun to answer the question for everyone.
Sun self-study: mostly occurs in the first trimester. First trimester fetal cessation mainly refers to the first three months of early pregnancy, during which the following three conditions are common, depending on the period of embryonic development. The first is ultrasound before the visible gestational sac, at which point the embryo is discontinued into a biochemical pregnancy; The second is that the gestational sac can be seen in ultrasound, but the yolk sac and germ echo cannot be seen for a long time, which is an empty sac. The third is that the ultrasound can show the gestational sac, the germ can be seen, no fetal heart rate is seen or the fetal heart rate is visible, but after a period of time, the fetal heart rate is re-examined and disappeared. Therefore, during the entire early pregnancy period, it is necessary to be vigilant at all times, regularly review the level of color ultrasound and blood HCG, and do a good job of close early pregnancy monitoring.
High-risk groups
1. Pregnant women who have a history of fetal arrest or repeated fetal arrest and childbearing. This is because in addition to the accidental factors, there are many inevitable pathogenic factors, these factors may become the cause of fetal cessation in re-pregnancy, especially after the occurrence of 2 or more fetal cessation, suggesting that the causes of illness may be more and more complex, and the risk of fetal cessation after re-pregnancy is greater, so these groups are at high risk of re-fetal cessation. And with the increase in the number of fetal stops, the chance of recurrent fetal stops or miscarriages will increase greatly. The 2011 American Academy of Obstetricians and Gynecologists' Guidelines for Early Pregnancy Failure state that the risk of spontaneous abortion after 2 or more consecutive miscarriages is 30%.
2. There is a history of birth defects in both families, or there is a history of fetal cessation or repeated fetal cessation in immediate family.
If there is a history of birth defects in the relatives of both families, it is indicated that they may also carry certain defective genes, causing birth defects or fetal cessation, or there are certain factors that may cause fetal discontinuation, such as the environment, eating habits, living habits, etc., and need to be vigilant. If there are serious reproductive function problems in immediate family members, or fetal cessation or repeated fetal discontinuation, it is necessary to clarify the cause and exclude chromosomal problems, because some chromosomal abnormalities have no abnormal manifestations, but can be inherited. For example, chromosomal balance translocation, Roche ectopic, inverted position, etc.
3. Elderly women older than 35 years old or men older than 45 years old.
With age, sperm or eggs will decline in quality due to aging, thereby reducing the quality of embryos, especially in elderly women, because in addition to the problem of egg quality decline, there are endocrine abnormalities, uterine abnormalities, endometrial conditions or the uterine environment will decline, increasing the risk of fetal abortation. Therefore, elderly women or men are at high risk of fetal cessation.
4. Women who are overweight or underweight.
Abnormal lipid metabolism can cause endocrine abnormalities, which directly affect the quality of eggs and the secretion of hormones in the body, and are not suitable for the growth and development of embryos, causing fetal cessation.
5. Those who have a history of infertility for many years. A large number of clinical studies have found that the risk of fetal cessation after pregnancy in infertile couples is significantly higher than the risk of fetal cessation in ordinary couples. Because of years of infertility, it suggests that there are some pathogenic factors in the body, and after pregnancy, the existing pathogenic factors have become the main cause of fetal cessation. Therefore, the population of infertility for many years is also a high-risk group of fetal cessation.
6. Pregnant couples who have been working in environments containing formaldehyde, radiation, radiation and other environments for a long time or couples who smoke and drink a lot for a long time; Studies have confirmed that formaldehyde, radiation, radiation, etc. have a teratogenic effect on sperm, eggs or embryos. The adverse effects of alcohol and tobacco on pregnancy are also clear.
7. Those who have had 1 or more abortions in the past. Hysteresis or medical abortion may cause uterine cavity damage or endocrine abnormalities, increasing the risk of re-pregnancy and fetal cessation.
Question Seven: Many fathers-to-be mothers-to-be are anxious to have children, but do not know how long it will take to get pregnant, how long does it take for the door professor, fetal cessation or contraception to get pregnant again?
Menbo: After fetal cessation terminates pregnancy, many patients will ask, when is the next pregnancy more appropriate? Many doctors will give many answers based on different considerations: 3 months, half a year, or a year, etc. We think 3 to 6 months is more appropriate.
Mainly based on three points: 3 to 6 months can produce a new batch of sperm, eggs, after correcting bad habits, 3 to 6 months is enough to produce a batch of better quality sperm, eggs, reduce the fetal suspension caused by embryo quality problems. In general, the treatment and conditioning of the cause of fetal cessation takes 3 to 6 months as a course of treatment, and in 3 to 6 months, the endocrine and uterus can be fully restored, unless the cause is very complex, the trial pregnancy time can be postponed as appropriate. Latent pregnancy may cause underlying inflammation, and delaying pregnancy trials may increase the risk of secondary infertility, which is common clinically. After fetal cessation of childbirth, due to the fear of premature pregnancy to increase the risk of fetal cessation, 1 year later to try to conceive, found that for a long time can not conceive, fallopian tube examination suggests tubal obstruction, at this time, it is necessary to re-solve the fallopian tube problem. Therefore, contraception does not need to be spaced too long and does not increase the risk of provoking infertility. Of course, the specific situation still needs to be determined by the individual situation, and the opinion of the attending doctor shall prevail.
Question 8: When a woman becomes pregnant, HCG levels will continue to rise, Professor Wang, must HCG increase in the first trimester of pregnancy double every other day?
Wang Chunxia: HCG, as a glycoprotein secreted by the trophoblasts of the placenta, is an important indicator of pregnancy. Clinically, according to the HCG doubling value combined with B ultrasound, the embryonic development can be judged, however, the clinic is not completely stuck to the next day doubling, generally speaking, before the HCG 10,000 units, it is the doubling of the next day, after 10,000, it is the next day to increase 10,000 units. Later, as the pregnancy progresses, the level of blood hCG can continue to rise, and the embryonic development needs to be evaluated together with other test results, and the embryonic development cannot be judged by a report alone. Clinical complexity, everyone's situation is different, must be under the guidance of a specialist to judge the status of embryonic development, and regular review, in order to finally determine. We often encounter poor blood hCG indicators in the clinic, and finally confirmed that the fetal development is very good examples, there are also blood test hCG has been very good, sudden fetal cessation, so the assessment of embryonic development is more complicated, to consider various factors, can not only rely on a certain examination or a certain examination to make a judgment.
Question 9: How can both spouses prepare before pregnancy to reduce the incidence of fetal cessation? Ask Professor Door to answer the question for you.
Menbo: (1) Advocate that when you reach the legal age of marriage, you should marry and have children in a timely manner.
Scientific studies have shown that fertility tends to decrease with age: it is generally believed that the optimal age for women is 23 to 30 years old, and by 35 years of age, fertility is reduced by 50%; The optimal age for men is 25 to 35 years old, and sperm quality gradually declines as they age.
(2) Strengthen exercise and control weight. People who are overweight, lose weight appropriately, and those who are too light in weight need to increase nutrition and increase weight appropriately.
(3) Reasonable diet. Avoid spicy and greasy food, eat more vegetables and fruits, and quit smoking and alcohol; A reasonable and healthy diet such as eating more vegetables and fruits, and a diversified diet.
(4) Keep a happy mood and reduce the psychological burden.
(5) Pay attention to hygiene, stay away from unclean sexual life, and avoid infection of the reproductive system.
For example, TORCH, mycoplasma, chlamydia examination, etc. are performed before the couple becomes pregnant. The living environment should be fresh and comfortable, try to avoid living in places with serious air pollution, newly renovated houses are temporarily liveable, and various physical factors (X-rays, microwaves, noise, ultrasound, high temperatures, etc.) and chemical (such as heavy metals aluminum, lead, mercury, etc., dibromochlorohydrin, carbon disulfide, anesthetic gases, oral antidiabetic drugs, etc.) have an adverse factor that affect fertility. As little or no contact with pets as possible, away from radiation, radiation, formaldehyde harmful environment, smog weather need to wear a mask, reduce outdoor activities.
(6) During the preparation of pregnancy, reduce unnecessary medication, and take medication under the guidance of a specialist.
(7) Doing a good job in health care before marriage, pregnancy and the first trimester is an important means of eugenics, and it is also the key to preventing spontaneous abortion.
Blood group tests for both spouses in patients with recurrent spontaneous abortion or family genetic history include ABO blood group system and RH blood group system, as well as chromosomal, tissue-specific antibodies, and vascular endothelial growth factor. Both parties begin routine folic acid supplementation three months before the pregnancy trial, and adjust the dose under the guidance of a doctor if necessary.
(8) Contraception during pregnancy preparation, and improve relevant examinations before pregnancy. For those with a bad maternal history, it is necessary to find the cause, receive targeted treatment and conditioning under the guidance of the doctor, and then try to conceive under the guidance of the doctor. Generally, after pregnancy, it is necessary to continue to receive fetal protection treatment until the time of previous fetal cessation is exceeded, and the drug is gradually stopped under the guidance of a doctor.
(9) After pregnancy, the first three months can not be cohabited; Reduce strenuous activity, meditate on the fetus, and if there is abdominal pain or vaginal bleeding, immediately go to the hospital for examination and treatment.
In short, because the reasons for embryo cessation are complex, often multiple factors affect each other, so premarital examination can not be reduced to a formality; It is necessary to seriously carry out pre-pregnancy education and genetic disease counseling; Check in early and mid-pregnancy on time. After fetal cessation, it is particularly important to go to the hospital to terminate the pregnancy by abortion in time to prevent intrauterine infection caused by embryo retention, and at the same time, it is particularly important to do a good job in the care after the abortion of fetal cessation.
Question 10: At present, what are the prevention and treatment plans adopted by Henan Provincial Hospital of Traditional Chinese Medicine for fetal cessation? How effective is it? I would like to ask Professor Sun to introduce it to you.
Sun self-study: 1. Advocate husband and wife to investigate and rule together. Never favor women over men. Pay attention to the examination of the cause.
2. Give full play to the advantages of traditional Chinese medicine prevention and treatment, and formulate individualized prevention and treatment plans.
Guests in this issue:
Sun taught himself
Director of the Department of Reproductive Medicine (Reproductive and Andrology Diagnosis and Treatment Center) of Henan Provincial Hospital of Traditional Chinese Medicine (Second Affiliated Hospital of Henan University of Traditional Chinese Medicine).
Doctoral supervisor, expert enjoying special allowance of the State Council, the first batch of famous doctors
The first batch of famous traditional Chinese medicine in Henan Province, excellent experts in Henan Province
Leading talent in the clinical discipline of traditional Chinese medicine in Henan Province
He is the academic leader of the national key specialty of traditional Chinese medicine and the person in charge of the national regional traditional Chinese medicine (specialty) diagnosis and treatment center
Leader of the National Key Discipline of Traditional Chinese Medicine - Andrology Department of Traditional Chinese Medicine
Leader of the National Collaborative Group of The National Cooperation Group of The National Specialty of Traditional Chinese Medicine - Male Infertility The Chairman of the Reproductive Medicine Branch of the Chinese Association of Traditional Chinese Medicine
Vice Chairman of the Andrology Professional Committee of the Chinese Association of Integrative Traditional and Western Medicine
Menpo
Provincial well-known experts, chief physicians, professors, master tutors, members of the Reproductive Branch and Andrology Branch of the Chinese Association of Traditional Chinese Medicine, vice chairman of the Andrology Professional Committee of Integrated Traditional Chinese and Western Medicine in Henan Province, member of the Standing Committee of the Reproductive Medicine Professional Committee, and chairman of the Zhengzhou Andrology Professional Committee of Traditional Chinese Medicine. The fourth generation of the Zhongyuan Men's gynecological school, Professor Men Chengfu is a disciple of Professor Yan Chuan. He is good at traditional Chinese medicine, integrated traditional Chinese and western medicine in the treatment of infertility, recurrent miscarriage (fetal cessation) and pregnancy diseases and other gynecological difficult diseases; Reproductive and andrology diseases such as male infertility, sexual dysfunction, prostate diseases, and eugenics counseling.
Wang Chunxia
Deputy Director of the Department of Reproductive Medicine, Chief Physician, Professor, Master Tutor of Henan Provincial Hospital of Traditional Chinese Medicine, Well-known Expert of Henan Province, Professor Zhang Binghou of National Famous Old Chinese Medicine and Famous Teacher of Chinese Medicine in the Capital, Professor Li Zhongyu of Henan Province, Professor Zhang Lei, Master of Traditional Chinese Medicine, Professor Chu Yuxia, a gynecologist of Henan Provincial Famous Traditional Chinese Medicine, and Professor Luo Zhijuan, a gynecologist of Ruikang Hospital affiliated to Guangxi University of Traditional Chinese Medicine. He is also a member of the Reproductive Medicine Professional Committee of the Chinese Association of Traditional Chinese Medicine, a member of the Standing Committee of the Reproductive Medicine Professional Committee of the Henan Association of Integrative Traditional and Western Medicine, and a member of the Reproductive Medicine Professional Committee of the Henan Association of Traditional Chinese Medicine. He has published 75 papers, including 4 in SCI, 2 second prizes in provincial and ministerial "second prizes" for scientific research, 5 "first prizes" at the departmental and bureau levels, 10 projects he has presided over and participated in, and edited 3 books.