Foreword: Recently, I saw such news, a 21-year-old female college student, after three abortions, the lining of the uterus has become very thin and thin, but because of another indulgence, she was unexpectedly pregnant for the fourth time, unlike usual, after this miscarriage, the doctor told her that she may never be able to get pregnant again, 21-year-old she may not understand, what kind of experience it is to not be able to have children, because she is young, so there is no fear. So, what kind of experience is miscarriage, and what harm does it really do to a woman's body?
In this regard, today we specially invited Zhao Shujun, director of the gynecological tumor ward of the Third Affiliated Hospital of Zhengzhou University, Gao Xiang, attending physician of the gynecological tumor ward of the Third Affiliated Hospital of Zhengzhou University, Yang Hongli, deputy director of the obstetrics and gynecology ward of Zhengzhou Huazhuo Hospital, and Bai Sujuan, director of the gynecology department of Xinzheng Maternal and Child Health Hospital, to discuss the "miscarriage of those things".
Highlights of this issue:
Question one: Speaking of miscarriage, most people think that this is just an accidental event, but many people do not realize that abortion is more common than we think, just like the female student in the case has miscarried four times at the age of 21, so at the beginning of the program, you first tell us about how to define abortion in the end.
A: Medically, miscarriage is the termination of a pregnancy before 28 weeks and the fetal weight is less than 1,000 g.
Classification according to the timing of miscarriage: miscarriage that occurs before 12 weeks of pregnancy, we call it early miscarriage; Miscarriage that occurs after 12 weeks of pregnancy is called a late miscarriage.
According to the mode of abortion, we also divide abortion into spontaneous abortion and induced abortion; Induced abortion includes surgical abortion and medical abortion.
Question two: It turns out that it is like this, as if it is not very similar to our usual understanding of miscarriage, there are so many classification methods, so in the clinic, which abortions are more common?
A: Yes, the general public usually limits abortion to early pregnancy abortion and equates abortion with surgical abortion. This is actually incomplete. But in fact, spontaneous abortion is the most common complication of pregnancy, its incidence accounts for 10-15% of all pregnancies, of which more than 80% occur in the first trimester, that is, early miscarriage. When artificially requesting termination of pregnancy, it is generally in the early pregnancy period, unless the fetal development is obviously abnormal, or there are other medically considered unsuitable circumstances to continue the pregnancy, otherwise the late artificial abortion is rare.
Question three: Listening to your remarks, I think that the audience friends, like me, have a further scientific understanding of the classification of abortion. It is understood that on January 27, 2022, the No. 1 document of 2022 of the 2022 work points of the China Family Planning Association pointed out that in 2022, reproductive health promotion actions should be implemented, focusing on solving the prominent problems of reproductive health of adolescents, childbearing age groups and other specific groups, and carrying out special actions for artificial abortion intervention for unmarried people, reducing unintended pregnancies and abortions among adolescents, and improving the reproductive health level of the masses. I would like to ask, why does the state put such content on the work agenda? What is the significance?
A: In fact, this problem, I think every obstetrician and gynecologist has a deep feeling, because in the gynecological clinic, the most contact is two types of patients: one is that there is no pregnancy plan, but accidentally pregnant, to have an abortion, or even repeated abortions, the other is repeated medical infertility, or repeated spontaneous abortion and suffering. For the first type of patient, we will repeatedly ask and confirm whether we really can't have this child, whether we must have a miscarriage, and the answers we get are overwhelmingly resolute. For the second type of patient, after asking about the medical history in detail, many of them have actually experienced abortion for various reasons, or even repeated abortion, on the one hand, it is very regrettable, on the other hand, it is also necessary to further examine, and some have to undergo surgery again, so that there may be opportunities for pregnancy and childbirth. So our clinicians are actually very much in favor of the state to write these things into the work plan, which is very necessary.
Question four: Listening to your explanation, it is true that these two kinds of patients are actually different stages of the same patient, first do not want to have a miscarriage, and then want to get pregnant. So what do you think about the key groups written in the document, including teenagers?
A: Actually, this one is very easy to understand. Let's take a look at the data, from 2014 to 2019, the number of Chinese workers who have miscarried has always hovered around 9.5 million. In 2021, the number of chinese births will be only 10.62 million. That is to say, the gap between the number of abortions and the number of births may be only more than 1 million.
In addition, a group of data shows that 8% of girls aged 15 to 19 have sexual experience and the rate of multiple pregnancies is higher than that of 20 to 24 years old, and the proportion of chinese women with abortions under the age of 25 accounts for nearly 50%.
According to the Data of the National Health Commission, the repeat abortion rate among Chinese women who have abortions is 55.9%, of which the proportion of frequent abortions with more than 3 times is 13.5%, and the interval between repeated abortions is 0.5-1.5 years. Repeated abortions, induced abortions and abortions under the age of 20 within six months have occupied the top 3 high-risk abortions. After more than 4 abortions, the incidence of infertility will reach 92.13%. Now, nearly 90% of all secondary infertility patients have experienced abortion.
Therefore, teenagers, unmarried young women, or married women with no birth plans are definitely the key groups we need to pay attention to.
Question five: This set of data is really surprising! Such a large number of abortions, must have brought great harm to women's reproductive health, then combined with the female students in the case, you specifically tell us about the harm of abortion!
A: The harm of miscarriage is very much, which will bring many physical and psychological problems to women. These hazards roughly include the following aspects: First: injuries during surgery, uterine perforation, heavy bleeding, and the need for further surgery to stop the bleeding; Second: after the abortion, the cervical opening is open, the bacteria of the reproductive tract rise to cause infection, fever, secondary endometritis, salpingitis, pelvic inflammatory disease; Third: induced abortion may damage the uterine lining, causing uterine adhesions, menstrual abnormalities, amenorrhea or menstrual blood reflux; Fourth: the above conditions may lead to an increase in the probability of ectopic pregnancy and spontaneous abortion, and can also cause infertility and endometriosis; Fifth: there may be abnormal implantation position of the embryo in the subsequent pregnancy, placenta previa, repeated bleeding or even heavy bleeding during pregnancy, the probability of caesarean section is also increased, etc.; Most importantly, no matter what the reason, the vast majority of women will have many regrets, guilt, and even depression in their hearts, which affect their physical and mental health.
Question six: There are many women like the female students in the story, when they were young, they did not know self-love, committed irreparable mistakes, maybe they did not know that there would be so many harms when they had a miscarriage, they thought that this child would not succeed, I did it, good maintenance, next time pregnant, then, this idea is correct?
A: This is not true.
Every miscarriage is irreparable to women and to the uterus, which is why doctors will repeatedly persuade patients in the clinic not to do abortion without miscarriage, which is what we do every day. Regarding the word "maintenance", there are really no special miracle drugs or health supplements that make the uterus as perfect as if it had not been operated on. However, for these patients who have had abortions, we will carry out preoperative education, explain the reasonable prevention of infection after surgery, do a good job of contraception, plan pregnancy, and reduce repeated abortions.
Question seven: Like the female college student in the case, if you accidentally get pregnant, then for these people with an infertile constitution, although they are usually very careful, it is still easy to get pregnant.
A: Actually, there is no so-called "fertile constitution", only that you can't use contraception, or that you don't have contraception.
To put it simply, pregnancy actually requires several conditions: first, sperm and eggs can be discharged normally; Second, sperm and eggs can meet and combine smoothly; Third, after the sperm and egg are combined, they can return to the uterine cavity and be planted.
Then contraception, in fact, is to block any of the above steps can be.
At present, the main contraceptive methods we recommend are: condoms, compound short-acting oral contraceptives, intrauterine devices (that is, upper ring), and ligation. If condoms can be standardized, regular oral combinations of short-acting oral contraceptives, or intrauterine devices and ligations can be placed, the contraceptive success rate will definitely be 95%-100%.
And we often hear about extracorporeal sperm evacuation, emergency contraception, safe period contraception, these contraceptive effects are relatively poor, we do not recommend.
Question 8: In fact, simply put, as long as scientific contraception, it can significantly reduce the probability of unintended pregnancy, and can also reduce the number of abortions, is this so?
A: Yes. Regarding scientific contraception and reproductive health, we also need to further popularize science and publicize key groups, and middle school students to women of childbearing age should be the target groups of our publicity and science popularization.
Question nine: We talked about the problem of abortion before, so as mentioned earlier, spontaneous abortion is the most common complication of pregnancy, so about spontaneous abortion, do teachers have anything to share with the audience and friends?
A: As the name suggests, spontaneous abortion refers to abortion that occurs for non-human reasons, according to the different stages of abortion development, spontaneous abortion is divided into threatened abortion, inevitable abortion, incomplete abortion, and complete abortion. According to the gestational age, it can also be divided into early spontaneous abortion and late spontaneous abortion. There are also special circumstances, such as residual miscarriage (that is, we often hear about embryos stopping development), recurrent miscarriage, miscarriage co-infection, etc. Its etiology is more complex, including embryos, mothers, fathers, environmental factors and other aspects, screening is more troublesome. Different clinical treatments are required for different etiologies.
Question 10: Is it necessary to conduct a comprehensive examination for patients with a history of spontaneous abortion?
A: According to epidemiological surveys, patients with only 1 history of miscarriage have a low risk of miscarriage in their second pregnancy and a higher success rate in pregnancy, and for patients with only 1 history of miscarriage, in addition to a clear family history or clinical manifestations, comprehensive etiological screening is not recommended, and with the increase in the number of miscarriages, the risk of recurrent pregnancy miscarriage will increase significantly, especially after 3 or more miscarriages, the risk of recurrence of miscarriage can reach more than 80%. Patients with recurrent miscarriage should be screened for a comprehensive and systematic etiology. Keep an eye on its risk of recurrence and assess its prognosis.
Question 11: There are also some patients consulting, repeated natural abortion at a larger gestational week, the stomach does not feel pain, to the hospital to check the uterine opening, it can not be saved, this situation should be done what?
A: If there is a repetitive mid- or late-stage miscarriage or premature birth, we need to consider a disease called cervical insufficiency. In patients with recurrent miscarriages, the incidence of cervical insufficiency is about 8% to 15%, usually at the same gestational age, or painless cervical dilation occurs at a smaller and smaller gestational age, resulting in miscarriage. Treatment of such patients is mainly cervical cerclage. Includes cervical cerclage during and before pregnancy.
Cervical cerclage during pregnancy is generally performed at 14-18 weeks of pregnancy or before the week of pregnancy of a previous miscarriage, and the preconception cerclage is performed before pregnancy and then after the perceptual tyration.
Question 12: So is there any difference between these two types of cerations? How should I choose the appropriate method of ligation according to my physical condition?
A: Pregnancy cerclage is generally transvaginal cerculation, this surgical operation is not complicated, the position of the cerclage is relatively low, if there is an unavoidable miscarriage, premature birth or delivery, the transvaginal removal of the cerclage line can be; Preconception cernica generally refers to laparoscopic cervical internal orifice cerclage, this operation has a certain degree of difficulty, requiring skilled laparoscopic operation of the foundation and a good anatomical basis, its cernic position is relatively high, but because of the intra-abdominal cynulitis, the cynical line is relatively difficult to remove, and caesarean section is the mainstay during childbirth. Of course, there are also some patients for various reasons, pregnancy can not be transvaginal cerclage, you can also consider transarcopic cervical circumpuncture, this operation is more difficult, it is recommended to go to a regular hospital, please have relevant surgical experience of doctors for surgery.
Question 13: Although we all hope that every pregnancy can have a happy ending, but in the face of miscarriage, we also need the courage and love to face the reality, so at the end of the show, Director Zhao, do you have anything to tell you?
A: Today we mainly talked about the issue of miscarriage, and I hope that after watching our program, you can gain something. I hope that everyone can achieve scientific contraception, plan pregnancy, try not to perform abortion, and ensure the reproductive health of our women. If you have miscarriage-related problems, have a history of repeated spontaneous abortion or cervical insufficiency, if you need it, you are welcome to come to us, Zhengda Third Affiliated Hospital, our gynecology and reproductive medicine department will do our best to help you!
Conclusion: Don't think of youth as a play capital, and don't make childbirth a mission that must be achieved, for women, every miscarriage is dangerous to lead to infertility.
Speakers:
Zhao Shujun, Director of gynecological oncology ward of the Third Affiliated Hospital of Zhengzhou University, Doctor of Medicine, Chief Physician, Professor, Master Supervisor. Vice Chairman of gynecological oncology committee of Henan Medical Information Society, deputy leader of the second gynecological endoscopy group of Henan Medical Association Obstetrics and Gynecology Branch, standing committee member of Henan Gynecological Oncology Professional Committee, standing committee member of Henan Maternal and Child Health Gynecology Oncology Branch, member of China Eugenic Tumor Youth Committee and other academic part-time. Professional expertise: 1, gynecological benign and malignant tumors: cervical precancerous lesions, cervical cancer; Uterine fibroids, uterine malignancies; Benign and malignant tumors of the ovaries; Trophoblastic tumors; 2. Endometriosis: adenomyosis; Ovarian chocolate cysts; Deep endometriosis. 3. Hysteroscopy and fertility-related treatment: infertility, cervical insufficiency, uterine adhesions, uterine mediastinum, submucosal fibroids, endometrial polyps; 4. Common gynecological diseases: reproductive system inflammation, menstrual abnormalities, endocrine abnormalities, etc.
Gao Xiang, The Third Affiliated Hospital of Zhengzhou University, Attending Physician of Gynecological Oncology Ward, Ph.D. candidate. Standing Committee Member of Gynecologic Oncology Professional Committee of Henan Medical Information Society Henan Anti-Cancer Association Member of Retroperitoneal Tumor Professional Committee Member of Reproductive Surgery and Uterine Fallopian Tube Disease Professional Committee member of Henan Provincial Anti-Cancer Association Tumor Prevention and Treatment and Science Popularization Committee member specializes in the diagnosis and treatment of common benign and malignant diseases in gynecology, hysteroscopy, laparoscopy and open surgery treatment and long-term management
Yang Hongli, Deputy Director of the Department of Obstetrics and Gynecology of Zhengzhou Huazhuo Hospital, graduated from the Department of Clinical Medicine of Zhengzhou University in 1996, engaged in obstetrics and gynecology for 20 years, and is proficient in the diagnosis and treatment of common diseases and multiple diseases in obstetrics and gynecology. He studied at the Third Affiliated College of Zhengzhou University. Proficient in laparoscopic uterine fibroids, ovarian cysts, ectopic pregnancy and other surgeries, he has rich clinical experience in perinatal health care and difficult labor progression
Bai Sujuan is the director of gynecology and attending physician of Xinzheng Maternal and Child Health Hospital. Engaged in obstetrics and gynecology for more than ten years, he has studied in Zhengzhou Maternal and Child Health Hospital and Henan Provincial Maternal and Child Health Hospital. He has rich clinical experience in the diagnosis and treatment of common and difficult diseases in obstetrics and gynecology, especially in the diagnosis and treatment of gynecological inflammation, cervical diseases, endocrine diseases such as menstrual irregularities, infertility, and menopausal women's health care; He has the qualification of gynecological fourth-level endoscopic surgery, is good at gynecological and family planning surgery, and focuses on postoperative psychological counseling and health guidance.