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Is it the greatness of motherhood, or the gamble of life
Recently I was struck by a news:
Ms. Liu (pseudonym) from Wuhan, Hubei Province, because she suffers from immune diseases, in order to realize her dream of childbirth, from 2010 to the present, in 12 years, she has been pregnant 14 times and miscarried 13 times!
It wasn't until last year, after she became pregnant again, that the 32-year-old managed to give birth to a baby boy.
Figure 1 Image source Weibo
I don't know how to evaluate it when I see it.
I can only borrow a word from a doctor, although the final result is satisfactory, but this desperate fertility mentality cannot be imitated.
After all, not everyone has Ms. Liu's luck.
In the episode "Birthday" of "The World on Earth", there is a pregnant woman who suffers from severe congenital heart disease with severe pulmonary hypertension, and the doctor diagnoses that it is "absolutely not suitable for pregnancy", because she believes that "if life is complete, it is to have a child", insists on risking to have a child, and finally dies after cesarean section, and the young life is fixed at the age of 25.
frequent miscarriages, pregnancies,
It will seriously affect women's physical and mental health
Spontaneous abortion is one of the most common pregnancy complications in obstetrics and gynaecology for women, with about 15%-25% of women experiencing spontaneous abortion during pregnancy. Spontaneous abortion after 2 or more episodes is called "recurrent miscarriage".
Each miscarriage reduces a patient's chances of getting pregnant again, and studies have shown that patients with a history of more than 3 consecutive spontaneous abortions can lose up to 40% of their embryos after re-pregnancy! It has a great impact on women's physical and mental health.
Pregnancies that are too frequent can also pose risks to women's health.
In 2018, a study published in JAMA Internal Medicine collected data from nearly 150,000 Canadian pregnant women to understand the effects of the short interval between two births on pregnant women of different ages.
Figure 2
The study found that for women aged 20 to 34, the risk of frequent pregnancies occurred mostly in the fetus or newborn, including premature birth, low weight, newborn death and other issues, while for women over 35 years old, the risk occurred more in themselves.
Therefore, both the study and the World Health Organization believe that it will take at least about 18 months from the birth of the previous child to the next pregnancy so that women can recover from the loss of childbirth.
Figure 3 Changes in a woman's body during pregnancy Graph source network
Women with immune diseases,
Be more cautious about pregnancy
Ms. Liu in the above case, one of the reasons why she has multiple miscarriages may be immune diseases.
In recent years, a growing body of research has shown that autoimmune diseases significantly increase the risk of adverse pregnancy outcomes such as miscarriage, with about 15% of recurrent miscarriages being caused by autoimmune diseases.
Common autoimmune diseases that are prone to recurrent miscarriage include antiphospholipid syndrome (APS), systemic lupus erythematosus (SLE), undifferentiated connective tissue disease (UCTD), Sjögren syndrome (SS), rheumatoid arthritis (RA), and systemic sclerosis (SSc). When symptoms such as pulmonary hypertension, mitral or tricuspid valve reflux, blocked arrhythmias, preeclampsia or HELLP syndrome, and thrombocytopenia occur during pregnancy, it is also necessary to be highly vigilant for the possibility of autoimmune diseases.
Taking systemic lupus erythematosus as an example, systemic lupus itself does not affect fertility, but because pregnancy is easy to induce systemic lupus erythematosus disease activity or aggravation, the risk of bad pregnancy will increase significantly, and some drugs used to control the disease may reduce fertility or have teratogenic effects on the fetus.
Therefore, patients with immune diseases are not infertile, but they must undergo a multidisciplinary doctor's pregnancy risk assessment and wait for the disease to be controlled before planning to become pregnant. During pregnancy, it is also necessary to receive regular disease monitoring and actively control the disease.
Which women should not force fertility?
According to the China Health and Family Planning Statistical Yearbook 2017, the top 3 "killers" who caused maternal deaths were obstetric hemorrhage, hypertensive diseases during pregnancy and heart disease.
▌ Patients with severe heart disease
If at the time of family planning, the woman's heart function reaches grade III or above, or the pulmonary artery pressure reaches 40 mmHg or more, or the congenital heart disease of right-to-left shunting, it is not recommended to become pregnant until treatment correction.
Because women will greatly increase the burden on the cardiovascular system after pregnancy, and because the burden on the heart increases with the increase of pregnancy, there may be no performance in the first and second trimesters of pregnancy, neglect of prevention, and eventually lead to tragedy.
In the childhood hit drama "Lavender", the heroine took smoke as a congenital heart disease, and everyone advised her not to have children, and as a result, she eventually died of difficult childbirth because she insisted on pregnancy. But it earned me a lot of tears.
Figure 4 Source TV series "Lavender"
▌ Patients with high blood during pregnancy
The incidence of hypertension during pregnancy is about 5% to 12%, including hypertension during pregnancy, preeclampsia, eclampsia, and chronic hypertension complicated by preeclampsia and chronic hypertension in combined pregnancy.
The occurrence of hypertensive disease during pregnancy requires early intervention for treatment, control blood pressure level, reduce the risk of eclampsia, protect the safety of mother and child' life, if after active treatment, the maternal and fetal situation still does not improve, and the condition continues to progress, termination of pregnancy is the only effective treatment measure.
In addition, women with severe chronic kidney disease, sclerosing decompensated period, severe diabetes complicated by kidney, cardiac or retinopathy, severe aplastic anemia, acute stage of psychosis, life-threatening malignancy, and other serious medical and surgical complications should be considered again in the context of disease control.
Don't force a pregnancy by chance.
In addition to the above diseases, there is also a category of diseases that do not affect fertility, but will seriously affect the quality of life of the next generation, such as some genetic diseases, which have attracted attention.
There was such a discussion on Zhihu: Should genetic diseases have children?
Figure 5 The source of the figure is known
As Gao Zan's answer shows, the core is not only whether or not to have children, but also the question of how to raise after childbirth.
In some people's minds, a childless life and family are incomplete. Even independent and autonomous, such as the artist Yang Liping, will be commented that "a woman's biggest failure is not to have a child."
Figure 6 Source Weibo
Not to mention whether the value of women's lives can be assessed by fertility, is it because not having children affects you to enjoy life, enrich yourself, care for your family, and give back to society?
In some cases, the physical condition is not suitable for pregnancy, medicine can not solve, this time is not recommended to hold a fluke mentality or fight with their lives, giving up childbirth is the safest choice.
bibliography:
Cui Yang,Zhang Xiao. Integrated management of systemic lupus erythematosus during pregnancy[J].Journal of Union Medicine,2020,11(3):6.
Liu Yang Tengyu,Zuo Xiaoxia. Characteristics of the immune system during pregnancy and pregnancy complicated with autoimmune diseases[J].Chinese Journal of Obstetric Emergency Electronics,2019,8(2):5.
Obstetrics and Gynecology Branch of Chinese Medical Association. Expert consensus on the diagnosis and treatment of recurrent miscarriage[J].Chinese Journal of Obstetrics and Gynecology(1):7.
[4] Laura Schummers et al.,(2018),Association of Short Interpregnancy Interval With Pregnancy Outcomes According to Maternal Age,JAMA Intern Med.doi:10.1001/jamainternmed.2018.4696.
[5] LI Congcong,ZHAO Aimin. Immune index screening and diagnosis and treatment strategies for unexplained recurrent miscarriage[J].Journal of Practical Obstetrics and Gynecology,2021,37(08):567-570.
This article was first published: Medical Sciences Obstetrics and Gynecology Channel
Author: Lin Yuan
This article is reviewed: Gu Zhuowei
Editor-in-Charge: Ichikawa