Ms. Zhang of Laixi, Qingdao, is an internal medicine doctor at a local hospital, but as a doctor, she has been married for 4 years, but she has faced repeated abortions. As the saying goes, "it is difficult for a healer to heal herself", and she herself could not cope with her habitual miscarriage.
Ms. Zhang, a doctor by profession, accidentally became pregnant in 2017, and gave up the child herself because she needed to continue to graduate school, who knows how difficult it is to have a baby after that.
In 2018, I was pregnant with another one, and my husband was full of joy, but I still couldn't see the fetal heartbuds after more than 7 weeks of pregnancy, when the gynecological director suggested that Ms. Zhang come back a week later, but the results were still the same after a week, so I had to do uterine clearance surgery.
In 2019, Ms. Zhang was pregnant again, and in order to save the fetus, she also took a leave of absence from Corey and applied not to work the night shift, but she was pregnant until about 7 weeks, and she felt abdominal pain when she went home from overtime, and she still couldn't save the child by running the emergency room in the middle of the night.
In 2020, pregnant again, the husband did everything to protect her, sending her to work every day, picking up after work, going home at night is also cooking and bringing water, not allowing Ms. Zhang to take a little heavy object, but she still sees blood in the 8th week.
Ms. Zhang is always unwilling in her heart, as a doctor, she knows that there must be a reason for the incident, but she is an internal medicine doctor, and there are not many obstetrics and gynecology things, so she will look up the literature herself, check the information, and see what reasons will make her repeated abortions and stops. But there are too many reasons for fetal arrest, and the conditions of the hospital where they are located are also limited, so the two families feel that they have come to Qingdao to see.
Ms. Zhang herself is a doctor, and it can be said that it is barrier-free to communicate with me, the medical history and symptoms are very clear, and the previous cases and examination reports are also clearly sorted out. Based on her situation, I arranged for the couple to do the relevant examinations. The man is normal; the woman's fallopian tubes are unobstructed and positive for anticardiolipin antibodies. The final diagnosis is: recurrent miscarriage, tubal incompatibility, anticardiolipin syndrome.
The main cause of Ms. Zhang's recurrent miscarriage was due to immune factors. Immune factors play a very important role in the reproductive process, and miscarriage can be a form of immune rejection. Unexplained habitual miscarriage is mainly related to immune factors, of which 1/3 may be related to autoantibodies, especially anticardiolipin antibodies, that is, autoimmune type; and about 2/3 may be related to immune tolerance abnormalities, that is, alloimmune types.
Therefore, while giving patients traditional Chinese medicine enema, oral and topical treatment of fallopian tubes, patients are treated with problems in conditioning reproductive immunity, and anticoagulation is mainly taken for positive anti-cardiac phosphorus antibody bodies, and after 4 months of treatment, the re-examination reaches the condition of trial pregnancy, and successful pregnancy in the second month of trial pregnancy. After pregnancy, continue anticoagulation therapy to maintain the fetus for 3 months and then transfer to the obstetrics department.
The clinical manifestations of antiphospholipid syndrome mainly include: fetal arrest, premature birth, severe eclampsia, preeclampsia, placental insufficiency, recurrent miscarriage, as well as long-term infertility, decreased amniotic fluid, repeated implantation failure of IVF, ectopic pregnancy and other manifestations.
Heparin anticoagulation may be given after confirmed pregnancy in patients with a history of recurrent miscarriages and those who have had a miscarriage after 10 weeks' gestation or more. In patients with a history of recurrent miscarriage with a history of thrombosis, anticoagulation should be started before pregnancy. Because pregnant women have a higher risk of developing thrombosis within 3 months of giving birth, anticoagulation should be continued until 6 to 12 weeks postpartum.
During the treatment process, if the fetus is well developed and the abnormal indicators related to the prethrombotic state return to normal, the drug can be discontinued, and the relevant indicators of the prethrombotic state can be reviewed regularly after stopping the drug, and the fetal growth and development should be monitored at the same time, if there is an abnormality, the drug should be considered to start again, and if necessary, the treatment can be continued until the entire pregnancy, and the use should be stopped 24 hours before the termination of pregnancy.
Recurrent miscarriage can be the result of a combination of many factors, so systemic screening is needed and then treatment based on the cause and the condition of each patient. Women with a history of recurrent miscarriage should pay attention to tubal examination before preparing for pregnancy again, and treat problems together. After treating pregnancy, the patient should also actively carry out fetal protection treatment, and the time of fetal protection must exceed the time of the last spontaneous abortion. The treatment of recurrent miscarriage is relatively complicated and the process is relatively long, so both husband and wife should face it together and cooperate with doctors and patients to achieve a good treatment effect.