"Yeah! I'm 'graduating'!"
Test tubes are long, and I finally saw the "two bars" and thought I've "graduated". Unexpectedly, after returning to the hospital for examination, the doctor said that he had "fetal discontinued".
The sisters who are test tubes have more or less experienced or heard of fetal discontinuation, which makes people happy. What's going on? What should I do? We have successively launched the "What to do after fetal suspension" series of reproductive health popular science , from the reasons, diagnosis and treatment methods, precautions for preparing for pregnancy next time, etc., to fully reveal the "fetal suspension" to you.
spermia is one of the most common pregnancy complications in obstetrics and gynecology. This is also the thing that mothers with difficulty in pregnancy are the least willing to see.
In recent years, due to the delayed average childbirth age, the number of elderly pregnant women increased after the adjustment of the birth policy, the risk of adverse pregnancy in pregnant women increased, and the number of previous miscarriages is the prognostic influencing factors of recurrent miscarriage . The Chinese expert consensus on diagnosis and treatment of spontaneous abortion in 2020 and the Chinese expert consensus on diagnosis and treatment of recurrent miscarriage in 2022 both suggest that The same spouse has twice or more consecutive miscarriages before 28 weeks of pregnancy is defined as recurrent miscarriage. It is recommended to intervene before pregnancy again.
The causes of recurrent miscarriage are very complex, mainly including: chromosomal or genetic abnormalities, anatomical abnormalities (including congenital and acquired), autoimmune disease , pre-thrombotic status (including hereditary and acquired), endocrine factors, infection factors, male factors, and environmental psychological factors, etc. . It is worth noting that a considerable number of recurrent miscarriages have unknown specific causes and pathogenesis. Excluding the above factors is called recurrent miscarriages with unknown causes.
Chinese experts agree that systematic etiology screening for patients with recurrent miscarriage , but for patients with only one miscarriage, comprehensive etiology screening is not recommended unless they have a clear family history or clinical manifestations of related diseases (such as autoimmune diseases).
So how should we intervene? What examinations are needed? How can we minimize the possibility of another miscarriage in the next pregnancy? Today, the gynecology doctor of Guangxi Zhuang Autonomous Region Reproductive Hospital will explain it to you. What chromosome or gene screening is required for
?
Recommended couples with recurrent abortions to perform chromosomal karyotyping analysis ; chromosomal karyotyping analysis of aborted embryonic tissues is recommended, and chromosomal microarray analysis (CMA) can be combined with chromosomal microarray analysis (CMA) if conditions permit.
For those with spontaneous abortion once, elderly, with underlying diseases, family genetic history, and a history of recurrent miscarriage among their immediate family, the peripheral blood chromosome karyotype analysis and abortion chromosome karyotype analysis of both spouses shall be selected as appropriate.
For chromosome balance translocation and inversion, or considering insufficient depth of CMA detection and unexplainable detection results, whole exome sequencing (WES) or whole genome sequencing (WGS) detection can be performed. However, at present, domestic and foreign experts still have different opinions on whether to undergo WES or WGS examinations for recurrent miscarriage.
What are the screening methods for abnormal factors of anatomical structure?
Congenital uterine anatomic abnormalities associated with recurrent miscarriage mainly include mediastinal uterus , bicorner uterus , unicorn uterus and diuterus. Acquired uterine anatomy include uterine adhesions, uterine fibroids, endometrial polyps, , adenomyosis, cervical insufficiency, etc. The recommended examination methods are routine pelvic ultrasound, three-dimensional ultrasound and hysteroscopy. If there is a suspected abnormality of the uterine cavity and/or abdominal cavity structure, hysteroscopy can be used to further clarify the diagnosis.
How to screen for autoimmune diseases?
Recommended to use classic aPL test for primary screening in patients with RSA or patients with unknown abortion for 10 weeks or more of pregnancy: including LA, aCL and anti-β2-GP IAb. At the same time, such as anti-nuclear antibody , anti-double-stranded DNA antibody , anti-nuclear antibody spectrum (including anti-extractable nuclear antigen antibodies and rheumatoid factor ), etc., to eliminate autoimmune diseases such as SLE, SS, and RA.
For those who have miscarriages less than 10 weeks, combined with elderly, underlying diseases, connective tissue disease clinical manifestations or connective tissue disease among their immediate relatives, the examination criteria aPLs, ANA, dsDNA, anti-ENA antibodies, RF, anti-CCP antibodies, TPOAb, TGAb and autoantibodies corresponding to their clinical manifestations of autoimmune diseases. How to screen for thrombosis?
1 clotting routine, protein C, protein S, antithrombin‑III (AT‑III), serum homocysteine , platelet aggregation rate detection, among which protein C, protein S, AT‑III, and platelet aggregation rate detection is recommended during non-pregnancy period; if high-risk factors of thromboelasticity are combined, thromboelastic map, coagulation factor, MTHFR gene or other coagulation factor genes can be selected. At the same time, classic aPL detection is recommended to exclude APS-related acquired PTS.
What are the screening items for endocrine factors?
methyl 5, thyroid autoantibodies (such as TPOAb). Feasible hormone tests are possible for those with abnormal menstrual cycles. For those with suspicious diabetes or insulin resistance, fasting and postprandial blood sugar screening can be performed. If necessary, oral glucose tolerance test (OGTT) and insulin release test can be performed. People with suspicious HPRL undergo serum prolactin test.
How to diagnose recurrent miscarriage of unknown cause?
Unexplained recurrent miscarriage is also called alloimmune recurrent miscarriage. The pathogenesis is not completely clear. There is currently no unified diagnostic criteria, which is an exclusion diagnosis. After strict and comprehensive screening, all known causes of the abortion cannot be identified. The cause of the abortion can be selected according to the history of abortion and the patient's wishes, such as blocking antibodies (APLA), number and activity of NK cells, tumor necrosis factor α (TNF-α), etc., according to the patient's wishes.
Does infection factor screening need to be carried out?
Studies have shown that chronic endometritis is related to impaired endometrial receptivity, plasma cell matrix infiltration, and transplant-related gene expression changes. It can lead to infertility, repeated transplant failure, and increase the incidence of RSA, but there is still insufficient evidence. Patients with cervical secretions,
late recurrent miscarriage, such as premature birth, premature rupture of the fetal membrane , etc., regularly test for related infection indicators such as cervical secretions, ureaplasma ureaplasma , Mycoplasma humanoid, Chlamydia trachoma and other related infection indicators.
When there are symptoms of infection such as fever and abnormal contractions during pregnancy, examinations for infection-related factors are required; it is recommended to rule out infection before emergency cervical cervix.
Does male factor screening need to be carried out?
Multiple studies have found that the incidence of chromosomal diploids and DNA fragments in men's sperm of recurrent miscarriage couples has increased, but it is not consistent with the incidence of abnormal genetic material in embryonic tissues. The relationship between sperm quality and recurrent miscarriage is not yet clear. Sperm DNA or DNA fragments can be detected without routinely.
