fetal abortion occurs, find out the cause!
For those who want to be parents, pregnancy is a thing full of expectations.
fetal abortion is tantamount to a bolt from the blue.
A female, 31 years old. Married for 4 years, menstruation is 3/28, moderate amount, no dysmenorrhea, G3P0, 3 pregnancy in the past 3 years, the first 2 pregnancy 7-9 weeks B-ultrasound stopped development after the fetal heart beat, underwent uterine purging; One year ago, there was no fetal bud or heart beat after 8 weeks of menopause. She is 158cm tall, weighs 50kg, and her gynecological examination is normal.
has many fetal abortions, no matter how strong the family is. What is
1
?
A fertilized egg is like a seed undergoing a series of complicated and wonderful processes before it finally grows into a healthy baby. For example, in the initial stage, the fertilized egg does not germinate well, then it is likely to stop healthy growth.
We call this abnormal embryonic development that occurs in the first trimester as "embryonic arrest".
"Embryostopping" is different from abortion in the second and third trimesters. It stops the development of the embryo before it is formed. What signals are there for
2
?
If embryo stop occurs, all pregnancy reactions of pregnant women will gradually disappear.
no longer have early pregnancy reactions such as nausea and vomiting;
the feeling of breast swelling is weakened;
vaginal bleeding, often dark red bloody vaginal discharge;
lower abdomen pain, discharge embryo. The clinical manifestations of
vary from person to person. In some cases, there is no sign of abdominal pain, and then abortion, or asymptomatic after embryo is stopped, which is found by B-ultrasound routine.
When the above signals appear in the body, does it mean that the fetus has stopped? The diagnosis of fetal abortion also depends on ultrasound. Embryo monitoring by B-ultrasound:
≥6 weeks without gestational sac, or gestational sac but deformed and shrunken;
when the gestational sac is ≥4cm but no fetal bud can be seen;
fetal bud with head arm length ≥1.5cm but no fetal heartbeat .
The above three conditions can diagnose fetal abortion. Why does
3
encounter fetal abortion?
Common reasons for embryo abortion include the following aspects:
z16
17zgenetic factors
chromosome number is large or small (86%), chromosome structure deletion, inversion, translocation, etc. (6%), other such as chromosome mosaic Phenomenon and submicroscopic chromosomal abnormalities (accounting for 8%). This chromosomal problem of
may come from the embryo itself or from both husband and wife.
z16
17z
abnormal anatomical structure of the reproductive tract
The uterus is the place where embryos grow and develop. When this "house" has an incorrect structure, smaller space or environmental problems, it will inevitably affect embryo growth.
The most common congenital abnormalities of the reproductive tract are uterine mediastinum, saddle uterus, bicornuate uterus, twin uterus, uterine dysplasia and so on.
Acquired abnormalities are common in cervical insufficiency, intrauterine adhesions, uterine fibroids, endometriosis and adenomyosis.
z16
17zendocrine factors
estrogen, progesterone and human chorionic gonadotropin are dependent on embryo implantation and development, lack of endogenous hormones or internal environment disorders, increased blood sugar, increased insulin, etc. will not satisfy the embryo. Need or affect the fetal growth environment. Such as corpus luteum insufficiency, polycystic ovary syndrome, abnormal thyroid function, diabetes, hyperprolactinemia and endometriosis, etc. .
z16
17z
infectious factors
include systemic infections and female reproductive tract infections.
Systemic infection caused by bacteremia or sepsis can produce toxins or toxins on embryos or fetuses during pregnancy.Trigger contractions.
Genital tract infections During pregnancy, bacteria from vaginal and cervical canal infections can travel along the genital tract mucosa or infect the fetal membranes or placenta through the blood, causing chronic endometritis and chorioamnionitis, and induce local endometrium Organize immune response, interfere with and destroy embryo development.
z16
17zimmune factors
autoimmune factors are caused by the mother's production of autoantibodies, common antiphospholipid antibodies and thyroid antibodies. The
allogeneic immune factor is the immune recognition of the fetal antigen by the mother's immune system, causing immune intolerance and immune attack on the fetus.
In addition, there is the "prethrombotic state" that is currently attracting attention, which is a blood prone to coagulation state caused by the increase of the procoagulant components in the mother or the decrease in the concentration of the coagulation inhibitor.
In this state, thrombus is very easy to produce. When thrombus causes decidual and placental vascular infarction, it can cause embryonic ischemia and death.
z16
17z
Unexplained cause
Using current inspection techniques, the causative factors cannot be detected.
z16
17zEnvironmental factors
overweight, will increase the burden on the body's various systems and organs, causing hypertension, diabetes and other metabolic diseases and endocrine function. Lack of nutrients such as folic acid and vitamins can also lead to miscarriage due to fetal malformations.
Occupational exposure to high-lead environments, computer operations for more than 20 hours a week in the first trimester, noise in the work environment> 85dB, and high stress will increase the risk of miscarriage. What should I do if
4
encounters fetal arrest? It is impossible to reverse the situation that
fetal arrest has occurred. The remaining embryos in the uterine cavity have stopped developing, and there is no meaning in staying in the uterine cavity.
needs to be cleaned up in time to prevent the aborted embryos from remaining in the uterine cavity for a long time, resulting in missed abortion and inflammation in the uterine cavity.
Before 12 weeks, the treatment is relatively easy, usually medical abortion is used, mifepristone combined with misoprostol; if the third day is not discharged or the bleeding is heavy during the discharge, an artificial abortion is performed. Hospitalized labor induction over 12 weeks.
For women with embryo abortion, if you want to explore the cause, the main consideration should be the number of embryo abortions.
If it is only one embryo abortion
, generally speaking, there are many accidental factors, because the embryo abortion itself is the result of natural selection and survival of the fittest. It may be a problem with this pregnancy, which leads to chromosomal abnormalities. keep an eye on.
One embryo stop can be checked for the reasons that caused the embryo stop.
If there is no targeted inspection, close observation during the second pregnancy. The most important thing for
is to relax your mind, adjust your body well, and prepare for the next pregnancy. Generally, it will not affect the second pregnancy.
Two fetal abortions
If it is two fetal abortions, we must pay attention to it, and check as much as possible. The second abortion genetic test, the chromosome detection of both spouses, and the reason for multiple abortions.
More than two fetal abortions
If there are more than two embryo abortions in a row, it is necessary to consider the possibility of recurrent miscarriage, check the possible etiology, clarify the cause, and guide the next pregnancy.
Repeated fetal abortion, the possibility of immune factors is high, pregnant women often have a strong autoimmune system, which triggers an autoimmune response under the guidance of the embryo and appendages.
At this time, under the guidance of rheumatology and immunology and obstetrics experts, a set of reasonable treatment plans should be jointly developed and pre-pregnancy examinations should be done.
Do you remember the case at the beginning?
The couple went through both chromosomes, vaginal ultrasound, hysterosalpingography, hysteroscopy, TORCH series, and endocrine and immune factors. Finally, it was found that the couple’s repeated fetal abortion was due to: uterine malformation (mediastinal uterus) .
After hysteroscopy combined with lower mediastinum resection and adjustment for three months after the operation, a female baby weighing 3000g was finally delivered at 37+5 weeks of pregnancy.
It can be seen that after some treatment, everyone ended up happylike.
An accidental fetal abortion is not terrible. Fetal abortion is the result of natural selection and survival of the fittest. For multiple inevitable fetal abortions, the most important thing is to find the reason, relax your mind, actively correct the cause of fetal abortion, and strive to welcome the next baby.
References:
[1] Chang Yuting, Jing Xinyong, Sun Mingying. Early diagnosis and treatment of fetal arrest[J].Clinical Medicine,2002,22(10):40.
[2]周青,刘帅妹,张Rui Jin,Shi Hui,Lin Ning,Wu Yulin,Xu Haoqin.Research Progress on Related Factors of Embryo Discontinuation[J].China Medical Herald,2019,16(23):53-56.
[3]Zhu Zaixia.Mifepristone combined with rice Observation on the effect of soprostol and uterine evacuation in the treatment of embryonic development[J].Journal of Practical Medical Techniques,2019,26(1):92-93.
[4]李丽巧.How to avoid "fetal abortion"[J] ]. Family Medicine, 2019, (6): 79.
Source of this article: Reproductive Medicine Space
Editor: Tang Ying
