"Yeah! I’m" graduated "!"
The test tube road was long and finally saw the "two bars", thinking that "graduation".Unexpectedly, after returning to the hospital for examination, the doctor said that he had "stopped the fetus."
Sisters who are test tubes, more or less experienced or heard of fetal stops, make people happy.How is this going?What should I do?We have launched a series of reproductive health science for you one after another. From the aspects of reasons, diagnosis and treatment methods, and precautions for the next pregnancy, we will fully reveal the "fetal stop".
Natural abortion is one of the most common pregnancy complications in obstetrics and gynecology. For the hardesty of pregnancy in pregnancy, this is also the most unwilling to see.
In recent years, due to the delay in the average fertility age, the number of pregnant women has increased after the adjustment of the fertility policy, the risk of adverse pregnancy in pregnant women has increased, and the number of previous abortion is the prognostic factors of recurrence abortion.The consensus of Chinese experts in abortion diagnosis and treatment recommends that the same spouse will occur twice or more in a consecutive or more. Before 28 weeks of pregnancy, abortion is defined as a recurrence abortion. It is recommended to intervene before pregnancy.
The cause of recurrent abortion is very complicated, mainly including: chromosomal or genetic abnormalities, anatomical abnormalities (including congenital and acquisition), autoimmune diseases, pre -thrombosis status (including heredity and acquisition), endocrine factors, infection factors, infection factors, and infection factors, Men’s factors and environmental psychological factors.It is worth noting that a considerable part of the specific causes and pathogenesis of relapse abortion are unknown, and the above factors are called unknown recurrence abortion.
The consensus of Chinese experts recommend the systemic cause of systematic etiology for patients with recurrent miscarriage, but for patients with a history of only one current, unless they have a clear clinical manifestation of family history or related diseases (such as autoimmune diseases), it is not recommended to perform it.Comprehensive cause screening.
So how should I intervene?What inspections do you need to do?How can we minimize the possibility of the next pregnancy?Today, the gynecologist of the Gynecology Hospital of Guangxi Zhuang Autonomous Region will explain it for you.
Which chromosomal or gene screening is needed?
Recommended recurrent abortion couples perform chromosomal nuclear analysis; it is recommended to perform chromosome nuclear analysis of abortion embryo tissues, and conditions can be combined with chromosomal micro -array analysis (CMA).
For natural abortion, those who have a history of age, basic diseases, family genetics, and family genetic medical history, and those who have a history of recurrence of abortion in their direct relatives, choose the analysis of the peripheral blood chromosome nuclear type and fluid chromosome nuclear analysis of both the husband and wife.
When the chromosomal balance is not available, the position of the chromosomes, or considering the insufficient depth of the CMA detection, and the inability to explain the test results, it can be tested in the whole exterior sub -sequencing (WES) or the whole genome sequencing (WGS) test.However, at present, domestic and foreign experts are not uniform for whether recurrence of abortion or WGS examination.
What are the screening methods of anatomical structure abnormal factors?
The anatomy of an anatomical structure associated with relapse abortion mainly includes aphrodisiac uterus, bipolar uterus, monocular uterus and twin uterus.Obtaining anatomical anatomy of sexual uterine include uterine cavity adhesion, uterine fibroids, endometrial polyps, uterine adenocular disease, and incomplete cervical function.The recommended examination method is routine pelvic ultrasound examination, three -dimensional ultrasound and hysteroscopy.When the suspected uterine cavity and/or abnormal abnormal abnormal abnormal abnormalities, the combined diagnosis of laparoscopy in the uterine abdominal mirror can be further diagnosed.
How to screen for autoimmune diseases?
It is recommended to use classic APL testing for patients with RSA patients or 10 weeks of pregnancy or more for 1 pregnancy: including LA, ACL, and Anti‑β2‑gpⅰg.At the same time,: anti -nuclear antibodies, anti -dual -chain DNA antibodies, anti -nuclear antibody spectrum (including antigen antibody antibody and rheumatoid factors), etc., eliminate SLE, SS, RA and other autoimmune diseases.
For those who are less than 10 weeks of abortion, those who have an old age, basic diseases, clinical manifestations of connective tissue diseases, or connective tissue diseases among relatives in direct systems, choose 3, ANA, DSDNA, anti -ENA antibodies, RF, anti -anti -ENA antibodies, RF, anti -anti -ENA antibodies as appropriate.CCP antibodies, TPOAB, TGAB and their own antibody examination corresponding to the clinical manifestations of autoimmune diseases.
How to screen can be performed?
Concrete routine, protein C, protein S, anticoagulantase ‑ (AT‑ Ⅲ), serum same -type cysteine, platelet aggregation rate detection, of which protein C, protein S, AT‑In III, platelet aggregation rate detection is recommended inNon -pregnancy period; if high -risk factors that are easily susceptible, you can choose to test the detection of thrombosis, coagulation factor, MTHFR gene or other coagulation factor genes.At the same time, a classic APL detection is recommended to eliminate APS -related acquisition PTS.
What are the screening items of endocrine factors?
Five armor and thyroid antibodies (such as TPOAB).Available hormone examination with abnormal menstrual cycle.Those who have suspicious diabetes or insulin resistance can screen for the empty stomach and postprandial blood glucose screening. If necessary, conduct oral glucose tolerance test (OGTT) and insulin release test.Suspicious HPRLs performed serum prolactin examination.
How to diagnose unknown reasons for recurrent abortion?
Unknown cause recurrence abortion is also called the same immune recurrence abortion. The pathogenesis is not completely clear. At present, there is no unified diagnostic standard, which is an exclusive diagnosis.After rigorous comprehensive screening and excluding all the known causes, the cause of miscarriage cannot be clearly selected according to the history of abortion and the willingness of the patient, such as the number of closed antibodies (APLA), the number of NK cells and activity, tumor necrosis factor α (TNF-α) Wait for inspection.
Do you need to screen infection factors?
Studies have shown that chronic uterine endometritis is related to the endometrium tolerance, infiltration of the substrate of the pulp cells, and changes in planting related gene expression.Essence
In advanced recurrence abortion such as premature birth and premature fetal membrane breakthroughs, cervical secretions, cervical secretions to solve the detection of related infection indicators such as chlamydia, human -shaped mycoplasma, and chlamydia.
When there are symptoms such as fever and abnormal contractions during pregnancy, infection must be checked; infection must be checked; urgent cervical ring tie operations are recommended to eliminate infections.
Do I need to screen male factors?
Multiple studies have found that the incidence of duplex and DNA fragments of the male sperm medium chromosomes and DNA fragments of recurrent abortion couples have increased, but the incidence of abnormalities in the genetic material of embryo tissue is not consistent.EssenceYou can use the sperm DNA or DNA fragments without routine.