Patient's question:
Dear Doctors:Hello! I am 28 years old and have had two miscarriages. The first was at 47 days, and the second was at 69 days. At 61 days, I went to the hospital for a check-up. The ultrasound findings showed: an anteverted uterus with a gestational sac measuring 2.61.5 cm in the endometrial cavity, but no fetal pole or fetal heartbeat was observed. I naturally miscarried at 69 days. The pathology analysis (vaginal discharge) revealed placental tissue with partial regional tissue bleeding and a large amount of inflammatory cell infiltration, as well as focal areas of fibrinoid necrosis of tissue. (Endometrial cavity) blood clots, fibrin, and significantly degenerated placental villous tissue were also observed. Additionally, there was endometrial tissue showing secretory response.
What is going on? What should I do?
Doctor's answer:
Through your description, it is very likely to be habitual abortion.Definition of habitual abortion: It refers to three or more consecutive natural miscarriages. In recent years, "recurrent abortion" has replaced "habitual abortion," referring to two or more natural miscarriages. Habitual abortion is defined as three or more consecutive natural miscarriages, often occurring in the same gestational month. In traditional Chinese medicine, it is called "slippery."
The factors or causes of habitual abortion are mostly luteal phase deficiency in the pregnant woman, hypothyroidism, congenital uterine malformations, uterine developmental abnormalities, intrauterine adhesions, uterine fibroids, chromosomal abnormalities, and autoimmune conditions. Habitual late abortion is often caused by cervical incompetence. It is usually due to cervical damage from procedures such as curettage or cervical dilation, though in some cases, it may be due to congenital developmental abnormalities. For such patients, after the mid-pregnancy stage, as amniotic fluid increases and the fetus grows, intrauterine pressure rises, and the gestational sac may protrude from the cervical os. When intrauterine pressure reaches a certain level, membranes may rupture, leading to abortion, often without any preceding symptoms. Due to unclear etiology and the lack of effective classification methods, clinicians often blindly prescribe traditional Chinese medicine, progesterone, or human chorionic gonadotropin for so-called "fetal preservation" treatment. However, given the unknown causes, the effectiveness of such treatments is predictable. Some domestic and international doctors have adopted the method of vaccinating patients with their husband's or others' lymphocytes to treat habitual abortion, but this carries significant side effects, making clinical efficacy controversial.
Habitual Abortion Examination Quick Read - Clinical Significance
Main Examination Items:
- Endocrine Factors: Basal body temperature, blood estrogen, progesterone, prolactin, etc.
- Infection Factors: Cervical discharge tests for Toxoplasma, Mycoplasma, Chlamydia, Cytomegalovirus, Herpes Simplex Virus, Rubella Virus, etc.
- Reproductive Factors: Hysterosalpingography, hysteroscopy, etc.
- Genetic Factors: Karyotype analysis of both partners.
- Immune Factors: Zona Pellucida Antibody, Phospholipid Antibody, ABO Blood Group Antibody, Blocking Antibody, Blocking Antibody Anti-Idiotype Antibody, etc.
Prevention is Key: Both partners should undergo thorough examinations before conception, including reproductive organ exams and necessary lab tests. If possible, undergo karyotype testing. If the cause or etiology is identified, treatment should target the specific factor. For those already pregnant, follow the doctor's guidance for different "fetal preservation" measures based on the identified cause or etiology.
Precautions:
1. After a miscarriage, the pregnant woman should avoid anger, worry, or shock. The husband should provide comfort but avoid sexual activity in the short term.
2. Seek medical examination and follow the doctor's advice; do not self-medicate.
3. During subsequent pregnancies, avoid heavy physical labor, especially straining, lifting heavy objects, or forceful bowel movements, which can increase intra-abdominal pressure and lead to miscarriage. Avoid excessive warming or tonification; in early pregnancy, avoid exposure to X-rays, ultrasound, radioactive isotopes, or similar equipment to prevent fetal malformations and miscarriage.
4. Pregnant women should avoid activities in areas with influenza, typhoid, pneumonia, or other epidemics, as well as crowded public places, to reduce infection risk. Avoid active or passive smoking, contact with pets, or inhalation of coal gas.