Patient's question:
My wife has experienced two instances of pregnancy where the development stopped. Each time she got pregnant was around the same time, and the time when development stopped was also similar (this makes it the fourth miscarriage, as she had had two miscarriages before, but back then she was young and didn't understand). I am asking all the experts for advice on what methods can be used to avoid such heart-wrenching events from happening. Both of us have had medical check-ups and there were no issues, including blood tests, viral tests, sperm tests, and overall good health. Is there anything else that needs to be checked? Please help me out, thank you all!!! First question supplement: (2008-3-10 12:07:19) Her menstrual cycle is very irregular. Previously, it used to come every two months.Doctor's answer:
The causes of miscarriage include:(1) Embryonic (or fetal) factors
1. Abnormal embryonic development is the most common cause of early miscarriage, accounting for approximately 50–60% of cases due to chromosomal abnormalities.
2. Placental abnormalities, such as incomplete trophoblast development, degeneration of placental villi, or a low-lying placenta, can disrupt fetal-placental circulation, leading to miscarriage.
(2) Maternal factors
1. Acute infections can cause fetal death due to pathogens or toxins invading the placenta, or lead to miscarriage due to high fever or poisoning-induced uterine contractions.
2. Severe anemia or heart failure may cause fetal hypoxia and death.
3. Endocrine disorders, such as luteal insufficiency, can result in poor decidua development, impairing embryo growth.
4. Uterine malformation, uterine fibroids, or congenital anomalies may also hinder embryonic development.
5. Sometimes, cervical incompetence (relaxation of the internal os) may fail to withstand the pressure of the growing fetal sac, leading to late miscarriage.
6. Severe emotional stress, trauma, or sexual intercourse can also cause miscarriage, though these are often contributing factors, with the primary cause typically being embryonic defects.
(3) External factors
Toxic substances that can lead to miscarriage include cadmium, lead, organic mercury, DDT, and other radioactive materials. These toxins may directly affect fetal somatic cells or indirectly influence the fetus through the placenta, resulting in miscarriage.
(4) Immunological factors
Post-implantation, maternal-fetal immune incompatibility may lead to fetal rejection and miscarriage. Identified immunological factors include:
- Spousal histocompatibility antigens
- Fetal antigens
- Blood group antigens
- Maternal cellular immune regulatory imbalance
- Maternal (blocking antibodies) during pregnancy
- Lack of maternal cytotoxic antibodies against paternal lymphocytes
(5) Maternal-fetal blood type incompatibility
Blood type incompatibility between mother and fetus often causes late miscarriage, such as in cases of ABO or Rh blood type mismatches.
Recommendation:
- Test hormones and anti-embryonic antibodies using electrochemical luminescence on days 3–5 of the menstrual cycle.
- Perform vaginal mirror examination, dynamic digital hysterosalpingography, and 4D vaginal ultrasound 3–5 days after menstruation ends.