Good "pregnancy", "slip" and then "slip"?Note that these screenings quickly do


Pregnancy, a complex physiological process

Involved in the couple

With reproductive cells, uterine environment, embryo bed,

Endocrine is closely related to various factors such as immune regulation

For some women

They are eager to get pregnant, but they are afraid of pregnancy

Because the baby is always here and left again

Physical and mental strike is undoubtedly huge

Only by checking the cause and making correct judgments can we really treat the symptoms.

Refers to embryos or more before 28 weeks of pregnancy or more than 3 times or loss of pregnancy (including biochemical pregnancy); the early natural abortion rate occurred in 12 weeks (especially 10 weeks ago).The live production rate can be improved.

Screening object: It is recommended to try to screen as much as possible

The RCOG (Royal Association of Obstetrics and Gynecology) is suitable for the loss of fetuses 3 times or more than 3 times with the same sexual partner and lost 3 times and before 24 weeks of pregnancy.

ASRM (American Reproductive Medicine Association) standards are suitable for: 2 or more clinical pregnancy failure.

my country Standards: The fetus lost 3 or more at 28 weeks before pregnancy.

There is no abnormality in line hair dyeing; old age: close to menopause, or ovarian function is low; repeated auxiliary fertility failure after miscarriage; abortion after many years of infertility; explanation, patients require screening.

Genetic factors, anatomical factors, immune factors (autoimmune disorders and same immune), pre -thrombosis, endocrine factors, infection factors, male factors, and other factors.It is recommended to be divided into a preliminary screening plan and deep inspection plan.

1. Screening of genetic factors

Preliminary screening: Couple dyeing color nuclear analysis

Structural abnormalities (about 5%): Increase the natural abortion rate

Polymorphism: Do not directly lead to abortion, but may increase the abnormality of embryo chromosome

In -depth investigation:

Embryo has abnormal genetic genes or micro lacks

Clear or highly suspect that these abnormalities are related to abortion

The couple can do the corresponding gene or micro -lack check

2. Screening of anatomy factors

Such as uterine malformation, severe uterine cavity, endometrial polyps, submucosal fibroids, severe endometrial thin or hypertrophic, etc., are related to the early RSA.

Preliminary screen: Pelvic ultrasound examination, at least once routine; hysteroscopic examination, you can find some tiny problems in the uterine cavity.

Deep investigation: Hysteroscopy, abnormal menstrual flow, cycle, and menstrual periods; uterine cavity and fallopian tubes are unnecessary for those who are not difficult to conceive.

3. Screening for immune factors

APS laboratory diagnostic standard indicator

Preliminary screening: It is necessary to check the standard items of APS, including antipathy antibodies, anti -β glycoprotein 1 antibodies, lupus anticoagulation, etc.

Deep investigation: clinical is in line with APS, but when the first screen is negative, it is necessary to further detect the non -standard indicators of APS

APS laboratory diagnostic non -standard indicators include: antichen antibody, anti -phospholipidal antibody antibody, antichenylline antibody, antichen glycolic antibody, anti -phosphologenic choline antibody, anti -β2gpi domain, anticipullase collateral eggsV antibody, anticoagulantase original antibody

Laboratory diagnosis of autoimmune disease

Preliminary screening: ANA qualitative and quantitative, anti -nuclear antibody spectrum (ANAS), such as anti -SSA antibodies, anti -SSB antibodies, anti -RO52 antibodies

Deep investigation: clinically suspected that those who have autoimmune diseases must further check the anti -nuclear antibodies (ANA) and anti -nuclear antibody spectrum (ANAS)

Immune-related examinations include: immunoglobulin quantity, tonic, NK cells and activity, cytokines TNF-A Inf-Y IL-10 IL-9, other immunocreas (reproductive antibodies and anti-nailing gland antibodies, etc.)

The same immune examination includes: unknown reasons RSA check closed antibodies, number of NK cells, activity, number of B cells, etc.

4. Examination of the state before thrombosis

The high -coordinated state of blood is typical in deep venous embolism, but the changes in patients with recurrent abortion are not obvious. The state of state relationships before obtaining sexual thrombosis is mainly APS.

In addition, the relationship between the pre -state state and RSA before the hereditary thrombosis is not yet certain.

Preliminary screening: coagulation function, D dizate, standard indicators of APS, same type cysteine, PS, PC, AT-III, folic acid metabolism, etc.

Deep investigation: non -standard indicators of APS

5. Endocrine factors screening

Gynecological endocrine, such as hyperculfinemia, polycystic ovary syndrome, luteal incompleteness, is related to abortion.

Early sieve:

Ovarian hormone level measurement: Especially for men with menstruation

Empty blood glucose, OGTT and IRT: high -risk women must do, such as family history of diabetes, age, obesity, menstrual disorders, abnormal ovulation, infertility, etc.

Thyroid function: Must be conventional sieve

Thyroid antibody: can be used as a first screen, or if there are abnormal nail skills

6. Infection factors screening

TORCH: It is not recommended to screen for routine, but you can detect LGM antibodies before preparing for pregnancy to avoid conception under positive conditions

Uterine endometritis: It affects the bed and has something to do with abortion. It is recommended that routine hysteroscopy test at the same time to check inflammation at the same time

Inflammation of the inflammation of the genitalism;

Seven, male factors screening

Preliminary screening: outer peripheral blood chromosome nuclear type, analysis of routine semen examination

Deep investigation: Especially those who have difficulty in pregnancy, check the quality and functional test of semen

Hunan Guangxi Hospital Gynecology

Causes of the cause of recurrent miscarriage

And related treatment

Guard the good pregnant dream of each mother

Items for early recurrence abortion can be sieved.

The four -dimensional ultrasound of the uterus and double accessories, hysteroscopy+CD138

Peripheral peripheral blood chromosomes; ACA and αβ2-GP1, LA

ANA qualitative and quantitative, ANAS, EMAB, ASAB; coagulation function, D di agent, platelet aggregation rate; ovarian hormone, PRL, thyroid function, fasting blood glucose, OGTT, IRT reproductive tract inflammation, HIV, TP, TORCH; men’s semen;Conventional, Pasa dyeing, SCSA (analysis of sperm chromatin structure); anti -A anti -B videos or anti -D cost.

Reminder: Smoking, drinking, weight control, and bad environment are also important exclusion factor. Patients with recurrent abortion such as> 35 years old recommend PGS for pregnancy.

If no abnormal factors are found at the initial screen, or the condition cannot be evaluated, it is necessary to further check the relevant items (HLA, APCA; TH balance, NK phenotype; uterine endometrial capacity monitoring, etc.).

(Edit yh.)

Source: Gynecology at Guangxi Hospital of Hunan

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