How to diagnose spontaneous abortion?

How to check and confirm spontaneous abortion? If a woman finds signs of miscarriage during pregnancy, she must not be careless and must not have a fluke mentality. After all, if miscarriage is discovered and treated in time, there is still a chance of cure, so she must go to the hospital for examination and treatment in time. So how to check and confirm spontaneous abortion? What are the examination items?

Examination items: uterus and appendage examination, semen examination, chromosomes, oxytocin stimulation test

1. Chromosomal abnormalities are mainly based on the analysis of embryonic chromosomes and the chromosome karyotype of the couple's peripheral blood to determine whether it is a chromosomal abnormality of the embryo or a paternal or maternal chromosomal abnormality.

2. Endocrine function examination is mainly based on the patient's menstrual cycle, basal body temperature, full set of sex hormones, endometrial biopsy, thyroid function and blood sugar tests, etc., to understand whether there is luteal insufficiency or other endocrine diseases. The laboratory diagnosis of luteal insufficiency is based on: endometrial biopsy shows that the development of the endometrium lags behind the menstrual cycle by 2 days or more.

(1) Progesterone: During the luteal phase, the 24-hour urine pregnanediol level is measured. The normal value is 6-22 μmol/24h urine. A value below the lower limit indicates luteal insufficiency. The peak value of serum pregnanediol during the luteal phase is 20.7-102.4 nmol/L. A value below 16 nmol/L indicates luteal insufficiency. The progesterone level continues to rise after pregnancy, reaching (76.4±23.7) nmol/L at 7 weeks of pregnancy, (89.2±24.6) nmol/L at 8 weeks, (18.6±40.6) nmol/L at 9-12 weeks, and (142.0±4.0) nmol/L at 13-16 weeks. It is worth pointing out that there are large individual differences in progesterone determination, and there are also variations in the values ​​measured at different times of the day, so the measured values ​​can only be used as a reference. Low progesterone levels are prone to miscarriage. It has been reported that the sensitivity and specificity of progesterone alone in predicting intrauterine fetal survival are both 88%. Hahlin et al. reported that 83% of patients with spontaneous abortion had low serum progesterone values, and a progesterone level below 31.2 nmol/L indicated that the embryo had died.

(2) HCG: Generally, HCG can be detected in the mother's blood 8 to 9 days after pregnancy. As the pregnancy progresses, HCG gradually increases. The doubling time of HCG in early pregnancy is about 48 hours, and it reaches a peak at 8 to 10 weeks of pregnancy. Low or decreasing serum β-HCG values ​​indicate the possibility of miscarriage. Table 2 shows the relationship between serum β-HCG and ultrasound during pregnancy.

(3) Human placental lactogen (HPL): HPL secretion is closely related to placental function. The normal value of serum HPL is 0.02 mg/L at 6-7 weeks of pregnancy and 0.04 mg/L at 8-9 weeks. Low HPL levels are often a precursor to miscarriage.

(4) Cervical mucus: If fern-like crystals are seen in the smear, it indicates a poor prognosis.

(5) Vaginal cytology: If chorionic syncytial cells are found in vaginal smears, the incidence of miscarriage is almost 100%. Therefore, this method can predict the outcome of miscarriage. Once such cells appear, it is advisable to terminate the pregnancy as soon as possible. The characteristics of syncytial cells on the smear are: the cells are of different sizes, the cytoplasm is basophilic, and contain different numbers of dark-stained nuclei, and are often surrounded by red blood cells and white blood cells.

(6) Thyroxine and blood sugar measurement: Both hypothyroidism and hyperthyroidism are prone to miscarriage. Radionuclide measurement of free T3 and T4 can help determine thyroid function during pregnancy. The normal fasting blood sugar value is 5.9mmol/L. If it is abnormal, a glucose tolerance test should be performed to rule out diabetes.

3. Infection-related examinations should include tests for Toxoplasma gondii (TOXO), cytomegalovirus (CMV), Chlamydia trachomatis (CT), Mycoplasma hominis and Ureaplasma urealyticum (MH, UU), etc.

4. Immune examination (1) Autoimmune recurrent miscarriage: The patient excludes abnormalities such as embryo and couple's peripheral blood chromosome karyotype, reproductive tract infection, endocrine and reproductive organ anatomy. Autoantibody test is positive. There are usually two situations: ① Antiphospholipid antibody (ACL, LCA) is positive; ② Antinuclear antibody (ANA) and extractable nuclear antigen antibody (ENA) are positive.

(2) Alloimmune (unexplained) habitual abortion:

① No abnormalities were found in the etiological screening of chromosomes, anatomy, endocrine system and infection.

②Various autoantibodies are negative.

③ There was a lack of blocking antibodies, the microlymphocytotoxicity test (LCT) was negative, and the one-way mixed lymphocyte culture (MLC) + inhibition test showed that the proliferation inhibition was significantly reduced.

B-ultrasound examination is currently widely used and has practical value in differential diagnosis of miscarriage and determination of the type of miscarriage. Generally, the gestational sac halo can be seen in the uterine cavity after 5 weeks of pregnancy. It is a round or oval anechoic area. Sometimes, due to a small amount of bleeding during implantation, a ring-shaped dark area can be seen around the gestational sac. This is the double ring sign of early pregnancy. After 6 weeks of pregnancy, the embryonic sound image can be seen, and the heart tube pulsation appears. Fetal activity can be seen at 8 weeks of pregnancy, and the gestational sac occupies about half of the uterine cavity. The outline of the fetus can be seen at 9 weeks of pregnancy. At 10 weeks, the gestational sac almost fills the entire uterine cavity. At 12 weeks of pregnancy, the fetus appears in a complete shape. Different types of miscarriage and their ultrasound image characteristics are also different, which can help with differential diagnosis.

1. Sonographic features of threatened abortion: ① The size of the uterus is consistent with the month of pregnancy; ② In cases of minor bleeding, an echo-free area is seen surrounding one side of the gestational sac; ③ In cases of major bleeding, a large amount of blood is accumulated in the uterine cavity, and sometimes the fetal membrane can be seen separated from the uterine cavity, with an echo area behind the fetal membrane; ④ Normal heart beats can be seen after 6 weeks of pregnancy.

2. Sonographic features of inevitable miscarriage: ① The gestational sac is deformed or collapsed; ② The internal cervical os is dilated, and there is embryonic tissue blocking the cervical canal. If the amniotic sac is not ruptured, the amniotic sac can be seen protruding into the cervical canal or protruding from the external cervical os; ③ The heart beat has mostly disappeared.

3. Sonographic features of incomplete abortion: ① The uterus is smaller than that in normal pregnancy months; ② There is no complete gestational sac structure in the uterine cavity, instead there are irregular light clusters or small dark areas; ③ The heart tube pulsation disappears.

4. Sonographic features of complete abortion: ① The uterus is of normal or near normal size; ② The uterine cavity is empty, with regular uterine cavity lines and no irregular light masses.