Road of Healthy: Recurrent Spontaneous Abortion

主持人：观众朋友们，您们好!这里是中央电视台《健康之路》直播节目，今天我们来聊的是习惯性流产的免疫治疗方面的问题。
Host: Hello everyone, this is CCTV live “Road of Healthy”,today we are going to talk about the immunotherapy of recurrent spontaneous abortion (RSA).
主持人：到底什么是习惯性流产?
Host: What is recurrent spontaneous abortion (RSA) after all?
陈凤林：医学上定义习惯性流产为连续两次以上，在同一妊周内发生了胎停育，进而出现流产的现象。
Dr. Chen：The medical definition of RSA is when miscarriage occurs in two or more consecutive embryo arrests during the same week of pregnancy.
主持人：同一妊周内应该怎样理解呢?
Host: How should you understand the same week of pregnancy?
刘桂霞：比如上次怀孕50天左右发生了流产，第二次也在50天左右发生流产。
Liuguixia: For example, there was a miscarriage about 50 days after the last pregnancy, and the second miscarriage also occurred about 50 days after the pregnancy.
主持人：停育是什么意思?
Host: What does embryo arrest mean?
刘桂霞：通常胎儿在40-50天左右就开始有了胎牙和胎心的情况，如果在这个期间通过B超检查没有发现有胎牙和胎心，这就属于胎儿停止发育，在早期就称之为胎停育。
Liuguixia: Usually the fetus will have embryo and fetal heart in about 40-50 days. If no embryo and fetal heart are found during this period of B ultrasound examination, it means the fetus stopped developing. It is called embryo arrest in the early days.
主持人：来看一个短片：
Moderator: Let’s watch a short video
记者：卢女士曾经两次怀孕都因为工作的原因放弃了，在她们打算要一个孩子的时候却遭遇了习惯性流产。
Journalist: Mrs. Lu had given up two pregnancies because of work, and she experienced a recurrent spontaneous abortion when they were planning to have a baby.
卢女士：我们93年的时候就计划要孩子，第一次计划怀孕后也挺高兴的，当时医生说三个月时才开始检查，因为怀孕的时候一直也比较正常，但是到了检查的时候就发现是胎停育，没有胎心。当时确实打击也挺大的。
Mrs. Lu: We were planning to have a baby in 1993, and we were happy with the first pregnancy. The doctor said the antenatal care should start at the third month, because it was normal at the time of pregnancy, however there was no fetal heart by the time of the examination, it was discovered as embryo arrest. It was a big hit for us.
记者：卢女士认为这也许是一次偶然事件，可能下次就没事儿了。他们计划两年后再怀孕，这次他们比较警惕，做了很多准备。两个多月时卢女士做B超检查，很不幸，结果和第一次一样，仍然是胎停育。
Journalist: Mrs. Lu thinks it might be an accident. Maybe next time it will be all right. They plan to get pregnant again after two years. This time they are more vigilant and have made a lot of preparations. Mrs. Lu had a B ultrasound in more than two months, unfortunately, the result is the same as the first time, it was still embryo arrest.
卢女士：我想这一定是有原因的，可是又不敢轻易要孩子。第三次怀孕和这次流产间隔五年，在这五年中我吃过一年的中药，这时候我又看了西医。我想等中西医都没问题的时候再怀应该没问题。
Mrs. Lu: I think there must be a reason for this, but I dare not have children easily. The third pregnancy was five years apart from this miscarriage. In these five years, I took one year of Chinese medicine. And I went to see a Western medicine. I think it should be fine when the Chinese and Western medicine are all right.
记者：这次卢女士认为应该是没有问题。
Interviewer: This time, Mrs. Lu thinks there should be no problem.
卢女士：到了第八周的时候就应该能够看到胎心了，因此第八周的时候我赶紧去医院做B超，结果又是一个不幸的消息。
Mrs. Lu: By the eighth week, I should be able to see the fetal heart, so I rushed to the hospital to do the B ultrasound at the eighth week. The result was another unfortunate news.
记者：这些年卢女士和丈夫都做过全面检查，两人都身体健康，他们不明白为什么三次怀孕都是在第八周的时候发生胎停育。
Interviewer: Mrs. Lu and her husband have had thorough examinations over the years, both of them are in good health, they don’t understand why every embryo arrest occurred during the eighth week of pregnancy.
记者：小黄和小李也是一对恩爱夫妻，婚后不久他们就有喜了，这是他们第一次怀孕，他们既兴奋又紧张，夫妻俩开始憧憬着婚后的幸福。然而在怀孕60天时小黄出现了少量阴道出血，到医院就诊，医生给她注射了黄体酮保胎，一个多星期后，小黄B超检查也是胎停育。此后小黄怀过两次孕，都是在60天左右有少量出血，后做B超都确诊为胎停育。
Interviewer: Huang and Li are also a loving couple. They were pregnant soon after marriage, it was their first pregnancy, they were excited and nervous, they were began to look forward to the happiness after marriage. However, Huang had a small amount of vaginal bleeding when she was pregnant for 60 days, she went to the hospital and the doctor injected her with progesterone, more than a week later, her B ultrasound result was also embryo arrest. Since then, Huang have had two pregnancies, all of which have a small amount of bleeding in about 60 days, and were diagnosed as embryo arrest by B ultrasound.
主持人：到底是什么原因导致的习惯性流产?
Host: What exactly caused recurrent spontaneous abortion?
陈凤林：严格说来习惯性流产并不是一种疾病的名称，习惯性流产是很多种疾病的一种共同表现。临床统计大约有43种左右的疾病能够引起流产。
Dr. Chen: Strictly speaking, RSA is not the name of a disease, it’s a common manifestation of many diseases. Clinical statistics indicate that there are about 43 diseases that can cause RSA.
引起习惯性流产的疾病大约有43种疾病
1、 免疫因素占67%
2、 解剖因素占14%
3、 内分泌因素11%
4、 遗传因素占5%
5、 其它因素占3%
There are about 43 diseases that cause RSA
1, immune factors accounted for 67 %
2, anatomical factors accounted for 14 %
3, endocrine factors accounted for 11 %
4, genetic factors accounted for 5 %
5, other factors accounted for 3 %
主持人：为什么免疫因素会造成习惯性流产?
Host: Why does immune factor cause RSA?
刘桂霞：免疫因素是指在怀孕早期母体和胎儿处于一种同种异体的状态，正常情况下由于胎儿和母体之间的胎盘屏障现象，就可以继续妊娠，不会发生排斥。如果免疫有一些因素不正常了，母体产生抗体后就可以造成免疫排斥。
Liuguixia: The immune factor is that in the early stages of pregnancy, the mother and the fetus are in a state of allogenic, under normal circumstances, due to the placental barrier between the fetus and the mother, the pregnancy can continue without rejection. The mother produces antibodies that can cause immune rejection if there are something wrong with the immune factor.
陈凤林：胎盘屏障有两个概念，一个是起物理的分割作用，另一个是化学的分割作用。实际上母体和胎儿之间在血型以及组织配型上一样的几乎很少见，之所以能够顺利生产出来就是因为这个屏障的完好，这个屏障被破坏以后，免疫排斥反应就一定会发生。
Dr. Chen: The placental barrier has two concepts. One is physical segmentation and the other is chemical segmentation. In fact, the same blood type and tissue type between the mother and the fetus are almost rare. The reason why it can be successfully delivered is because the barrier is intact. After the barrier is destroyed, the immunological rejection must occur.
主持人：除了免疫因素以外的其它因素之中还有什么我们比较熟悉的疾病?
Host: What other factors besides immune factors are we familiar with?
刘桂霞：比如解剖因素中的子宫肌瘤、子宫畸形等都可以造成流产。
Liuguixia: For example, uterine fibroids and uterine malformation in anatomical factor can cause miscarriage.
主持人：怎么理解感染和内分泌因素引起的流产呢?
Host: How to understand miscarriage caused by infection and endocrine factors?
陈凤林：感染引起的流产往往是偶然一次的，不会是习惯性的，这是一个流产因素，往往并不是习惯性流产常见的因素。内分泌因素是一个习惯性流产的因素，临床医生或者是经历过保胎治疗的患者大部分都是用内分泌的方法进行的胞胎(注射黄体酮等)。这一类病因在临床上并不常见。内分泌因素引起的疾病大概有以下几种，包括子宫内膜异位症，可以引起卵巢功能改变。还有多囊卵巢综合症，也引起排卵后的黄体功能不足。还有全身内分泌因素，包括糖尿病、甲状腺低功，甚至有一些肿瘤疾病导致内分泌紊乱。当然内分泌紊乱后母体环境就不适合胎儿生长了。
Chenfenglin: Infection causes an miscarriage that is often accidental and not habitual. This is a factor in miscarriage. It is often not a common factor in habitual miscarriage. Endocrine factors are a factor in habitual miscarriage. Most of the patients who have undergone prenatal care or have undergone prenatal care are babies(injection of progesterone, etc.). This type of etiology is not common clinically. Endocrine causes diseases may include the following types, including endometriosis, which can cause changes in ovarian function. There are also polycystic ovary syndrome, which also causes insufficient luteal function after ovulation. There are also systemic endocrine factors, including diabetes, hypothyroidism, and even endocrine disorders caused by some tumor diseases. Of course, the maternal environment after endocrine disruption is not suitable for fetal growth.
主持人：除了这些生理因素以外还有没有别的原因导致习惯性流产?比如人的某种行为?
Host: Are there other causes leading to RSA besides physiological factors? Such as human behavior?
陈凤林：其实人的行为问题导致的习惯性流产占到了70%左右，这些行为比如像卢女士那样首次怀孕后进行了人工流产，就是这样的行为导致了体内产生了抗胚胎抗体，这个抗胚胎抗体进一步破坏了免疫屏障，导致再次妊娠失败。
Dr. Chen: Actually RSA caused by human behavior accounted for about 70 %. These behaviors, such as Mrs. Lu had induced abortion at the first pregnancy. This behavior led to the production of anti-embryo antibodies in the body. This anti-embryo antibody further destroys the immune barrier and leads to failure of another pregnancy.
主持人：来看一段片子
Host: Let’s watch another video
记者;有过自然流产经历的人下次怀孕首先会想到保胎，卢女士就给我们谈起了她的保胎经历。
Interviewer: Those who had had spontaneous miscarriages first thought of prevent miscarriage when they got pregnant next time, and Mrs. Lu told us about her experience of preventing miscarriage.
卢女士：提前给医生打招呼，说我过去有过那段历史，医生也觉得既然这样就提前保胎吧，就给我打了促绒激素，还有吃一些保胎药，比如养血安胎之类的。从一怀孕就开始吃，一直吃到两个半月的时候。
Mrs. Lu: I told the doctor about my medical history in advance, and the doctor thought I should prevent miscarriage beforehand, I was given a dose of HCG and took some medicine of prevent miscarriage, such as
I needed to take it from the beginning of the pregnancy, not until two and a half months.
记者：同样小黄也吃过保胎丸、安胎散之类的保胎药，他们和其他孕妇一样，怀孕一开始就不上班了，他们不敢乱走，也不敢乱动，吃饭喝水有人端，想干什么都有人帮着做。家里人的心都绷得紧紧的，俨然是全家一起保胎。事实上有的人经过这样的保胎确实获得了成功，可是卢女士和小黄最终没有保住，这是为什么呢?
Interviewer: Mrs. Huang also had the same kind of drug, such as prevent miscarriage pill and An Tai San. Like other pregnant women, they did not go to work since the beginning of their pregnancy. They’re afraid of any activities, they were taken care by others. The whole family were nervous about it. In fact, some people did succeed, but Mrs. Lu and Mrs. Huang were not one of them, why?
刘桂霞：这也说明进行保胎以前一定要查明原因，不能够盲目保胎，没有查清原因的盲目保胎最终还是容易导致流产。保胎应该是针对原因进行的保胎。
Liuguixia: It also says that the causes must be diagnosed before preventing miscarriage, aimless prevention can lead to miscarriage easily. Prevent miscarriage should be specific.
陈凤林：现在临床上存在一些误区，特别是一些医务工作者，竟然把流产的现象当作一种疾病来进行治疗，很多情况下都是在没有查清楚原因的情况下进行胞胎，效果当然是不好。
Dr. Chen: There are some errors in clinical practice, especially some medical workers who treat miscarriage as a disease, in many cases, the effect will not be good if the prevention was performed without a clear cause.
主持人：有哪些因为盲目保胎带来的严重的后果?
Host: What are the serious consequences of aimless prevent miscarriage?
陈凤林：这项技术出现已经8年了，从近期的情况看来，经过治疗后怀孕并生产出的胎儿中没有发现大体的畸形，也没有明显的遗传疾病。我们临床发现这项技术的成功率达到了95%以上，其它失败的例子大多都是误诊造成的，也就是说把非免疫性的习惯流产当作了免疫性的习惯流产进行治疗。
Dr. Chen: It's been eight years since this technology was developed, according to recent cases, there were no major malformations have been found in the fetus that were delivered after treatment, and there were no obvious genetic diseases. We clinically discovered the success rate of this technique was more than 95 %, most of the other failures were caused by misdiagnosis, that is, non-immune RSA was treated as immune RSA.
主持人：卢女士也通过这种免疫治疗有了自己的孩子，来看看卢女士的情况：
Host: Mrs. Lu also had her baby through this immunotherapy, Let’s have a look at her condition
卢女士：儿子今年三岁半了，我们给她取名叫喜子，非常活泼可爱。
Mrs. Lu: My son is three and a half years old, we named her xizi, he is very adorable.
主持人：浙江邱女士 33岁 我家几个姐妹都是习惯性流产，每次都在3个月左右，请问这是什么原因?
Host: Mrs. Qiu is 33 years old from Zhejiang, my sisters are diagnosed with RSA, every pregnancy was about 3 months, Why?
刘桂霞：首先要查清习惯性流产的原因，然后给予治疗。
Liuguixia: You have to find out the cause of RSA and then treat it.
陈凤林：家里三个姐妹都有这样的情况可能是遗传引起的，那么我们要求在月经来的时候到医院进行内分泌检测，如果内分泌没有问题，在月经后3-7天我们还要进一步证实宫腔的形态、输卵管状态、输卵管和盆腔的关系，然后进一步确诊是否有解剖因素。如果是遗传因素引起的，不是在内分泌上表现出来就一定会在解剖上表现出来。
Dr. Chen: All three sisters have the same condition maybe genetic,  we require them to have endocrine detection during menstruation, if the endocrine is fine, we also need to confirm the morphology of their uterine cavity, the state of fallopian tube, and the relationship between fallopian tube and pelvic cavity in 3-7 days after menstruation, and then determine if there are any anatomical factors. If it’s caused by genetic factors, it will show on endocrine or anatomical.