Road of Healthy: Recurrent Spontaneous Abortion
Host: Hello everyone, this is CCTV live “Road of Healthy”,today we are going to talk about the immunotherapy of recurrent spontaneous abortion (RSA).
Host: What is recurrent spontaneous abortion (RSA) after all?
Dr. Chen：The medical definition of RSA is when miscarriage occurs in two or more consecutive embryo arrests during the same week of pregnancy.
Host: How should you understand the same week of pregnancy?
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.
Host: What does embryo arrest mean?
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.
Moderator: Let’s watch a short video
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.
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.
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.
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.
Interviewer: This time, Mrs. Lu thinks there should be no problem.
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.
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.
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.
Host: What exactly caused recurrent spontaneous abortion?
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.
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 %
Host: Why does immune factor cause RSA?
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.
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.
Host: What other factors besides immune factors are we familiar with?
Liuguixia: For example, uterine fibroids and uterine malformation in anatomical factor can cause miscarriage.
Host: How to understand miscarriage caused by infection and endocrine factors?
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.
Host: Are there other causes leading to RSA besides physiological factors? Such as human behavior?
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.
Host: Let’s watch another video
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.
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.
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?
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.
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.
Host: What are the serious consequences of aimless prevent miscarriage?
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.
Host: Mrs. Lu also had her baby through this immunotherapy, Let’s have a look at her condition
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?
Liuguixia: You have to find out the cause of RSA and then treat it.
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.