Spontaneous abortion Diagnosis
Diagnosis:
1. Medical history to determine whether menopausal history and the history of recurrent miscarriage.
2. A detailed observation of clinical manifestations of vaginal bleeding and abdominal pain, the vaginal secretions of traits such as body check: whether the appearance of anemia, blood pressure, pulse of the situation. Gynecological check Miyaguchi open or open the mouth and vaginal cervical pregnancy and whether the product discharged from the uterus, uterine size and gestational age in line.
3. B-ultrasound examination in accordance with the availability of intrauterine pregnancy sac, with or without fetal heart rate and fetal movement reflection to determine whether embryonic or fetal survival or whether it may also determine the existence of incomplete abortion and missed abortion. Quantitative β-HCG and other hormones such as the determination of blood progesterone may help determine the prognosis of threatened abortion.
Laboratory examinations:
1. Chromosomal abnormalities primarily on the basis of fetal chromosomes and couples both in peripheral blood karyotype analysis to identify chromosomal abnormalities are embryos, or the father or the mother-derived endogenous chromosomal abnormalities.
2. Endocrine function tests in patients with clinically primarily on the basis of the menstrual cycle, the basal body temperature, a full set of measured sex hormones, endometrial biopsy, and thyroid function and blood sugar testing to know whether there is luteal phase defect or other endocrine diseases. Luteal phase defect is based on laboratory diagnosis: endometrial biopsy showed endometrial development lagged behind the menstrual cycle days 2 days or more.
(1) PR: Determination of luteal phase pregnanediol-24-hour urine, the normal value for the 6 ~ 22μmol/24h urine, less than the lower limit for luteal phase defect luteal phase serum progesterone peak diol 20.7 ~ 102.4nmol / L, low at 16nmol / L for luteal phase defect after pregnancy progesterone levels continue to rise for seven weeks pregnant (76.4 ± 23.7) nmol / L, 8 weeks (89.2 ± 24.6) nmol / L, 9 ~ 12 weeks (18.6 ± 40.6) nmol / L, 13 ~ 16 weeks (142.0 ± 4.0) nmol / L. It is worth pointing out, progesterone and large individual differences measured at different times every day to determine his value variations exist, it can only be measured as a reference. Low levels of progesterone abortion-prone. Have reported that a single index measures the progesterone intrauterine fetal survival prediction sensitivity and specificity were 88% Hahlin and other reports, 83% of spontaneous abortion in patients with lower serum progesterone, progesterone level of less than 31.2nmol / L were prompted embryos died.
(2) HCG: General pregnancy after 8 ~ 9 days in maternal blood can detect HCG, along with the process of pregnancy, HCG gradually increased early pregnancy HCG doubling time of 48 hours around 8 ~ 10 weeks pregnant at peak level. Serum β-HCG value of low or declining, suggesting that abortion may occur. Table 2 Time to pregnancy is the serum β-HCG and ultrasound relationship.
(3) Human placental lactogen (HPL): HPL secretion and is closely related to placental function. 6 ~ 7 weeks of pregnancy when the serum HPL normal for the 0.02mg / L, 8 ~ 9 weeks 0.04mg/LHPL abortion are usually low-level precursor.
(4) cervical mucus: see sheep such as smear dentate crystallization, suggesting a poor prognosis.
(5) vaginal cytology: vaginal smears in the villi syncytiotrophoblast cells see there is abortion the incidence of almost 100%; Therefore, this method can predict the outcome abortion of such cells in the event of early termination of pregnancy are advised. Syncytial cells in the smear on the characteristics are: cell size, basophilic cytoplasm, which contains a different number of deep-staining nuclei, often surrounded by red blood cells and interleukin
(6) Determination of thyroid hormone and blood sugar: hypothyroidism and hyperthyroidism are prone to miscarriage. Radionuclide determination of free T3 and T4 thyroid function during pregnancy contribute to judgments. Normal fasting blood glucose value of 5.9mmol / L, abnormal glucose tolerance test should be further to do, to exclude diabetes.
3. Infection inspection should include Toxoplasma gondii (TOXO) cytomegalovirus (CMV), Chlamydia trachomatis (CT), Human Mycoplasma and Ureaplasma urealyticum (MH, UU), such as inspection.
4. Immunohistochemical examination
(1) auto-immune-type recurrent spontaneous abortion: Patients excluded from the peripheral blood of embryos and couples Karyotype, reproductive tract infections, endocrine and genital anomalies, such as anatomy. Detect positive autoantibodies are often two kinds of cases: ① antiphospholipid antibodies (ACL, LCA) positive; ② anti-nuclear antibody (ANA) and extracted nuclear antigen antibodies (ENA)-positive.
(2) the same kinds of immune-type (unknown causes) of habitual abortion:
① by chromosomes, anatomy and other aspects of endocrine and infectious etiology have not seen any abnormal screening
② various autoantibody negative.
③ the lack of blocking antibodies, micro-lymphocytotoxicity test (LCT)-negative, one-way mixed lymphocyte culture (MLC) + inhibition test showed that growth inhibition was significantly reduced.
Other auxiliary examinations:
B-ultrasound is currently applied more widely, the differential diagnosis of abortion and abortion to determine the actual value of the type. General pregnancy 5 weeks pregnant Temple capsule cavity can see a halo, for round or oval echo-free zone because sometimes in the process of implantation bleeding pregnancy sac can be seen around the circular dark area, this is early pregnancy symptoms Shuanghuan. Pregnant 6 weeks after the embryo can be seen panning, and a heart throb tube. 8 weeks pregnant visible matrix activity and progestin intrauterine sac about half. 9 weeks pregnant fetal outline can be seen. 10 weeks pregnant sac occupying almost the entire 12 weeks of fetal intrauterine pregnancy appear complete the form. Different types of abortion and its ultrasonic image feature has been the difference, can help the differential diagnosis.
1. Threatened abortion Ultrasonographic Characteristics: ① uterine size consistent with the month of pregnancy; ② bleeding from the side of those who see no pregnancy sac enveloping the echo area; ③ uterine bleeding who have many many more hematocele, sometimes with visible fetal membranes cavity separation, after the membrane has echo area; ④ pregnancy can be seen 6 weeks after the heart tube of normal pulsatility.
2. Inevitable abortion sonographic characteristics: ① progesterone capsule deformation or collapse; ② cervix within the mouth opening and see there is embryonic tissue obstruction in the cervical canal, the amniotic sac has not been broken and can see the amniotic sac into the cervical canal or cervical prominent outside the mouth; ③ heart throb many tubes had disappeared.
3. Sonographic characteristics of incomplete abortion: ① the uterus than normal month of pregnancy small; ② intrauterine pregnancy without a complete capsule structure, replaced by irregular light corporation or a small dark zone; ③ heart tube pulsation disappeared.
4. Complete abortion Ultrasonographic Characteristics: ① uterine size of normal or near normal; ② intrauterine emptiness, see the rules there is intrauterine lines, no irregular-ray Mission.