Habitual abortion

　　Habitual abortion is often caused by inherent weakness, insufficient kidney Qi, or internal heat due to Yin deficiency. In addition, it is closely related to postpartum carelessness, irregular sexual life, emotional disorders, or falls and injuries, which can damage the Chong and Ren meridians, cause malnourishment of the fetus, and lead to repeated pregnancy and repeated abortion. The main pathological mechanism is the instability of the Chong and Ren meridians and the loss of sealing of the kidney.

　　Insufficient kidney Qi The kidney is responsible for reproduction and is the root of congenital endowment, closely related to the Chong and Ren meridians and the uterine cavity. The Chong is the sea of blood, and the Ren is responsible for the fetus. Deficiency of kidney Qi leads to instability of the Chong and Ren meridians, the fetus is not solid, and the embryo cannot develop normally, leading to abortion.

　　Both Qi and blood deficiency Due to insufficient Qi and blood, the spleen and stomach are weak after pregnancy, unable to transform Qi into blood, resulting in both Qi and blood deficiency, leading to insufficient Qi to retain the fetus and insufficient blood to nourish the fetus.

　　Yin deficiency and blood heat Due to the inherent excess of Yang, multiple miscarriages, after pregnancy, the heat accumulates in the Chong and Ren meridians, forcing blood to flow recklessly, causing damage to the fetus.

　　Injury from falls Having a history of multiple abortions, and after pregnancy, due to fatigue, falls, or injuries, the fetus is directly damaged, leading to abortion.

　　The causes of habitual abortion

　　1. Genetic factors: Abnormal number or structure of chromosomes in the embryo can lead to poor embryo development. This is the most common cause of abortion, accounting for 60%-70% of spontaneous abortions, and about 2-4% of habitual abortions are related to genetic factors.

　　2. Maternal diseases: Gynecological diseases such as endocrine disorders, abnormal uterine development, unhealthy cervix, cervical relaxation, fibroids, and other diseases can cause habitual abortion. In addition, serious internal diseases such as kidney disease, heart disease, hypothyroidism, and other problems can also lead to abortion.

　　3. External factors: Excessive drinking, smoking (including passive smoking), exposure to chemical toxins, severe noise and vibration, high-temperature environment, and other factors can cause damage to the placenta and fetus, leading to abortion.

　　Habitual abortion is prone to the following complications:

　　1. Easy to cause infection: Multiple abortions can make it easy for bacteria to enter due to excessive dilation, leading to mild cases of endometritis or salpingitis. Even if the embryo implants, it can be damaged due to frequent aspiration and scraping of the endometrium, which can affect the implantation of the placenta and lead to obstacles in the placental blood circulation, causing hypoxia and slow growth, resulting in an increased mortality rate of premature infants and neonates.

　　2. Easy to cause spontaneous abortion: Multiple induced abortions pose a risk of spontaneous abortion. Due to multiple abortions, women's nervous endocrine and reproductive function are greatly affected, especially for primiparas, which can increase the rate of spontaneous abortion in early and middle pregnancy. It also increases the incidence of ectopic pregnancy, placenta previa, and postpartum hemorrhage.

　　3. Easy to damage the endometrium: Multiple induced abortions can easily damage the endometrium, as the basal layer of the endometrium is most easily damaged during aspiration and scraping, and many cases of uterine perforation are also caused by this. After the normal tissue between the endometrium and the functional layer basal layer tissue is destroyed, the endometrium is easily grown into the basal or muscular layer tissue, causing adenomyosis or adenomyoma of the uterus, leading to symptoms such as excessive menstrual bleeding, infertility, and abdominal pain.

　　The clinical manifestations of habitual abortion are the same as those of general abortion, which also involves threatened abortion.

　　The stages of habitual abortion include childbirth, inevitable abortion, incomplete or complete abortion. In the early stage, it may only manifest as slight vaginal bleeding or mild lower abdominal pain, with bleeding lasting for several days or several weeks and less blood. Once the vaginal bleeding increases, abdominal pain worsens, and the cervix is found to be dilated, even with the fetal sac blocking the cervix, abortion has become inevitable. If all pregnancy products are excreted, it is called complete abortion; if only part of the pregnancy products are excreted and some remain in the uterine cavity, it is called incomplete abortion, and immediate uterine evacuation is required.

　　According to the time of occurrence of habitual abortion, it can be divided into early habitual abortion and late abortion. Early habitual abortion refers to abortion occurring before 12 weeks of pregnancy, which is generally related to genetic factors, maternal endocrine disorders, and immunological factors; late habitual abortion generally refers to abortion occurring after 12 weeks of pregnancy, which is often related to uterine malformation, poor cervix development, blood type incompatibility, and maternal diseases.

　　Early symptoms

　　1. Slight vaginal bleeding: The early symptoms of habitual abortion in women are similar to those of general abortion, with vaginal bleeding that may last for several days or several weeks, but the amount of blood is generally less. If women experience an increase in blood volume, it indicates that they will have an abortion and it cannot be avoided.

　　2. Lower abdominal pain: Women with habitual abortion will have a sense of dull pain in the lower abdomen, usually accompanied by slight bleeding from the vagina. If women experience both the dull pain in the lower abdomen and vaginal bleeding, then it needs to be paid attention to.

　　3. Exclusion of pregnancy products: When women excrete part of the pregnancy products inside the uterus, this condition where there is some residue inside the uterus is called incomplete abortion; if the pregnancy products inside the uterus are completely excreted out of the female body, it is called a complete abortion phenomenon. When women experience this situation, they should go to the hospital in a timely manner for corresponding uterine evacuation to avoid infection caused by pregnancy products inside the body.

　　Late symptoms

　　Increased vaginal bleeding, severe abdominal pain: at this time, the cervix can be found to be dilated, or the fetal sac can be seen to form a blockage at the cervix opening, then habitual abortion has inevitably occurred.

　　The measures for preventing habitual abortion are as follows: six points:

　　1. Regular Life: Living in harmony is the priority, neither too indulgent (such as oversleeping) nor too exhausted (such as carrying heavy objects or climbing dangerous heights). Indulgence leads to Qi stagnation, causing difficult labor; exhaustion leads to Qi depletion, causing fetal injury or miscarriage. Therefore, pregnant women must develop good living habits, have regular rest and sleep, and try to ensure at least 8 hours of sleep per day, and appropriate exercise.

　　2. Rational Diet: Pregnant women should pay attention to eating foods rich in various vitamins and trace elements, and easy to digest, such as various vegetables, fruits, beans, eggs, meats, etc. People with gastrointestinal cold should be cautious when consuming foods with cold properties, such as mung beans, silver ear, lotus seeds, etc.; those with yin deficiency and fire hyperactivity should be cautious when consuming foods such as roosters, beef, dog meat, and carp that are easy to cause internal heat.

　　3. Pay attention to personal hygiene: Pregnant women should bathe and change their underwear frequently, but should avoid taking a bath in a bathtub or swimming. When bathing, be careful not to catch a cold. Pay special attention to the cleanliness of the genital area, and wash the external genitalia with clean warm water every night to prevent bacterial infections.

　　4. Maintain a cheerful mood: Studies suggest that some spontaneous abortions are caused by central nervous system excitement in pregnant women. Therefore, pregnant women should pay attention to regulating their emotions, try to maintain a cheerful mood, avoid various adverse stimuli, eliminate tension, irritability, fear, and especially avoid extreme joy, sadness, anger, and worry, as these can be very detrimental to the growth and development of the fetus.

　　5. Regular prenatal check-ups: Pregnant women should start regular prenatal check-ups during the second trimester to detect and handle any abnormalities during pregnancy in a timely manner, ensuring the healthy development of the fetus.

　　6. Caution with sexual activity: Pregnant women with a history of spontaneous abortion should avoid sexual activity during the first three months and after the seventh month of pregnancy. Habitual aborters should strictly avoid sexual activity during this period.

　　The following laboratory tests need to be done for habitual abortion:

　　1、Examination for internal reproductive organ malformations

　　(1) Hysterosalpingography (HSG): Hysterosalpingography is a sensitive and specific method for diagnosing uterine malformations. Based on whether there are abnormalities or defects in the uterine cavity, it can be determined whether there is a uterine malformation. If the diameter of the cervical os shown by the contrast is greater than 6 millimeters, it can help diagnose incomplete cervical function.

　　(2) Ultrasound examination: Ultrasound is not as effective in diagnosing uterine abnormalities as hysterosalpingography, but it is of great significance in diagnosing external uterine morphological abnormalities. For example, when combined with hysterosalpingography, ultrasound examination can help differentiate between septate uterus and bicornuate uterus; ultrasonic examination can clearly determine the number, size, and location of uterine fibroids.

　　(3) Magnetic resonance imaging: Although expensive, it plays a significant role in judging malformations of internal reproductive organs.

　　(4) Laparoscopy and hysteroscopy: Both can directly observe the external morphology of the uterus and the condition inside the uterine cavity, enabling the clear identification of uterine malformations and their types. Hysteroscopy can also diagnose uterine adhesions and can perform some degree of treatment. Laparoscopy can also diagnose and treat pelvic lesions, such as pelvic adhesions and endometriosis.

　　(5) Cervical dilator examination: The ease with which an 8-number cervical dilator can be inserted into the cervical os suggests incomplete cervical function.

　　2、Examination for pathogen infection

      Urine and cervical mucus cultures are used to determine the presence of microbial infections. Pathogen infections are also a cause of recurrent abortions, and cultures of cervical secretions for mycoplasma, chlamydia, beta-hemolytic streptococcus, and other pathogens should be performed. Generally, the significance of TORCH testing (immunological testing for toxoplasmosis, rubella virus, cytomegalovirus, and herpes virus) and other pathogen antibody determinations is not significant unless there is a history of chronic infection. Pathological examination of the products of conception after abortion should be performed.

　　Women with a history of habitual abortion should avoid spicy, strong-flavored foods during normal life and pregnancy (such as dried ginger, scallions, garlic, chili peppers, alcohol, etc.);

　　It is not advisable to consume excessive amounts of fried, roasted, or spicy foods with strong heat properties;

　　35. Try not to eat or eat less greasy food.

　　34. It is advisable to eat light dishes such as steamed fish, chicken soup, beef bone soup, steamed eggs, meat cake soup; eat more vegetables and fruits. Main food can be eaten as rice (porridge), noodles, steamed buns, mantou, mantou, and try to make them varied and diverse. Participate in moderate physical exercise before pregnancy to enhance physical fitness;

　　33. After pregnancy, avoid overwork, do not twist the waist too much, and avoid impact on the lower abdomen. It is best to avoid sexual intercourse in the first 3 months of pregnancy and in the month when it is easy to have a miscarriage. During pregnancy, keep the bowels smooth and avoid enema. Living habits should be regular, not staying up late, and ensuring adequate sleep. It is best to wait a year after a miscarriage before getting pregnant again.

　　In addition, psychological factors are one of the important causes of abortion. Therefore, it is necessary to maintain a good mental state and be cheerful.

　　29. Habitual abortion refers to spontaneous abortion of 3 times or more. After habitual abortion occurs, both husband and wife should go to a regular hospital or family planning service center for examination, find out the cause of abortion, and treat it accordingly. Treatment methods include:

　　28. Women with uterine malformations should undergo surgical correction.

　　27. For women with uterine cavity adhesions, taking traditional Chinese medicine to promote blood circulation and remove blood stasis can achieve the purpose of loosening adhesions.

　　26. For women with incomplete corpus luteum function, progesterone supplementation can be given. If there is a possibility of pregnancy, starting from the 3rd to 4th day after the basal body temperature rises, progesterone 10-20mg/d should be given, and the treatment should be continued until the 9th to 10th week of pregnancy after confirmation of pregnancy.

　　25. For women with chromosomal abnormalities, if they become pregnant again, they must undergo prenatal examination. Through amniocentesis and karyotype analysis of amniotic fluid cells, it can be understood whether the fetus has congenital malformations. Once abnormalities are found, pregnancy should be terminated in a timely manner.

　　24. For women with positive bacterial cultures in vaginal discharge and seminal fluid, appropriate treatment should be given based on drug sensitivity tests until complete recovery. Condoms should be used for contraception during treatment.

　　23. For women with small uterine fibroids, medication can be taken; if the fibroids are large and solitary, surgery can be used to remove them.

　　22. For women with relaxed cervical os, cervical os suture can be performed between 12-20 weeks of pregnancy based on the time of past miscarriage. If there is vaginal inflammation before the operation, it must be cured before surgery. After the operation, progesterone, traditional Chinese medicine, and sedatives should be used to ensure the pregnancy, and regular follow-up should be carried out.