Abortion

　　Abortion is a very common phenomenon, and there are many causes of abortion, mainly the following aspects.

　　Genetic Gene Defect

　　During early spontaneous abortion, about 50%-60% of the embryos have chromosomal abnormalities, mainly due to abnormalities in the number of chromosomes, followed by structural abnormalities. The number abnormalities include trisomy, triploidy, and X monosomy; the structural abnormalities include chromosomal breakage, inversion, deletion, and translocation. The majority of embryos with chromosomal abnormalities end in abortion, with a very few continuing to develop into a fetus, but they may also have certain functional abnormalities or associated malformations after birth. If abortion has occurred, the products of conception may sometimes be only an empty gestational sac or a degenerated embryo.

　　Environmental Factors

　　Many external adverse factors can affect reproductive function, which can directly or indirectly harm the embryo or fetus. Excessive exposure to certain harmful chemicals such as arsenic, lead, benzene, formaldehyde, chloroprene, ethylene oxide, and physical factors such as radiation, noise, and high temperatures can all cause abortion.

　　3. Maternal factors

　　1. Systemic diseases: Acute illness and high fever during pregnancy can cause uterine contractions and lead to abortion; bacterial toxins or viruses such as herpes simplex virus, cytomegalovirus, etc., can enter the fetal blood circulation through the placenta, causing fetal death and resulting in abortion. In addition, pregnant women with severe anemia or heart failure can cause fetal hypoxia, which may also lead to abortion. Pregnant women with chronic nephritis or hypertension may experience placental infarction, leading to abortion.

　　2. Genital organ diseases: Pregnant women with uterine malformations such as bicornuate uterus, septate uterus, and underdeveloped uterus, pelvic tumors such as uterine fibroids, and other factors can affect the growth and development of the fetus and lead to abortion. Relaxation of the internal os of the cervix or severe cervical laceration is prone to cause late abortion due to premature rupture of membranes.

　　3. Endocrine disorders: Hypothyroidism, uncontrolled severe diabetes, and insufficient corpus luteum function can all lead to abortion.

　　4. Trauma: During pregnancy, especially in the early stages, abdominal surgery or trauma in the second trimester can lead to uterine contractions and cause abortion.

　　5. Deficiency of placental endocrine function: In the early stages of pregnancy, in addition to the corpus luteum of the ovary secreting progesterone, the trophoblasts of the placenta also gradually produce progesterone. After 8 weeks of pregnancy, the placenta gradually becomes the main site for the production of progesterone. In addition to progesterone, the placenta also synthesizes other hormones such as beta-human chorionic gonadotropin, placental lactogen, and estrogens. In the early stages of pregnancy, the levels of these hormones decrease, making it difficult to continue the pregnancy and leading to abortion.

　　6. Immunological factors: Pregnancy is like a same species allograft, with a complex and special immunological relationship between the embryo and the mother, which prevents the embryo from being rejected. If there is an immunological incompatibility between the mother and the fetus, it can lead to the mother's rejection of the fetus, resulting in abortion. The main immunological factors include the father's histocompatibility antigens, fetal-specific antigens, blood group antigens, maternal cell-mediated immune regulation disorders, insufficient maternal封闭antibodies, and insufficient maternal cytotoxic antibodies against paternal lymphocytes.

　　The main complications of abortion are severe hemorrhage and infection.
　　1. Severe hemorrhage
　　Sometimes inevitable abortion or incomplete abortion can cause severe hemorrhage, even shock, so it should be actively treated.
　　2. Infection
　　All types of abortion can be complicated by infection, which occurs more frequently in incomplete abortions. Infection often occurs when instruments that have not been strictly sterilized are used for abortion procedures, causing damage to the cervix, or when there is an existing infection focus in the uterine cavity. Abortion procedures or the postpartum period can lead to the spread of infection. In addition, not paying attention to hygiene after abortion (whether spontaneous or induced) and early sexual intercourse can all lead to infection. The infectious pathogens are often a variety of bacteria. In recent years, various reports have shown that anaerobic bacteria account for the majority, up to 60-80%. Infection can be limited to the uterine cavity, or it can spread to the surrounding uterus, forming salpingitis, salpingo-ovarian inflammation, pelvic adhesion tissue inflammation, or even beyond the reproductive organs to form peritonitis, sepsis.

　　The clinical characteristics of abortion mainly include the following aspects.
　　1. Medical history：常有停经史和早孕反应。
　　There is often a history of amenorrhea and early pregnancy reactions.2. Vaginal bleeding
　　Threatened abortion and complete abortion have less vaginal bleeding, incomplete abortion and inevitable abortion have more vaginal bleeding.3. Abdominal pain
　　Threatened abortion has no pain or mild pain, inevitable abortion has increased pain, incomplete abortion has decreased pain, and complete abortion has decreased pain.

　　How to prevent abortion
　　To prevent and avoid abortion, the following points should be noted:
　　1. Acute infectious diseases should wait for a period of time after recovery before pregnancy; chronic disease patients should be treated until the condition is stable and approved by a specialist doctor before pregnancy.
　　2. For couples with a history of abortion, they should go to the hospital in a timely manner to check the cause of the abortion. Whether there is a problem with either partner, timely treatment should be sought, and then have a child after recovery.
　　3. For women who are already pregnant, they should avoid contact with harmful chemical substances such as benzene, mercury, and radiation. In the early stages of pregnancy, they should avoid going to public places to prevent viral and bacterial infections. If the pregnant woman is sick, she should take medication under the guidance of a doctor and should not take medication arbitrarily.

　　Abortion can be diagnosed based on medical history and clinical manifestations, and only a few require auxiliary examinations.

　　1. Medical history; Ask the patient about the history of amenorrhea and recurrent abortion, whether there are early pregnancy reactions and vaginal bleeding. Ask about the amount and duration of vaginal bleeding, whether there is abdominal pain, the location, nature, and severity of abdominal pain, and whether there is vaginal discharge. The color, amount, and odor of vaginal discharge, and whether there is any product of pregnancy discharged should also be understood.

　　2. Physical examinationObserve the patient's general condition, whether there is anemia, and measure body temperature, blood pressure, and pulse, etc. Under sterile conditions, perform gynecological examination, pay attention to whether the cervix is dilated, whether the amniotic sac is prolapsed, whether there is any product blocking the cervix; whether the size of the uterus is consistent with the number of weeks of amenorrhea, and whether there is tenderness. Check for lumps, thickening, and tenderness in both adnexa. The operation should be gentle, especially for those suspected of threatened abortion.

　　3. Auxiliary examinationFor those with difficult diagnosis, necessary auxiliary examinations can be adopted.

　　1. B-ultrasound imagingUltrasound is currently widely used, having practical value in differential diagnosis and determining the type of abortion. For those suspected of threatened abortion, the viability of the embryo or fetus can be determined based on the morphology of the gestational sac, the presence or absence of fetal heart reflex and movement, to guide the correct treatment method. Incomplete abortion and missed abortion can all be determined with the help of B-ultrasound examination.

　　2. Pregnancy testThe clinical use of paper strip tests in recent years is significant for diagnosing pregnancy. To further understand the prognosis of abortion, radioimmunoassay or enzyme-linked immunosorbent assay is often used for quantitative determination of HCG.

　　3. Determination of other hormonesThe determination of blood progesterone, other hormones, can assist in judging the prognosis of threatened abortion.

　　Abortion is an experience that no woman wants to go through, however, many women have had at least one abortion experience during their childbearing years. After abortion, attention should be paid to the following points in diet:
　　1、Within half a month after abortion, a large amount of protein intake is needed. It is advisable to eat more chicken, lean pork, eggs, milk, beans, and bean products, etc.
　　2、Due to the weakness of the patient's body, they often sweat easily, so it is advisable to replenish water in small amounts and in multiple doses. More water-soluble vitamins are excreted in sweat, especially vitamin C, vitamin B1, vitamin B2, etc., so it is advisable to eat more fresh vegetables and fruits.
　　3、On the basis of normal diet, appropriately limit fat. Avoid spicy foods such as chili, alcohol, vinegar, ginger, and also avoid cold foods such as crabs,螺蛳, etc.

　　Traditional Chinese medicine believes that threatened abortion is often due to Qi and blood deficiency, kidney Qi damage, fetus not solid, leading to Qi and blood imbalance, Chong and Ren not solid, affecting embryo implantation and development, resulting in abortion. Traditional Chinese medicine mainly divides the following types in the treatment of abortion.

　　1、Qi and Blood Deficiency：In the early stage of pregnancy, vaginal bleeding, lumbago and abdominal distension, or in the middle stage of pregnancy, unstable fetus movement, vaginal bleeding, fatigue, pale tongue, slippery and weak pulse.

　　Therapeutic Method：Nourish Qi and blood to calm the fetus.

　　Prescription：Taishan Stone Drink with modification.

　　Composition：Codonopsis 10g, Atractylodes 10g, Astragalus 10g, White Peony 10g, Scutellaria 10g, Dipsacus 10g, Citrus peel 6g, Rehmannia 10g, Amomum 10g.

　　2、Kidney Deficiency：Patients have lumbago, leg weakness or a history of miscarriage. Unstable fetus movement during pregnancy, severe lumbago and abdominal pain, fetus descending with blood, frequent urination, deep and weak pulse, pale red tongue, thin fur.

　　Therapeutic Method：Tonify the kidney and calm the fetus.

　　Prescription：Shoutai Pill with modification.

　　Composition：Cuscuta 30g, Taxillus 10g, Dipsacus 10g, Eucommia 10g, Rehmannia 10g, Euisodiasis 10g (to be taken with water), Prepared Liquorice 3g.

　　3、Blood Heat：Unstable fetus movement,坠下，leakage of bright red blood, dry mouth, irritability, fever in the palm of the hand, jaundice of urine, red tongue, thin yellow fur, slippery and rapid pulse.

　　Therapeutic Method：Clear Heat and Calm the Fetus.

　　Prescription：Rehmannia 10g, Anemarrhena 10g, Scutellaria 10g, Dipsacus 10g, Dioscorea 10g, Herba Ecliptae 10g.