1, genetic examination
(1) For those who are suspected of hereditary diseases, both husband and wife should have chromosome karyotype examination, or further family genetic investigation and pedigree drawing.
(2) Family analysis: Through family investigation, analyze the influence of hereditary diseases on future pregnancy.
(3) Karyotype analysis: At the same time, detect the chromosomes of peripheral blood lymphocytes of both husband and wife, observe whether there are quantitative and structural aberrations and types of aberrations, and infer their recurrence probability.
(4) Molecular genetic diagnosis: At present, some genetic diseases can be diagnosed by molecular genetic examination.
2. Endocrine diagnosis
(1) basal body temperature measurement (BBT): basal body temperature can reflect the functional status of ovary and can be used to screen luteal insufficiency. Because luteal insufficiency can cause habitual abortion, the basal body temperature of patients with luteal insufficiency is as follows: the high temperature period is less than 1 1 day; The temperature rise in the high temperature stage is less than 0.3 degrees.
(2) Endometrial biopsy: The menstrual cycle varies greatly among individuals, mainly the follicular phase, while the luteal phase is basically the same as the endometrial changes. Endometrial biopsy at the end of luteal phase can diagnose luteal insufficiency if the maturity of endometrium is backward. In addition to routine histological examination, endometrial biopsy is best to simultaneously determine estrogen receptors. The content of estrogen and progesterone receptors in endometrium is low. Even if the luteal function is normal and progesterone is sufficient, the maturity of endometrium still lags behind the normal level, which is pseudoluteal insufficiency.
(3) Hormone determination, including quantitative detection of estrogen, progesterone and chorionic gonadotropin. Determination of serum progesterone: Progesterone in peripheral blood of menstrual cycle mainly comes from menstrual corpus luteum formed after ovulation, and its content gradually increases with the development of corpus luteum, reaching a peak when corpus luteum matures, that is, in the middle of corpus luteum, and then decreasing continuously, reaching the lowest level in premenstrual period. The change of progesterone content in peripheral blood in luteal phase is parabolic. When the corpus luteum is not functional, the secretion of progesterone decreases, so the determination of progesterone level in peripheral blood can reflect the functional state of corpus luteum. The serum progesterone level is greater than 3 micrograms per milliliter (3ng/ml), indicating that the ovary has ovulated, and the progesterone level in the middle luteal phase is greater than 15 micrograms per milliliter (15ng/ml), indicating that the luteal function is normal, and less than this is luteal insufficiency.
(4) Determination of serum prolactin (PRL): Serum prolactin is secreted by the anterior pituitary gland, and its main function is to promote postpartum milk secretion. At the same time, serum prolactin also plays an important role in maintaining normal luteal function. Too low or too high will lead to luteal insufficiency. Hyperprolactinemia with excessive serum prolactin secretion is common in clinic. The normal value of serum prolactin in serum is 4 ~ 20 micrograms per milliliter, and it rises when it is greater than 20 micrograms. The slight increase of serum prolactin is closely related to repeated abortion. Excessive serum prolactin will seriously interfere with the function of gonadal axis, leading to anovulation and infertility.
3. Immunological examination
(1) First, mixed lymphocyte culture reaction and lymphocyte toxic antibody determination were used to distinguish primary and secondary abortion. Most of the first abortions occur within 20 weeks of pregnancy. Husbands and wives have more human leukocyte antigens (HLA) than their normal spouses. The wife has no spouse immunity and shows a weak mixed lymphocyte culture reaction to her husband. Serum does not contain mixed lymphocyte culture blocking factors, so leukocyte therapy is effective. There is no human leukocyte antigen (HLA) between the spouses in the second abortion, and the wife has complement-dependent or complement-independent anti-spouse lymphotoxic cells, showing polyclonal antibodies against a group of cells. Heparin treatment is effective. The woman cultured the man's monophasic mixed lymphocytes and compared them with the antigens of unrelated third parties. If the woman shows a weak or lack of mixed lymphocyte reaction to her husband, it means that there is no anti-paternal antibody in her blood and she has the same human leukocyte antigen as her husband.
(2) Determination of anti-sperm antibody: If anti-sperm antibody is positive, it indicates low fertility. Anti-sperm antibody has a high titer, and there are anti-sperm antibodies in cervical mucus, which has a great influence on fertility. Sperm agglutination test can be used to detect sperm agglutination antibody, sperm fixation test can be used to detect sperm fixed antibody, and immune bead test can be used to detect sperm binding antibody.
(3) Determination of antiphospholipid antibody (APA): To detect antiphospholipid antibody in patients with suspected autoimmune diseases, we can directly determine antiphospholipid antibody and its titer in female serum by enzyme-linked immunosorbent assay.
(4) Determination of natural killer cell activity: The high activity of natural killer cells before pregnancy indicates the possibility of miscarriage in the next pregnancy.
(5) Determination of maternal anti-paternal lymphotoxic antibody: The lymphocytes of both husband and wife are incubated with complement * * *, and then the percentage of dead cells is counted. If the dead cells are above 90%, it is a normal pregnancy, and below 20%, there will be repeated abortions.
(6) Determination of blood type and blood group antibody: If the husband's blood type is A or B or AB, and the wife is O type and has a history of abortion, it should be further checked whether the husband belongs to O type when she is pregnant again, and O type will not cause ABO blood group incompatibility. On the other hand, if the husband is type A, B or AB, we should consider testing whether the wife has anti-A, anti-B or anti-AB antibodies, and do a good job of monitoring during pregnancy to prevent miscarriage and stillbirth.
There are more than forty reasons for habitual abortion or abortion, and the diagnosis and treatment is the specialty of Antai Hospital. It takes a day to find the cause, and anti-embryonic antibody+four-dimensional color Doppler ultrasound+electrochemiluminescence endocrine+dynamic digital hysterosalpingography should be done. About 3 thousand, after diagnosis and treatment, if it is genetic vaccine immunotherapy and cervical cerclage, it will be 30 thousand, and the treatment will be refunded in full; Other reasons range from 10 thousand to 30 thousand, and there are international patents!
4. Examination of internal genital malformation
(1) Hysterosalpingography (HSG): Hysterosalpingography is a sensitive and specific method to diagnose uterine malformation, which can be judged according to whether there is abnormality or filling defect in the uterine cavity. If radiography shows that the diameter of cervical internal orifice is greater than 6 mm, it is helpful to diagnose cervical incompetence.
(2) Ultrasonography: Ultrasonography is not as good as hysterosalpingography in the diagnosis of uterine cavity abnormalities, but it is of great significance in the diagnosis of uterine external morphological abnormalities. For example, ultrasound combined with hysterosalpingography is helpful for the differential diagnosis of mediastinal uterus and bicornuate uterus; Ultrasound examination can determine the number, size and location of uterine fibroids.
(3) Magnetic resonance imaging: Although the cost is high, it plays a great role in judging internal genital malformation.
(4) Laparoscopy and hysteroscopy: Both of them can directly observe the external morphology and intrauterine conditions of the uterus, and can identify uterine malformations and their types. Hysteroscopy can also diagnose intrauterine adhesions and treat them to some extent. Laparoscopy can also diagnose and treat pelvic diseases, such as pelvic adhesion and endometriosis.
(5) Examination of cervical dilator: When it is not difficult to insert the No.8 cervical dilator into the internal cervix, it indicates cervical incompetence.
5, pathogen infection Check urine, cervical mucus culture to see if there is microbial infection. Pathogen infection is also the cause of repeated abortion, so it is necessary to cultivate mycoplasma, chlamydia and β -hemolytic streptococcus in cervical secretions. Generally speaking, TORCH detection (toxoplasmosis, rubella virus, cytomegalovirus, herpes virus immune detection) and other pathogenic microorganism antibody detection is of little significance unless the medical history suggests chronic infection. Pregnancy after abortion should be examined pathologically.