Are there any symptoms of false fetal arrest?

When you think of immune diseases, what comes to mind? Rheumatoid arthritis? allergy? asthma? It\’s actually much more than that. Many immune diseases do not have very obvious symptoms and are easily ignored in life. But when you are preparing to conceive and have a baby, they scurry out of the shadows like poisonous snakes, causing fetal arrest, chemical pregnancy, and miscarriage again and again. The Reproductive Medicine Space previously invited Director Ge Guiping, the leader of the Department of Reproductive Immunology of Peanut Medical Beijing Fengtai Branch and a senior expert on fetal protection, to conduct a live broadcast to delve into the impact of immune factors on fetal termination. Today, Doudehui sorted out the live broadcast content for the convenience of sisters to review. Many patients are confused: Why do biochemical and fetal arrest occur after I am pregnant? Why doesn’t implantation occur every time I undergo in vitro fertilization? Even if implantation occurs, fetal arrest will occur within 6-8 weeks? What is the reason for this? These are not necessarily survival of the fittest; they may be single factors or multiple factors. The 2022 version of the Chinese expert consensus on the diagnosis and treatment of recurrent miscarriage states that embryo loss (including consecutive biochemical pregnancies) occurring two or more times in a row with the same partner before 28 weeks of gestation is called recurrent miscarriage. Epidemiological surveys show that age and number of previous miscarriages are the main risk factors for recurrent miscarriage. And as the number of miscarriages increases, the recurrence rate will become higher and higher. But if HCG doubling is not good, or there is a possibility of biochemical or fetal arrest, most patients first consider the endocrine cause, whether it is insufficient progesterone. At this time, doctors give progesterone supplements, dydrogesterone, or HCG injections, but they often have no effect, and fetal arrest or miscarriage may still occur. This is actually because the real cause has not been found. 01How does immunity lead to fetal arrest and miscarriage? First of all, we need to know that there are many causes of miscarriage, including endocrine, chromosomal or genetic abnormalities, anatomical abnormalities, infectious factors, immune factors, unknown causes, prothrombotic states (thrombophilia), environment, psychology, severe male partner Low sperm count, asthenozoospermia, teratozoospermia or a high rate of sperm fragmentation can lead to repeated pregnancy loss. The most important one is immune factor, which accounts for 50% to 60%, which is the highest proportion. More than 60% of unexplained infertility is also related to immune factors. There are many patients who experience repeated pregnancy loss, and the doctor will ask them to go to the rheumatology and immunology department for examination. The patient was very confused: Why is my pregnancy related to immunity? Subconsciously, I feel that repeated pregnancy loss may be related to endocrine, but I ignore immune factors. The embryo is a semi-homogeneous foreign object. After entering the mother\’s body, the mother\’s body must establish immune tolerance before it can accommodate the embryo. If the mother\’s immunity is abnormally active, it will judge the embryo as a foreign object that may cause harm to the mother and reject it as a virus or bacteria. This can easily lead to fetal arrest or miscarriage. 02If immune factors are suspected, what tests should be done? 01 Antinuclear Antibodies In fact, there are many antibodies related to immune diseases. However, some patients do not show immune-related symptoms, but are positive for antibodies. This is an undifferentiated connective tissue disease and has not yet developed rheumatism. ANAAbnormal levels may also affect the maternal coagulation function, causing changes in the blood rheology at the maternal-fetal interface, causing the formation of microthrombi in the blood vessels of the placenta, leading to placental tissue infarction, and fetal death due to ischemia and hypoxia. Once the embryo dies in the body, more antibodies are produced, which are first produced in the blood and then begin to accumulate in the lymphatic system and lymph nodes, making the next pregnancy more difficult. If the number of fetal arrests increases, these antibodies may even remain in the uterus in large amounts, interfering with the next pregnancy. Antibodies can activate the mother\’s body to produce an inflammatory response, resulting in a decrease in the receptivity of the endometrium to the embryo, ultimately leading to miscarriage. Abnormal ANA levels may also affect the maternal coagulation function, change the blood rheology at the maternal-fetal interface, and cause the formation of microthrombi in the blood vessels of the placenta, leading to placental tissue infarction and fetal death due to ischemia and hypoxia. As the number of miscarriages increases, the positive rate of antinuclear antibodies will gradually increase. 02 Lack of 25-hydroxyvitamin D. Vitamin D can not only promote the absorption of calcium and phosphorus, but also regulate immunity. 25- (OH) VD3 can decidualize the endometrium, which will play a key role in embryo implantation; it can promote the release of Th 2, a cytokine that controls embryo implantation, and prevent rejection of implanted embryos; it can inhibit the placenta Apoptosis of trophoblast cells improves adverse pregnancy outcomes. 03 Antiphospholipid syndrome is the main cause of recurrent miscarriage among immune diseases. It is mainly characterized by the presence of antiphospholipid antibodies in the blood circulation that can cause adverse consequences such as thrombosis or pathological pregnancy. It is a systemic autoimmune disease. . Antiphospholipid antibodies can easily damage the endothelial cells of blood vessels and cause microthrombi in the placenta; they can also damage trophoblast cells and cause trophoblast apoptosis; they can also activate complement, causing immune inflammation, which ultimately leads to fetal termination. To clinically diagnose antiphospholipid syndrome, first check three typical antibodies: anticardiolipin antibodies, anti-β2 glycoprotein antibodies, and lupus anticoagulant. If one antibody is positive, the diagnosis can be directly confirmed. If all three antibodies are negative, check the atypical antiphospholipid antibody profile and find a total of 11 antibodies: If any one of these 11 antibodies is positive, combined with the clinical symptoms, atypical antiphospholipid syndrome can be diagnosed. Without intervention during pregnancy, the live birth rate of patients with antiphospholipid syndrome is only 10%. With appropriate medication, the live birth rate can reach 50% to 70%. Active diagnosis and appropriate medication can lead to better pregnancy outcomes. 04 Thyroid antibodies Thyroid antibodies are one of the markers of autoimmune abnormalities, including anti-thyroid peroxidase antibodies and thyroglobulin antibodies. These two antibodies are also autoimmune diseases. If the antibodies are increased, they can lead to thyroid immunological damage. Causes thyroid deficiency and increases the demand for thyroid hormones in pregnant women, which can lead to adverse pregnancy, affect HCG, or directly damage placental tissue. Many patients will ignore thyroid antibodies when checking their thyroid function during pregnancy preparation. The 5 items of routine thyroid function do not include thyroid antibody test, but only the 7 items of thyroid function are included. Pay extra attention to this when inspecting. 05 Serum cytokines include interleukins, interferons, tumor necrosis factor superfamily, etc. can cause uterine smooth muscleContraction, causing the embryonic tissue to be rejected; it can cause the activation of thromboplastin, leading to the formation of placental thrombus; it can inhibit the function of the corpus luteum, causing the destruction or inhibition of uterine decidual cells and villous trophoblast cells; it can promote the apoptosis of trophoblast cells. Leading to embryonic arrest; in serum cytokine examination, tumor necrosis factor is mainly seen, which can cause tissue damage and chronic inflammation. 05 Immunoglobulin and complement immunoglobulins are produced by B lymphocytes responsible for humoral immunity. Hyperimmunoglobulinemia indicates an active humoral immune response, and low complement is related to disease activity. 07 The six items of reproductive immunity include anti-sperm antibodies, anti-endometrial antibodies, anti-trophoblast antibodies, anti-HCG antibodies, and anti-ovarian antibodies. These antibodies can cause infertility, embryonic infertility, or biochemical miscarriage. 08 Blocking antibody Blocking antibody is an antibody that protects the embryo. Under normal conditions, the blocking antibody is positive. If it is negative, it will block the immune recognition and immune response between mother and child, which is also an alloimmune abnormality. 09 Anti-A and anti-B titer If the woman has blood type O and the man has blood type A, B, or AB, you need to check the anti-A and anti-B titer. If the titer increases, it may easily cause hemolysis of the newborn. 10 Lymphocyte subsets and NK cell toxicity If the proportion of NK cells in peripheral blood increases, the risk of pregnancy failure will increase. A type of NK subgroup cells in the blood that are harmful to the embryo mainly accumulate around implantation and enter the placental tissue, which can hinder cell mitosis and embryo implantation, eventually leading to recurrent miscarriage, repeated implantation failure, and threatened abortion. If NK cell toxicity increases, adverse pregnancy outcomes will also occur. CCTV recommended over 500 high-scoring excellent documentaries. The child watched the pattern and became addicted to self-discipline. 11 HLA Compatibility During a normal pregnancy, the paternal HLA carried by the embryo can stimulate the maternal immunity to produce specific IgG antibodies against the spouse\’s lymphocytes to protect the embryo. , to protect the embryo from rejection. If the HLA of both spouses is similar at multiple sites, the embryo cannot stimulate the mother to produce the blocking antibodies needed to maintain pregnancy, and the maternal immune system is prone to immunological attacks on the fetus, treating the fetus as a foreign body and rejecting it, resulting in miscarriage or embryonic termination. For patients who continuously experience fetal arrest, biochemistry, miscarriage, or test-tube transplant failure, it is not necessarily the survival of the fittest, but may be caused by multiple factors. Through cause screening and conditioning medication, the clinical pregnancy rate can be greatly improved and the miscarriage rate can be reduced. When encountering fetal stoppage, miscarriage, or repeated pregnancy loss, sisters must cheer up and find an experienced immune-pregnancy doctor who is truly suitable for you. Timely screening and active treatment will achieve ideal results. Good luck with your pregnancy!