| Chapter One: Analysis of the Etiology of Early Recurrent Spontaneous AbortionObjective To investigate the etiology and distribution of RSA,and to provide a theoretical basis for clinical diagnoses of etiology of RSA as well as its treatment.Method Detailed information was collected and analyzed from 406 early RSA patients who attended the Reproductive Center of the First Affiliated Hospital of Anhui Medical University from March,2015 to September 2016.The information included age,week of pregnancy,number of miscarriages,profession,family history,and medical examinations.By analyzing the collected information,the distribution of age and number of miscarriages were analyzed,and the percentage of each cause of RSA was calculated.Patients were also grouped according to the number of miscarriages,and the percentages of causes of RSA were compared between groups.Results Firstly,the number of miscarriages ranges from 2 to 6 among all 406 early RSA patients.The youngest patient is 21 and the oldest is 43,the mean age is 30.44±4.51.Secondly,the etiological composition of all patients is as below.213 cases with unexplained causes account for 52.46% while 193 patients with determined causes account for 47.54%,among which 177 patients are identified with a single cause accounting for 43.60%,while 16 patients are diagnosed with multiple causes accounting for 3.94%.63 patients are related to immune system abnormalities accounting for15.52%.56 patients are caused by chromosomal abnormalities which account for13.79%.45 patients are related to endocrine disorders,which accounts for 11.08%.30 patients are associated with anatomical abnormalities,which accounts for 7.39%.13cases are caused by sperm abnormalities,which accounts for 3.20%.Thirdly,all 406 patients were grouped according to the number of miscarriages,one group contains 213 patients who have two miscarriages and the other one contains 193 patients who have three or more miscarriages.The distribution of each etiology was compared between groups based on the ?2 test.The test shows that the constituent ratio of anatomic abnormalities is significantly higher in patients who have three or more miscarriages(?2=13.69,P<0.001),while there is no statistically significant difference in the other factors(P>0.05).Conclusions Firstly,early RSA may happen at any stage among women of reproductive age.This study shows that the mean age of RSA is 30.44±4.51.Secondly,the main causes contribute to RSA include immune system factors,chromosomal abnormalities of both partners,endocrine abnormalities,anatomic abnormalities and sperm abnormalities.Many patients suffer RSA with multiple causes.Besides,approximately 50% patients suffer from RSA with unexplained causes.Third,RSA patients with anatomic abnormalities often suffer 3 or more miscarriages,which might be due to intrauterine adhesion.For the RSA caused by intrauterine adhesion,especially severe intrauterine adhesion,clinical treatment would be less effective.These patients might suffer another miscarriage in next pregnancy.Chapter Two: Study of Clinical Relevance of Trombophilia Markers Antithrombin-?,Protein C,Protein S in Unexplained Recurrent Spontaneous Abortion PatientsObjective To explore the occurrence of activation and deficiency of three thrombophilia markers,Antithrombin-?,Protein C,and Protein S in unexplained recurrent spontaneous abortion patients.Method This is a case-control study.406 early RSA patients who attended the Reproductive Center of the First Affiliated Hospital of Anhui Medical University from March,2015 to September,2016 were collected.According to the diagnostic criteria of URSA,132 women suffering miscarriages with unexplained causes were selected and 162 women who had one or more births without any miscarriage were also selected as control.By chromogenic substrate method,antithrombin-? and protein C activities were measured.Protein S was determined by freezing method.The activities of antithrombin-?,Protein C and Protein S in blood were compared between groups,as well as the deficiency ratio of antithrombin-?,protein C and protein S.Results Firstly,by comparing the activities of AT?,PC and PS in patient group and control group,there is no statistical significance in AT? and PC in control group(P>0.05).The average PS(83.67±17.18)in the patient group is noticeably lower than that of the control group(90.24±13.43).Secondly,by ROC curves,the cut-off value of AT?,PC and PS are determined when a miscarriage happens caused by thrombophilia.A significant difference(P < 0.05)was found in PS.the results indicates that the threshold of pre-thrombotic state is 74% based on PS and the area under the curve(AUC)is 0.612(P=0.001)with a sensitivity of94.4% and an accuracy of 28.0%.Thirdly,the occurrences of deficiency of AT?,PC and PS(8.33%,2.27%,23.48%)in the patient group are much higher than those in the control group(1.85%,1.23%,2.47%).A significant difference(P < 0.05)was found AT? and PS defects.A significant difference was not found between the groups for the prevalence of PC defects(P>0.05).Conclusions URSA is closely related to the reduction of Protein S activity,which could be used as an indicator of thrombophilia-caused URSA.URSA is also related with deficiencies in antithrombin and protein S. |
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