| BackgroundRecurrent spontaneous abortion(RSA)is a common disease in gynecology and obstetrics,with an incidence rate of 1% to 5%,which adversely affects the physical and mental health of women of childbearing age,the etiology is complex and it is a hot and difficult issue in the reproductive world.Researchers at home and abroad believe that the occurrence of RSA is closely related to the prethrombotic state and impaired uterine artery blood perfusion.At present,there are no clear laboratory indicators for assessing prethrombotic state,so finding indicators for detecting prethrombotic state is of great significance for clinical diagnosis and treatment of RSA.The anticoagulation therapy is mainly method for the treatment of prethrombotic state,but the specific drug selection,dosage and duration of treatment are inconclusive.At this stage,there is no unified treatment standard for abnormal uterine blood flow perfusion at home and abroad,further research is needed on the drug regimen,treatment effect and safety of RSA patients with uterine blood flow abnormality.ObjectiveTo explore the significance of platelet aggregation rate,plasma levels of D-dimer(D-D)and uterine artery blood flow parameters in the etiology screening of RSA patients,observe the changes of the above indexes after low-molecular-weight heparin calcium treatment,and the effect on pregnancy outcomes of RSA patients,aim to provide a reference for RSA etiology screening and treatment.(1)A total of 182 patients diagnosed with RSA who were hospitalized and delivered at xinxiang first people's hospital from January 2017 to February 2019 were selected as the treatment group,they were divided into traditional treatment group(n=69)and heparin treatment group(n=113)according to different treatment methods,the traditional treatment group were treated with dedrogesterone and Zishen yutai pills,while the heparin treatment group were treated with dedroprostone,Zishen yutai pills and low-molecular-weight heparin calcium;Another 80 healthy mothers who delivered in our hospital during the same period were randomly selected as the control group.The clinical medical records were collected and analyzed retrospectively.(2)The platelet aggregation rate,plasma levels of D-D and uterine artery blood flow parameters were compared between the treatment group and the control group.The platelet aggregation rate,plasma levels of D-D and uterine artery blood flow parameters during 10 to 14 weeks and 20 to 24 weeks of pregnancy and pregnancy complications,adverse pregnancy outcomes were compared between the heparin treatment group,the traditional treatment group and the control group.The adverse reactions during the treatment between the heparin treatment group and the traditional treatment group were compared.Results(1)The platelet aggregation rate,plasma levels of D-D and peak systolic velocity/ end diastolic velocity(S/D),resistance index(RI),pulsation index(PI)in the treatment group were significantly higher than those in the control group(P<0.01).(2)The platelet aggregation rate,plasma levels of D-D and S/D,RI,PI during 10 to 14 weeks of pregnancy in the heparin treatment group and the traditional treatment group were significantly higher than those in the control group(P<0.05),but the levels of the above indicators during 10 to 14 weeks of pregnancy in the heparin treatment group were significantly lower than those in the traditional treatment group(P<0.05).(3)The platelet aggregation rate,plasma levels of D-D and S/D,RI,PI during 20 to 24 weeks of pregnancy in the traditional treatment group were significantly higher thanMethods those in the heparin treatment group and the control group(P<0.05),but there was no significant difference of the above indicators during 20 to 24 weeks of pregnancy between the heparin treatment groups and the control group(P>0.05).(4)The incidence of pregnancy complications and total adverse pregnancy outcomes of patients in the traditional treatment group were significantly higher than those in the heparin treatment group and the control group(P<0.05),but there was no significant difference of the incidence of pregnancy complications and total adverse pregnancy outcomes between the heparin treatment groups and the control group(P>0.05).(5)There was no significant difference in the incidence of total adverse reactions between the heparin treatment group and the traditional treatment group during treatment(P>0.05).Conclusion(1)Prethrombotic state and abnormal uterine arterial blood flow may be the factors induced RSA,detection of platelet aggregation rate,plasma levels of D-D and uterine arterial blood flow parameters before pregnancy are helpful for etiology screening of RSA.(2)Heparin can reduce platelet aggregation rate,plasma levels of D-D and uterine artery RI and PI in RSA patients,improve coagulation status and uterine artery perfusion of patients,improve pregnancy outcomes,and it is safe. |
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