| 1 BackgroundRecurrent Spontaneous Abortion(RSA)is an abnormal pregnancy,which refers to women of childbearing age who suffer two or more consecutive fetal losses with a same partner.The etiology of RSA is complex,and about half of the patients have no obvious causative factors,so it is called Unexplained Recurrent Spontaneous Abortion(URSA).It is important to investigate the pathogenesis of URSA and find out the effective treatment methods to prevent and treat URSA in order to protect the reproductive health of women of reproductive age and maintain social stability and harmony.URSA is a hot and difficult problem in the world reproductive field,its pathogenesis has not been fully elucidated and is still in the exploration stage.Some studies have shown that its pathogenesis is related to the following aspects:imbalance of maternal-fetal immune tolerance,placental blood supply and polymorphisms of genes related to folate metabolism.Modern medical treatment for URSA includes immunotherapy,anticoagulation,hormone therapy,etc.However,the above treatments are mostly clinical small sample,observational and exploratory studies,and the efficacy and safety are highly controversial.URSA belongs to the category of "several abortions","slippery fetus" and"repeated pregnancy and repeated abortions" in Chinese medicine.Chinese medicine has a long history of understanding and treatment of this disease,and its efficacy has been confirmed.The idea of "treating the untreated disease" in Huangdi Neijing and Zhang Jinyue’s theory of "pre-cultivating its damage" have had a profound influence on the prevention and treatment of slippery fetus by later generations of doctors.In recent years,the research field has conducted exploratory studies on RSA from pre-conception intervention and post-pregnancy fetus preservation,but the current problem is that there are relatively few reports on clinical studies on URSA,and most of them focus on the efficacy of post-pregnancy fetus preservation treatment with traditional Chinese medicine,but there are very few reports on pre-conception intervention,which plays a key role in the prevention and treatment of RSA miscarriage.Dr.Xie Jinghong,the chief physician,has long been devoted to the clinical research of RSA,and based on the theoretical characteristics of the disease such as"continuity" and "coming down at the right time",she inherited the treatment philosophy of Cai Lianxiang,a famous Chinese medicine teacher in the capital,"to cultivate the source of nourishing the fetus and to intervene before pregnancy".We believe that the importance of "prevention before pregnancy" should be emphasized in the diagnosis and treatment,and that "pre-conception intervention" is the fundamental part of the treatment of RSA.Pre-pregnancy intervention is essential to the treatment of RSA,and it is important to prevent the recurrence of miscarriage by treating patients before they become pregnant.He also believes that the main cause of RSA is deficiency of kidney and spleen,which leads to deficiency of kidney essence and failure of the kidney to seal the fetus,and deficiency of spleen and stomach,which leads to lack of source of qi and blood production and loss of moistening of the twins,which can lead to slippage.In clinical practice,the formula for tonifying the kidneys and strengthening the spleen,which was created by Professor Cai Lianxiang,a famous national doctor in the capital,is often used to treat the pregnancy.For these reasons,the teacher established this project to objectively and systematically observe the clinical efficacy of preconception intervention using the method of tonifying the kidney and strengthening the spleen in the treatment of URSA.2 ObjectivesThrough this study,we hope to explore the solution to the difficult clinical URSA treatment problems,bring into play the characteristic advantages of TCM in preconception intervention to prevent recurrent miscarriage,and provide effective and practical TCM diagnostic ideas and methods for the treatment of clinical URSA.To fill the gap of research in this field.3 Contents3.1 Literature reviewReview 1:Overview of modern medical research on URSA.Through searching and analyzing the relevant literature,we summarize the understanding and research progress of modern medicine on the pathogenesis and treatment of URSA.Review 2:Overview of Chinese medical research on URSA:Through searching and analyzing the relevant literature and ancient Chinese medical texts,we summarize the understanding and research progress of Chinese medicine on the etiology and treatment of URSA from ancient times to the present.3.2 Clinical research3.2.1 Methods.This study used our hospital electronic medical record information database to query and retrospectively analyze the clinical data of a total of 48 patients who met the diagnostic criteria for unexplained recurrent miscarriage and also had Chinese medicine evidence of spleen and kidney deficiency in our gynecology department between June 2018 and December 2021,and these patients were divided into 32 cases in the treatment group and 16 cases in the control group.Treatment group:Patients who underwent 3 months of preconception intervention with the method of tonifying the kidney and strengthening the spleen before the planned pregnancy,and who became pregnant again within 6 months after the completion of treatment.The control group:patients who had no pre-pregnancy intervention before the planned pregnancy and became pregnant again.Both groups were treated with conventional fetal preservation until 12 weeks of gestation after pregnancy was confirmed.By observing the early pregnancy outcome,serum P and β-HCG levels,and TCM evidence score in the above two groups,the efficacy of preconception intervention with the method of tonifying the kidney and strengthening the spleen on URSA was objectively evaluated.3.2.2 Results(1)Early pregnancy outcome in both groups:the early pregnancy success rate after treatment was significantly higher in the treatment group(90.63%)than in the control group(62.5%),and the difference was statistically significant when compared between groups(P=0.019<0.05).(2)Changes in Traditional Chinese Medicine(TCM)symptoms before and after preconception intervention in the treatment group:the TCM symptom score before treatment(15.34 ± 4.90)was significantly higher than that after treatment(6.06±4.00),and the distribution of symptom score before treatment was mainly moderate and after treatment was mainly mild.The difference was statistically significant when comparing before and after treatment(P=0.000<0.05).The total effective rate of improvement of TCM symptoms after treatment was 93.75%.(3)Comparison of serum β-HCG and P levels after pregnancy between the two groups:the()values of serum β-HCG and P levels at the 6th,8th and 10th weeks of pregnancy in the treatment group were higher than the(x±s)values of serum β-HCG and P levels at the same weeks of pregnancy in the control group of patients,but none of the differences between the groups were statistically significant(P>0.05).4 Conclusions(1)After preconception intervention with the Kidney and Spleen tonification method and postconception conventional fertility preservation treatment for URSA with spleen and kidney deficiency evidence,compared with postconception conventional fertility preservation treatment alone without preconception intervention,preconception intervention with traditional Chinese medicine can improve the early pregnancy success rate and pregnancy outcome in URSA patients with another pregnancy.(2)The preconception intervention treatment of tonifying the kidney and strengthening the spleen method can improve the level of TCM evidence in URSA with spleen and kidney deficiency evidence and lay a good foundation for the next pregnancy.(3)Through this study,we initially explored to solve the difficult clinical URSA treatment problems,to bring into play the characteristic advantages of TCM in preconception intervention to prevent recurrent miscarriages,and to provide effective and practical TCM diagnostic ideas and methods for the treatment of clinical URSA.It fills the gap of research in this field. |
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