Analysis Of Anatomy Factor Of 488 Women With Recurrent Spontaneous Abortion

Background and objectivesMiscarriage is the commonest complication of pregnancy.There are two types of miscarriage:sporadic and recurrent.Recurrent spontaneous abortion refers to the two consecutive times or more than two times fetal lost before 20 weeks(fetal weight loss less than 500g),which must be confirmed intrauterine pregnancy by ultrasound.Biochemical pregnancy and tubal pregnancy abortion is not included in the calculation.According to epidemiological data,patients who have two or more times abortions accounted for about 5%of childbearing age women,and three times or more than three times of 1%.The definition of recurrent spontaneous abortion varies in different countries.The standard of American Society for Reproductive Medicine is two or more than two pregnancy failures.The Royal College of Obstetricians and Gynaecologists defines recurrent spontaneous abortion as three or more times abortions with the same sex partner before the gestation of 24 weeks.The department of obstetrics and gynecology of Chinese Medical Association defines RSA as three or more times abortions with the same sex partner before the gestation of 28 weeks.According to recent researches,patients with two consecutive abortions can be found structural abnormalities including congenital and acquired anatomy by hysteroscopy.Given this,this study still uses two times or more than two times consecutive abortions before 20 weeks as the standard of recurrent spontaneous abortion.The etiology of recurrent spontaneous abortion is complex and diverse.In addition to genetic,immune,infections and endocrine factors,the uterus as a place to provide survival environment for embryonic and fetal is particularly important.According to the epidemiological statistics,uterine factors accounted for 16.4%of all the etiology causes,and increases with the improving of incidence of abnormal pregnancy history.To analyze the data of types and proportion of abnormal uterine anatomy diagnosed by hysteroscopy in 488 women with recurrent spontaneous abortion and compare them with low risk population.Materials and methodsThe medical history,hysteroscopy and other relevant results of 488 patients with recurrent spontaneous abortion from January 2011 to June 2015 in Affiliated Reproductive Hospital of Shandong University,were retrospectively analyzed.The criteria of case group were applied as follows:the two consecutive times or more than two times fetal lost before 20 weeks(fetal weight loss less than 500g),which must be confirmed intrauterine pregnancy by ultrasound.Biochemical pregnancy and tubal pregnancy abortion is not included in the calculation.According to the number of abortion,the case group was divided into two groups:group A(two times abortion)and group B(three times or more than three times abortions).The medical history,hysteroscopy and other related results of 508 cases of low risk population(no chromosome abnormality in couple,no metabolic diseases or autoimmune diseases in wife)without recurrent spontaneous abortion history(including spontaneous abortion,embryo growth arrest and biochemical pregnancy)who came to Affiliated Reproductive Hospital of Shandong University for male factor or tubal factor were collected over the same period.The exclusion criteria of control group were applied as follows:chromosome abnormality,diabetes,thyroid dysfunction,polycystic ovary syndrome and other metabolic disorders;antiphospholipid antibody syndrome,Systemic lupus erythematosus and other autoimmune diseases.All patients were in accordance with the standard of hysteroscopy without any contraindication.Hysteroscopy was performed within one week after menstruation.The hysteroscopy in this study was performed with a 30 degree anterior oblique lens,a total of 5 mm rigid hysteroscopy(OLYMPUS,Germany)and conventional uterine distention.The cervical canal,the intact uterine cavity and the bilateral fallopian tubes were observed in the hysteroscopy.Congenital anomalies(including uterine septum/incomplete uterine septum,arcuate uterus,single angle uterus)and acquired abnormality(including intrauterine adhesions,endometrial polyps,submucous myoma etc.)were recorded.If any uterine abnormality was found,the patient was admitted to the hospital for hysteroscopic treatment,all specimens were sent to pathological examination.Comparisons of type and proportion of abnormal uterine anatomy among different groups were performed using chi-squared.SPSS Version 20.0 was used for analysis.When theoretical frequency is much less,the corrected chi square or Fisher exact probability method is given.Setting P<0.05 was statistically significant.Results:1.In 488 cases of patients with recurrent spontaneous abortion,there were 371 normal cases,accounting for 76.02%,and 38 cases with congenital anomalies(7.38%),98 cases with acquired abnormalities(20.08%).In 508 cases of control group,there were 406 normal cases,accounting for 79.92%,17 cases with congenital anomalies(3.35%)and 96 cases with acquired anomalies(18.90%).There was significantstatistical difference between the two groups in the incidence of congenital anomalies(P=0.005)?Among all kinds of acquired abnormalities,the highest incidence rate of case group and control group was the same one,that was intrauterine adhesions,and then was endometrial polyps.There were statistical differences between the two groups in the incidence of these two acquired abnormalities(P were both less than 0.001).2.According to the number of abortion,patients were divided into two groups,A and B.In group A(2 abortions),there were 228 normal cases,accounting for 78.62%,21 cases with congenital abnormality(7.24%)and 52 cases with acquired abnormality(17.93%).In group B(3 and more than 3 abortions),there were 143 normal cases,accounting for 72.22%,17 cases with congenital anomalies(8.59%)and 46 cases with acquired abnormalities(23.23%).There was no statistical significant difference between the two groups in the three types of cases.Conclusions:1.There was significant statistical correlation between congenital abnormal uterine anatomy and recurrent spontaneous abortion.The highest incidence of all kinds of acquired abnormalities rate was intrauterine adhesions,then was endometrial polyps.There was significant statistical correlation between these two acquired abnormalities and recurrent spontaneous abortion,2.Hysteroscopy in the diagnosis of abnormal uterine cavity has a unique advantage,and corrective surgery can be undergone.After two consecutive abortions,it is necessary to carry out hysteroscopy to find abnormal uterine anatomy,which will reduce the incidence of recurrent abortion.