When planting a tree, if the root of this tree is very small, like a tree in the desert, then the tree will not be able to grow into a big tree, and it will be easy to wither and die in the process of growth, so lush roots are the basic conditions for the tree to be able to grow into a big tree.
Pregnancy is the same, the fetal heart buds appeared, but the chorionic villi growth is not vigorous, and when the fetus continues to grow, or easy to fetal arrest.
To see if the chorionic villi are growing vigorously, the main thing to look at is the value of HCG. A normal pregnancy should have an HCG of 100,000 or higher by 70 days gestation.
If the HCG is too low, the pregnancy will be terminated, and the experience of the last few years has been that many of those whose heartbeat and buds show up but whose HCG is only 10-20,000 end up being terminated.
The lowest fetus that makes it to full term in fertility preservation therapy is one with an HCG of 50k. Therefore, for pregnant women with a history of fetal arrest, in addition to ultrasound to see if the fetal heart is present, the rise in HCG is usually monitored. If HCG rises slowly, look for the cause promptly and do your best to treat it.
Because, the root of the tree begins to grow from the seed planted, in the process of root growth is the best time for treatment, if by 50-60 days of menopause, the chorionic villi growth are completed, at this time, if you find that the HCG is low, and then the effect of the treatment will be poor.
So for patients with recurrent miscarriages, they usually come in before pregnancy to find out why, and then intervene immediately after pregnancy, so my recurrent patients are usually told to come in on the same day or the next day after they know they are pregnant. HCG monitoring at least twice a week during early pregnancy.
Plugging in Jinhua Fu's point of view:
I once had a patient who came to me for fertility preservation with a history of 3 arrests. Three times for blood HCG (blood drawn every other day), from 6800mIU/ml to 8000mIU/ml, 6 days in the middle of the HCG basically did not rise despite treatment, I let her stop the drug, give up and abortion. Because of the slow growth of HCG, there was no significance of preserving the fetus. And at this time the ultrasound showed that the buds were 0.8CM and the fetal heart rate was normal, I still told her to continue to check the HCG, and if the growth was still slow on the next day and there was a fetal heart in vain, I suggested stopping all the birth control measures. Because HCG 8000mIU/ml, the fetal heart, in fact, has already predicted that the fetus is not good. However, she was not willing to do so (I understand very well those recurrent miscarriage ladies who are persistent in pursuing the dream of motherhood), and insisted on continuing to keep the fetus on fertility preservation. As a result, 2 weeks later, the fetal heart disappeared, and the peak HCG was 13,000mIU/ml. I've encountered quite a few such cases.
The patient herself knows that when HCG is very low, even if there is a fetal heart, it is not normal. Because, the appearance of fetal heart and buds, usually after 6 weeks, if there is a fetal heart, HCG is very low, it only means, her HCG growth is very slow, the prognosis is very bad.
Even, some of them could reach 12 weeks, but ended up with fetal arrest. There was another patient who had a very bad HCG with a peak of only 20,000 and a fetus that was 2 weeks too small to develop at 12 weeks, and she was told to give up early on, but she persisted until 16 weeks with FGR (Fetal Growth Restriction) and still had a fetal arrest.
In my case (in the last 5 years, there have been about 1000 or more recurrent miscarriage deliveries), the peak HCG usually averages around 90,000mIU/ml. The lowest one was 43,000mIU/ml when she delivered a small 2.1KG full-term sample at 37 weeks (due to low amniotic fluid.) None of the HCG less than 40,000mIU/ml were successful.
Does the above suggest that relying only on ultrasound and resisting the idea of checking blood HCG is not a good idea either. ultrasound is important, but what happens if the HCG growth is bad and the ultrasound has a fetal heart?
2. Very poor blood supply to the uterine arteries
If the fetal heart is present, the HCG can also reach about 100,000, but if the blood supply to the uterine arteries is very poor, it is also easy to stop the fetus.
Like a farmer's uncle planting a tree, when the buds grow and are not watered, the buds will wither away. So, pregnant women with a history of fetal arrest we usually do a resistance index of the uterine arteries at the same time we do a fetal heart ultrasound in preparation for and after pregnancy, and intervene promptly if the uterine arteries are absent or inverted. It is treated with at least aspirin and dalteparin, and immunologic drugs are added if the immunocoagulant factor causing the arterial agenesis can be found.
3. Poor embryo quality
Sperm and eggs may have various assembly errors during their encounter.
For example, large defects will not land or biochemical pregnancy, single chromosome triploidy, such as trisomy 12, trisomy 16, chromosomal abnormality such as 45XO, etc., may be present in the fetal heart and then fetal arrest. trisomy 21, trisomy 18 can continue to survive, and can only be detected by further Down's syndrome.
We don't deserve the heartache of a fetal arrest with poor embryo quality, the best of the best. But to know whether the embryo quality problems, that need embryo chorionic villus sent chromosome examination. If two or more abortions are recommended to send the test, one abortions of pregnant women according to their own economic conditions, decide for themselves whether to send the test.
4. The second child of women of advanced age
Bad embryo quality is also the most important reason for the occurrence of embryonic arrest in women of advanced age. Because no matter how well maintained women, after 40 years of age, ovarian function began to go downhill, that is, women began to enter menopause, at this time, the function of the ovary is not as good as when young, need to have a higher FSH to stimulate follicle maturation, so that out of the follicle quality began to decline, follicle in the egg in the meiosis is prone to errors. The egg and sperm are also prone to errors during their union.
It is because such risks are increasing with age that the Maternal and Child Health Act requires amniocentesis after the age of 35. Older women whose second child has been liberalized should be more rational about having a second child, and pay special attention to prenatal screening and prenatal diagnosis if they become pregnant.
With increasing age, hypertension, diabetes, endocrine diseases, the second major cause of fetal arrest in advanced pregnancy for immune coagulation factors. Others, such as anatomical factors, already have two children, anatomical factors basically will not. Infectious factors, endocrine factors are also not considered for the time being.
Not a heart bud will definitely survive
Professor Chen Jianming believes that the difference between the normal gestational sac diameter and the length of the fetal buds is about 14-18mm, and is not within this ratio before the ninth week of pregnancy, suggesting that the embryo may be underdeveloped, such as a large gestational sac or a small gestational sac.
Large gestational sac
The difference between the diameter of the gestational sac and the length of the fetal bud is ≥18 mm
19-21 mm is a mildly large gestational sac
22-24 mm is a moderately large gestational sac
≥25 mm is a severely large gestational sac.
The difference between the diameter of the gestational sac and the length of the fetal bud is ≥22mm, and the risk of embryonic arrest is very high.
Some large gestational sacs present with uterine fluid 1-2 weeks after examination; most large gestational sacs have a favorable prognosis after fertility preservation therapy.
Small sacs
The difference between the diameter of the sac and the length of the bud is ≤13 mm
10-13 mm is considered a mildly small sac
6-9 mm is a moderately small sac
≤5 mm is considered a severely small sac
≤10 mm suggests that there is a possibility of embryonic failure
<8 mm is a higher risk of embryonic failure.
<5mm most embryos are in diapause
<3mm embryos are in diapause.
Most small gestational sacs develop uterine fluid or vaginal bleeding about 1-2 weeks after the test; the success rate of fertility preservation is significantly lower for small gestational sacs than for larger ones.
It can be seen that there are fetal heart buds can not avoid the occurrence of fetal arrest, the cause of fetal arrest is complex, a single fetal arrest may be the embryo's own reasons or accidental factors, which can be again try to conceive, such as the recurrence of fetal arrest should be a comprehensive systematic examination to determine the cause of fetal arrest.
It is recommended that women try to have children at the optimal age for childbearing, and to develop good habits, pay attention to a healthy diet, and to be rational about the age of the second child.