It should be noted that in the literature there is often an opinion that it is not necessary to carry out a survey due to habitual miscarriage, as every couple has a 60% chance of communicating a pregnancy without examination and treatment, and only 40% of it is lost again. And if the material possibilities are limited in the family, the survey can not be carried out, considering miscarriage as a manifestation of natural selection. Given the material condition of our society as unsatisfactory, and most of the survey methods due to miscarriages are expensive studies, for many families this issue is addressed in this way.
For those who wish to know the cause of miscarriage and seek help outside of pregnancy, we believe that the examination should be carried out in full, but without unnecessary costs for unjustified research for this patient.
Taking into account the polyethiologic nature of habitual miscarriage, we conduct a survey of patients with this pathology in 2 stages. At the first stage, the state of the reproductive system and the most common causes of embryo development are assessed.
At the second stage, the pathogenetic mechanism of habitual loss of pregnancy and more rarely occurring disorders are specified.
Hysterosalpingography is the first, necessary link in the survey. With the help of this method, we identify the developmental defects of the uterus, the presence of intrauterine synechia, Isthmiko-cervical insufficiency, and uterine hypoplasia. In case of miscarriage, hysterosalpingography should be performed on the 18-22 day of the menstrual cycle with no signs of infection, changes in blood, urine, and vaginal smears.
Studies in the second phase of the cycle can reveal not only anatomical changes, but also a number of functional disorders. The Isthmus of the cervix in the second phase of the cycle is narrowed by the action of progesterone and an increase in the tone of the sympathetic nervous system. The expansion of Isthmus may be due to ischemic-cervical insufficiency, as well as the inferior phase II of the cycle, a decrease in the level of progesterone. These conditions can be differentiated with the help of an adrenaline-progesterone test.
An alternative method of investigation is hysteroscopy, in which it is possible to more accurately determine the nature of the lesion of the uterine cavity, the spatial ratio for the developmental defects of the uterus, the vastness of intrauterine synechia. With hysteroscopy, there are fewer false-positive and false-negative test results than hysterosalpingography because of possible artifacts.
However, both these methods, giving very valuable information about the state of the uterine cavity, do not allow a clear differential diagnosis of the developmental uterus: a bicorne or an intrauterine partition.
Given that for habitual miscarriage the intrauterine part is more severe than the bicornic uterus, laparoscopy is often necessary to clarify the nature of the developmental defect in the uterus. However, due to possible complications and high cost of the method, research for these purposes is rarely used, only if there is a need for intervention with concomitant gynecological pathology.
An alternative method of laparoscopy may be resonance imaging. In recent years, data on the use of sonogasterosalpingography appeared in the press. Under the control of ultrasound in the uterine cavity, an echo-negative substance is administered and ultrasound is monitored not only for the condition of the uterine cavity, but also for the dynamics of tube cuts and their patency.
In the production of hysterosalpingography, we recommend the use of doxycycline 100 mg 2 times a day, Trichopolum 0.25 mg 3 times a day, nystatin 0.5 4 times a day for 5-6 days after the procedure. To ensure the procedure itself and reduce discomfort after it, you can recommend taking antiprostaglandin drugs: indomethacin, voltaren, ibuprofen in therapeutic doses for 1-2 days.
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