After pregnancy, expectant mothers are most worried, confused, and recommended by professionals and laymen for the most. After more than 20 years of medical practice, I have seen too many strange stories, outrageous practices and brain-dead formulas in the aspect of abortion and fetus protection, which really makes people speechless.
In order to let everyone have a correct understanding of abortion and abortion protection, let’s first tell you some basic facts about pregnancy and abortion:
In the whole female population, the total abortion rate of clinical pregnancy is about 15%, if biochemical pregnancy is calculated, the total embryo loss rate is as high as 60-70%, and only about one third of all pregnant embryos can be converted into surviving newborns. What is biochemical pregnancy? Is in the very early pregnancy abortion occurred, women themselves do not know, may have no performance, at most is menstruation slightly delayed a few days, menstruation a little more. Pregnancy is actually a trial and error process, is also a natural selection and natural elimination process.
The main cause of spontaneous abortion is embryo chromosome abnormalities, The proportion is about 50%, and other main reasons are maternal factors, including anatomical structure abnormalities of reproductive organs, autoimmune factors, infection factors, endocrine factors, and unknown factors (including thrombosis tendency, etc.). The proportion of abortion caused by lack of progesterone level caused by corpus luteum insufficiency is very small.
Routine determination of progesterone level is not recommended to guide early pregnancy and protect fetus.
Clinically, the reason for testing progesterone level is that one of the reasons for abortion is luteal insufficiency (a small proportion). Luteal insufficiency leads to low progesterone level and further leads to abortion. If found in time, progesterone can be supplemented to prevent abortion.
In fact, the gold standard for diagnosis of luteal insufficiency is endometrial biopsy in the middle luteal phase. However, since the diagnosis of corpus luteum insufficiency requires two consecutive endometrial biopsies, it is almost impossible to use the gold standard for clinical diagnosis. Therefore, some people propose to check progesterone levels to judge corpus luteum function, but this method is not reliable:
1. Progesterone levels in normal pregnancy fluctuate greatly.
2. Low progesterone levels are more likely to be the result of embryonic dysplasia than the cause of abortion.
3. Half of the patients diagnosed with luteal insufficiency have normal progesterone levels.
4. In early pregnancy, progesterone comes from two sources, one is corpus luteum secretion and the other is trophoblast secretion, so it is impossible to judge which causes the low level.
Therefore, routine determination of progesterone levels is not recommended to guide fetal protection. Of course, Can’t totally deny the role of testing progesterone, after testing hCG positive, B ultrasound did not find evidence of pregnancy, testing progesterone level is still helpful to judge the prognosis of pregnancy, low level of progesterone means abortion and ectopic pregnancy is more likely. However, the purpose of testing progesterone is definitely not to supplement progesterone.
Bed rest is not recommended for fetal protection.
Even if you repeat that there is no evidence-based medical evidence that bed rest can reduce the occurrence of miscarriages, There will still be many expectant mothers, Especially their mother-in-law and mother-in-law did not listen. One of the most exotic cases I have ever seen: The daughter’s first pregnancy was spontaneous abortion. After the second pregnancy, the mother forced her daughter to stay in bed absolutely, eating, drinking, pulling and scattering all in bed. She was not allowed to go to the fields for 6 months. When she brought her daughter to see my clinic, she also walked unsteadily. When she was examined, she found that the muscles of her lower limbs had obviously shrunk. It was really ridiculous!
In fact, without evidence-based medical evidence, Common sense should also be able to judge that bed rest is useless to protect the fetus. Nearly half of abortions are caused by chromosomal abnormalities of embryos. No matter what you do, this kind of situation is doomed to miscarriage. Don’t talk about bed rest, even if you take progesterone every day, even if you soak the patient in progesterone, it is useless. Will the child who fell off after walking and sneezing be saved? If the walking child will fall off, the family planning clinic of the hospital can be closed without induced abortion, so that everyone can walk or even run instead of curettage.
Routine oral or intramuscular progesterone injection is not recommended for fetal protection.
The latest Cochrane Review on Progesterone Preventing Abortion (the most authoritative evidence-based medical evidence) published in 2013 concludes that progesterone (whether intramuscular or oral) is ineffective in preventing abortion. For three or more consecutive spontaneous abortions, empirical progesterone supplementation may be beneficial, but this needs to be further confirmed by large sample multicenter studies.
Since progesterone is ineffective in protecting the fetus, why should progesterone levels be detected to guide the protection of the fetus?
WHO (World Health Organization) also does not recommend progesterone to protect fetus: please refer to WHO website.
Of course, progesterone supplementation is still required in a few cases, such as patients who have corpus luteum removed for some reason during early pregnancy and IVF patients whose progesterone level has decreased due to surgical operations.