What happens in your body during a miscarriage? - Nassim Assefi and Emily M. Godfrey

翻译人员: Lexi Ding 校对人员: Gia Hwang

Globally, around 23 million pregnancies end in miscarriage each year.

在全球范围内，每年约有 2300 万例妊娠以流产告终。

Despite how common it is, miscarriage is still considered a taboo subject.

尽管流产很常见， 但仍被视为禁忌话题。

The experience can feel isolating, and for some, emotionally traumatizing.

这种经历可能会让人感到孤立无援，

对某些人来说，还会造成情感创伤。

And myths about miscarriage add to the stigma,

人们对流产的误解加剧了耻辱感，

leading many to blame themselves for the loss.

导致许多人将流产归咎于自身。

However, most miscarriages are unpreventable

然而，大多数流产是无法预防的，

and caused by factors beyond a person’s control.

是由人类无法控制的因素导致的。

They happen because pregnancy is a complex process,

之所以发生这种情况， 是因为怀孕是一个复杂的过程，

which requires careful choreography between the fertilized egg and uterus.

需要在受精卵和子宫之间 进行仔细的编排。

In fact, of every three eggs that are fertilized,

实际上，每三个受精卵中，

only one progresses to a live birth.

只有一个顺利出生。

So, let’s take a closer look at what happens in the body

因此，让我们仔细看看 在怀孕的前 12 周内

during the first 12 weeks of pregnancy,

母体会发生什么变化，

when a majority of miscarriages occur.

大多数流产都发生在这一时段。

Pregnancy is maintained by several hormones:

妊娠由以下几种激素维持：

progesterone and estrogen, produced within the ovaries,

卵巢内产生的黄体酮和雌激素，

and human chorionic gonadotropin, or hCG, sent out by the fertilized egg.

以及由受精卵释放的 人绒毛膜促性腺激素，简称hCG。

During the first half of each menstrual cycle estrogen levels increase,

在每个月经周期的前半段， 雌激素水平升高，

followed by an increase in progesterone.

其次是黄体酮的增加。

These hormones signal to the uterine lining to enhance its blood supply

这些激素向子宫内膜发出信号， 增加子宫内膜的血液供应，

and thicken its mucosa,

并增厚其粘膜，

creating the conditions needed for an early pregnancy to grow.

从而为早孕胚胎的生长创造条件。

If an egg arrives at the uterus unfertilized,

如果卵子到达子宫时未受精，

these hormone levels naturally drop,

这些激素水平会自然下降，

triggering contractions and the shedding of the uterine lining in menstruation.

在月经期间引发子宫收缩 和子宫内膜脱落。

Yet, if the egg arrives fertilized, its outermost layer begins producing hCG.

但是，如果卵子受精了， 其最外层就会开始释放 hCG。

This hormone travels to the ovaries and stimulates the continued release

这种激素会进入卵巢，

of progesterone and estrogen,

并刺激黄体酮和雌激素的持续释放，

halting menstruation.

从而阻断月经。

hCG also binds to receptors on the uterine lining

hCG 还与子宫内膜上的受体结合，

to prevent it from rejecting the fertilized cell mass as it embeds.

防止受精细胞团着床时受到排斥。

This is a stage where things often go awry.

这个阶段经常出错，

For reasons that are not fully understood,

原因尚未完全弄清，

as many as one third of fertilized eggs fail to properly attach,

多达三分之一的受精卵 无法正常着床，

passing undetected in a normal-seeming menstrual period.

在看似正常的月经期间 被不知不觉地排出体外。

And implantation is only the first hurdle for fertilized eggs

而这还只是受精卵着床的

that do properly attach.

第一道关卡。

Once burrowed in the uterine lining,

一旦着床到子宫内膜上，

the rapidly dividing fertilized egg’s own DNA guides its growth.

受精卵自身快速分裂的 DNA 就会引导其生长。

Chromosomal abnormalities can therefore cause irregular development,

因此，染色体异常会导致发育不正常，

or stop embryo growth entirely.

或完全停止生长。

While many mistakenly believe their miscarriage was caused by factors

许多人错误地认为流产是由

like stress, exercise, vaccination, or past birth control use,

压力、运动、疫苗接种 或节育措施等因素造成的，

a vast majority are in fact caused by these genetic issues

但实际上绝大多数流产 是因为遗传问题

or other health factors beyond a person’s control.

或其他人类无法控制的健康因素。

Some pregnancy losses lead to few, if any, noticeable physical symptoms.

有些流产几乎不会导致 任何明显的身体症状。

In other cases, hCG levels drop, followed by a decrease in progesterone,

有些则会出现 hCG 水平下降， 随后黄体酮水平降低，

causing bleeding and cramping.

导致出血和抽筋。

In either situation, there are three treatment options—

无论哪种情况，都有三种治疗方案，

two of which are also used for induced abortion procedures,

其中两种也用于人工流产手术，

when patients choose to end a pregnancy.

即患者选择终止妊娠。

The first of the three options is what’s commonly known

三种治疗方案中的第一种 即通常所说的

as the “watch-and-wait” method.

“观察等待”法。

A person waits for pregnancy hormones to drop further,

孕妇等待妊娠激素进一步降低，

allowing the pregnancy tissue to be released with the shedding uterine wall.

让妊娠组织随着子宫壁脱落而排出。

This approach works up to 90% of the time,

这种方法在 90% 的情况下有效，

but it can involve several weeks of unpredictable pain and bleeding.

但可能会经历长达数周的 难以预料的疼痛和出血。

Others may opt for option two,

有些人可能选择方案二，

taking the pills mifepristone and misoprostol in sequence.

按顺序服用米非司酮和米索前列醇。

The first works hormonally, by blocking progesterone receptors,

第一种药物通过阻断黄体酮受体 来发挥激素作用，

and the second mimics a molecule which induces labor,

第二种药物则模仿 一种诱导分娩的分子，

stimulating uterine contractions and causing the cervix to soften and dilate.

刺激子宫收缩， 使子宫颈软化和扩张。

After taking the second pill, the process normally takes 1 to 6 hours.

服用第二种药物后， 该过程通常需要 1-6 小时。

It’s often safely self-managed, and can be done privately at home.

这种方案通常能安全地自行操作， 可以在家里私下进行。

The third possible treatment option is known as vacuum aspiration.

第三种可选的治疗方案 被称为真空抽吸。

During this five-minute procedure, the healthcare provider numbs the cervix,

手术时长为五分钟， 期间医生会麻痹子宫颈，

then places a thin tube connected to a syringe-like device

然后将一根细管连接到 注射器一样的设备上

to remove the pregnancy tissue.

来去除妊娠组织。

Treatment choice is often based on the pregnant person’s medical history,

治疗方法的选择 通常取决于孕妇的病史、

timeline, expectations, and personal preferences,

时间安排、期望值和个人偏好，

and all three methods have proven to be safe and effective.

这三种方法都被证明是安全有效的。

However, without the medication or vacuum aspiration options,

但是，如果没有药物 或真空抽吸这两种选择，

an untreated or an incomplete miscarriage can lead to life-threatening infections

未经治疗或不完全流产 可导致危及生命的感染

and hemorrhage.

和大出血。

And because they are the same treatments used in induced abortion care,

而且，由于它们也被用于人工流产中

they can be harder to access and even criminalized in some areas.

因此可能更难获得， 在某些地区甚至被定为犯罪。

Beyond this, over half the world’s population lacks access

除此之外，全球有一半以上的人口

to reliable basic healthcare,

无法获得可靠的基本医疗保健，

including these essential reproductive health services.

包括这些基本的生殖健康服务。

While pregnancy means different things to different people

在不同的人生阶段，

怀孕对不同的人来说意义不同，

at different points in their lives,

for many, losing a pregnancy can be devastating and overwhelming.

但对许多人来说， 流产可能是致命打击，难以承受。

During this difficult time,

在这个困难时期，

everyone deserves to be met with care and support,

每个人都应该得到关怀和支持，

and to have access to these life-saving treatments.

并有机会获得这些挽救生命的治疗。