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

譯者: Mina Liu 審譯者: 麗玲 辛

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

全球每年約有 2300 萬例 懷孕以流產告終。

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

儘管流產很普遍， 但仍然被視為禁忌的話題。

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

這個經歷會讓人感到孤立，對於 一些人來說，還會造成情緒創傷。

And myths about miscarriage add to the stigma,

關於流產的各種迷思加重其污名化，

leading many to blame themselves for the loss.

導致很多人會為了流產自責。

However, most miscarriages are unpreventable

然而，大多數流產是難以預防的，

and caused by factors beyond a person’s control.

並且是由個人無法控制的因素引起的。

They happen because pregnancy is a complex process,

這是因為懷孕是一個複雜的過程，

which requires careful choreography between the fertilized egg and uterus.

需要受精卵和子宮之間精密的配合。

In fact, of every three eggs that are fertilized,

事實上，每三個受精卵中，

only one progresses to a live birth.

只有一個最終能順利出生。

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

讓我們仔細看看懷孕的前 12 周，

during the first 12 weeks of pregnancy,

身體發生了什麼變化，

when a majority of miscarriages occur.

這也是流產最常發生的階段。

Pregnancy is maintained by several hormones:

懷孕由多種荷爾蒙來維持：

progesterone and estrogen, produced within the ovaries,

卵巢內產生的黃體素和雌激素，

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

以及由受精卵產生的 人類絨毛膜性腺激素 (hCG)。

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

在每次月經週期的前半段， 雌激素會增加，

followed by an increase in progesterone.

隨後黃體素也跟著增加。

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

這些荷爾蒙會傳遞訊號給 子宮內膜，增加血液供應，

and thicken its mucosa,

並讓黏膜變厚，

creating the conditions needed for an early pregnancy to grow.

從而為懷孕前期的發育 創造所需的狀態。

If an egg arrives at the uterus unfertilized,

如果卵子未受精就進入子宮，

these hormone levels naturally drop,

這些荷爾蒙濃度會自然地下降，

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

而引發月經期間的子宮收縮 和子宮內膜脫落。

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

不過，如果卵子已經受精， 它的最外層會開始分泌 hCG。

This hormone travels to the ovaries and stimulates the continued release

這種荷爾蒙會傳到卵巢， 並刺激黃體素和雌激素持續釋放，

of progesterone and estrogen,

halting menstruation.

並停止月經。

hCG also binds to receptors on the uterine lining

hCG 還會與子宮內膜上的受體結合，

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

以防止子宮在受精卵嵌入時 排斥這個細胞團。

This is a stage where things often go awry.

這個階段常常會出現問題。

For reasons that are not fully understood,

其原因尚未完全清楚，

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

但多達三分之一的 受精卵無法正常附著，

passing undetected in a normal-seeming menstrual period.

在看似正常的月經中， 不知不覺就排出了。

And implantation is only the first hurdle for fertilized eggs

而著床只是成功附著的受精卵 所面臨的第一個挑戰。

that do properly attach.

Once burrowed in the uterine lining,

一旦嵌入子宮內膜，

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

迅速分裂的受精卵會依靠 自身的 DNA 來引導它的生長。

Chromosomal abnormalities can therefore cause irregular development,

染色體異常會導致不正常的發育，

or stop embryo growth entirely.

或完全停止胚胎生長。

While many mistakenly believe their miscarriage was caused by factors

雖然許多人誤認為流產是由於

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

壓力、運動、接種疫苗或 過去使用避孕藥等因素引起的，

a vast majority are in fact caused by these genetic issues

但實際上，大多數流產 都是由基因上的問題

or other health factors beyond a person’s control.

或其他個人無法控制的 健康因素所造成的。

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

有些流產幾乎不會有明顯的症狀。

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

在其他案例中，hCG 濃度下降， 接著黃體素也減少，

causing bleeding and cramping.

因而導致出血和痙攣。

In either situation, there are three treatment options—

無論是哪種情況， 目前有三種治療選擇，

two of which are also used for induced abortion procedures,

當患者選擇終止懷孕時，

when patients choose to end a pregnancy.

其中兩種也用在人工流產的過程，

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

三種選項中的第一種是通常所說的

as the “watch-and-wait” method.

「觀察和等待」方法。

A person waits for pregnancy hormones to drop further,

病人等待孕期荷爾蒙進一步下降，

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

使懷孕組織隨著 子宮內膜的脫落一起排出。

This approach works up to 90% of the time,

這種方法有高達 90% 的成功率，

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

但它可能伴隨數週 難以預測的疼痛和出血。

Others may opt for option two,

有些人可能會選擇第二種方法，

taking the pills mifepristone and misoprostol in sequence.

依序服用美服培酮和 米索前列醇這兩種藥物。

The first works hormonally, by blocking progesterone receptors,

第一種藥物透過阻斷黃體素受體 來影響荷爾蒙的作用。

and the second mimics a molecule which induces labor,

第二種藥物則模擬 一種分子，來促進分娩、

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

刺激子宮收縮， 並使子宮頸變軟、擴張。

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

服用第二種藥品後， 過程通常需要一到六小時。

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

這通常能安全地自我管理， 並且可以在家裡私下完成。

The third possible treatment option is known as vacuum aspiration.

第三種治療選擇稱為真空抽吸術。

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

在這五分鐘的過程中， 醫護人員會先麻醉子宮頸，

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

然後放置一根連接到吸引裝置的細管，

to remove the pregnancy tissue.

來移除懷孕組織。

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

治療的選擇通常會根據孕婦的病史、

timeline, expectations, and personal preferences,

懷孕週期、期望和個人偏好，

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

這三種方法都已證明是安全有效的。

However, without the medication or vacuum aspiration options,

但是，如果沒有藥物 或真空抽吸術等選擇，

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

未經治療或不完整的流產

可能會導致危及生命的感染和出血。

and hemorrhage.

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

因為這些治療方法也用於人工流產，

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

在某些地方，婦女可能更難 獲得治療， 甚至會被定罪。

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

除此之外，全球超過一半的人口

缺乏可靠的基礎醫療，

to reliable basic healthcare,

including these essential reproductive health services.

包括這些不可獲缺的生殖健康服務。

While pregnancy means different things to different people

雖然懷孕對不同的人在不同的生命階段

at different points in their lives,

有不同的意義，

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

但對許多人來說，流產可能是 令人震驚且難以承受的。

During this difficult time,

在這個艱難時期，

everyone deserves to be met with care and support,

每個人都應該得到關懷和支持，

and to have access to these life-saving treatments.

並擁有這些救命治療的途徑。