妇产科学流产ppt课件

流产Abortion 复旦大学附属妇产科医院隋龙 定义 流产 abortion 28w 1000g早期流产 12w 晚期流产 28w 有生机儿 20 28w 500 1000g 病因 胚胎因素数目异常 结构异常母体因素全身性疾病 内分泌异常 免疫功能异常 生殖器异常 创伤刺激环境因素烟草 饮酒 咖啡因 辐射 避孕 环境毒素 流产时染色体异常的发生率 病因二 母体因素营养不良感染慢性衰弱性疾病内分泌异常创伤生殖道因素免疫因素自身免疫因素同种免疫因素 Etiology AbnormalproductsofconceptionOver15 offertilizedovadonotdivide15 arelostbeforeimplantation 1stweekofgest 25 arelostduringimplantation 2ndweekofgest About60 ofspontaneousabortionsoccurringduring1sttrimesterAbnormalkaryotype 10 chromosomalabnormalitiesgeneticabnormalities unknown infection anatomicdefects endocrinefactors immunologicfactors maternalsystemicdisease Themajorcausesof2nd trimesterabortion anatomicdefectsoftheuterusorcervix septum fetaldemisecircumvallateplacentation 病理 早期流产 无胚胎 结节状胚 圆柱状胚 发育阻滞胚 肢体畸形 神经管缺陷晚期流产 肉样胎块 石胎 压缩胎儿 纸样胎儿 浸软胎儿 脐带异常 临床表现 阴道流血腹痛反复阴道流血 贫血 感染 25 的妊娠在早期可以出现阴道出血腹痛蜕膜 胎盘 胎儿排出有关妊娠的症状消失 临床分类 先兆流产 threatenedabortion 难免流产 inevitableabortion 不全流产 incompleteabortion 完全流产 completeabortion 稽留流产 missedabortion 习惯性流产 habitualabortion 反复性自然流产 recurrentspontaneousabortion RSA 流产合并感染 septicabortion EssentialsofDiagnosis SuprapubicpainanduterinecrampingVaginalbleedingCervicaldilatationExtrusionofproductsofconceptionDisappearanceofsymptomsandsignsofpregnancyNegativepregnancytestorquantitative hCGthatisnotproperlyincreasingAdverseultrasonicfindings eg emptygestationalsac fetaldisorganization lackoffetalgrowth LaboratoryFindings Pregnancytests HCGCompletebloodcountBloodtypeandRhProgesterone corpusluteum 1stcourse chorioplacentalsystem Ultrasonography highlyaccurateindiagnosingimpendingspontaneousabortion especiallytransvaginally