国家级精品课《妇产科学》流产

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(2028w,5001000g),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, Abnormal products of conceptionOver 15% of fertilized ova do not divide15% are lost before implantation (1st week of gest)25% are lost during implantation (2nd week of gest) About 60% of spontaneous abortions occurring during 1st trimesterAbnormal karyotype:10% -chromosomal abnormalitiesgenetic abnormalities unknown infection anatomic defects endocrine factors immunologic factors maternal systemic disease The major causes of 2nd-trimester abortion:anatomic defects of the uterus or cervix(septum)fetal demisecircumvallate placentation,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（threatened abortion）难免流产（inevitable abortion）不全流产（incomplete abortion）完全流产（complete abortion）,稽留流产（missed abortion）习惯性流产（habitual abortion）反复性自然流产（recurrent spontaneous abortion, RSA）流产合并感染（septic abortion）,Essentials of Diagnosis,Suprapubic pain and uterine crampingVaginal bleedingCervical dilatationExtrusion of products of conceptionDisappearance of symptoms and signs of pregnancyNegative pregnancy test or quantitative -hCG that is not properly increasingAdverse ultrasonic findings(eg, empty gestational sac, fetal disorganization, lack of fetal growth).,Laboratory Findings,Pregnancy tests -HCG Complete blood countBlood type and RhProgesteronecorpus luteum(1st course). chorioplacental system. Ultrasonographyhighly accurate in diagnosing impending spontaneous abortion, especially transv