abortion

ABORTION,流 产one of the diseases of abnormal pregnancy,Definition,termination of pregnancy before the 28th week of gestation, the weight of fetus less than 1000g.,Abnormal duration of pregnancy,Abortion Premature delivery 早产 Postterm pregnancy 过期妊娠,28 37 40 42,Categories,spontaneous abortion (miscarriage ) 自然流产 induced abortion (artificial) 人工流产 early abortion (before 12th week) late abortion (12th 28th week),Incidence,about 10%15%It is not precise 80% of abortions: before the 12th week most of these: before the 8th week,Etiology,A. Embryonic factors (Hereditary遗传 factors) B. Maternal factors C. Immunologic factorsD. Environmental factors,A. embryonic factors,Chromosome abnormalities of zygote（受精卵） or embryo is the most common cause (50%-60%) -abnormalities of the number or structure eg. trisomy三体 or monosomy单体, triploidy三倍体, polyploidy多倍体, translocation易位,B. Maternal factors,Systemic diseases Genital organ abnormalities Endocrine disorders Emotional disturbance and harmful habit,C. Immunological factors,The implanted embryo are regarded as an allograft（同种异体移植物） containing foreign antigens which derive from the paternal genome.,D. Environmental factors,Chemical materialsPhysical factors drugs, lead and radiation,Pathology(early abortion ),Embryo death,Decidua basalisbleeding,Detached embryo,retroplacental hematoma,uterine contractionscervical dilatation,abortion,Vaginal bleeding,Abdominal pain,底蜕膜出血,胎盘后血肿, 12th week: the placenta is well formed. expulsion of fetus followed by placenta,Clinical aspects,Amenorrhea（闭经） Vaginal bleeding Lower abdominal pain Cervical os (dilates or not) Size of the uterus 12 week, vaginal bleeding first, then lower abdominal pain 12 week, lower abdominal pain first, then vaginal bleeding,Clinical categories, threatened abortion 先兆流产 inevitable abortion 难免流产 incomplete abortion 不全流产 complete abortion 完全流产,A. Threatened abortion,Slight vaginal bleeding With or without lower abdominal pain. Cervix is closed The size of the uterus corresponds to thegestational age Pregnancy may continue,B. Inevitable abortion,Vaginal bleeding is increased Abdominal pain becomes stronger Cervical os is dilated The size of uterus corresponds with or smaller than the gestational age Abortion is impending,C. Incomplete abortion,vaginal bleeding is profuse cervical os is dilated size of the uterus is smaller than gestational age.,D. Complete abortion,Vaginal bleeding cease Abdominal pain cease Cervix closes again Uterus becomes smaller and firmer to normal.,pregnancy continues threatened abortion incomplete abortion inevitable abortion complete abortion,Clinical categories actually is general process of spontaneous abortion,Diagnosis,A. History amenorrhea symptoms of early pregnancy amount and duration of vaginal bleeding character of abdominal pain and expulsion tissues,B. Clinical examination,General examinationPelvic examination cervix uterus: size and tenderness adnexa (the uterine appendages附件),C. Assistant examination,Ultrasound great value in diagnosis to distinguish the stage of abortion HCG test quantitatively lower than normalOther hormone progesterone（孕酮）,Plantule胚芽,Cyst胚囊,Treatment,A. Threatened abortion: Expectant observationadvise the patient taking restforbid intercourse observe the patients progress. progesterone, HCG,B. Inevitable & incomplete abortion,D&C (dilatation and curettage ) suction oxytocin(缩宫素) be given blood transfusion may be required antibiotics: risk of infection The tissues removed should be sent for pathologic examination.,C. Complete abortion,no particular management,Special abortion,missed abortion 稽留流产 habitual (recurrent) abortion 反复流产 septic abortion 流产感染,A. Missed abortion,Embryo or fetus died in uterus and was not expelled in time. Pain and bleeding minimal. Pregnancy symptoms ceased. Uterus smaller than expected for dates. Cervix os closed. B scan: absence of fetal heart activity.,Treatment,D&CCheck coagulation functionUse large dosage of estrogen before operation,B. Habitual abortion (recurrent abortion),Spontaneous abortion occurs consecutively two or more times Associated factors: Chromosomal abnormality Immune conditions Endocrine disorders Cervical incompetence（宫颈机能不全） Uterine abnormality,Treatment,Treatment according to causes Uterine malformation: hysteroscopy(宫腔镜) Cervical incompetence: cerclage(环扎术)Cause unexplained: Progesterone hCG,C. Septic abortion,Abortion complicated by infectionSept