国家级精品课《妇产科学》课件流产

流产Abortion,复旦大学附属妇产科医院隋龙,定义,流产(abortion):28w1000g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,AbnormalproductsofconceptionOver15%offertilizedovadonotdivide15%arelostbeforeimplantation(1stweekofgest)25%arelostduringimplantation(2ndweekofgest)About60%ofspontaneousabortionsoccurringduring1sttrimesterAbnormalkaryotype:10%-chromosomalabnormalitiesgeneticabnormalitiesunknowninfectionanatomicdefectsendocrinefactorsimmunologicfactorsmaternalsystemicdiseaseThemajorcausesof2nd-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-HCGCompletebloodcountBloodtypeandRhProgesteronecorpusluteum(1stcourse).chorioplacentalsystem.Ultrasonographyhighlyaccurateindiagnosingimpendingspontaneousabortion,especiallytransvaginally