Abortion妇产科学-课件

AbortionAbortion1DefinitionNatureorinducedexpulsionoffetusfromuterusbeforeitisabletosurvive.≤20weeksfromthefirstdayofthelastperiodorafetusweighing<500g(developedcountries)<28weeksfromthefirstdayofthelastperiodorafetusweighing<1000g(ourcountry)DefinitionNatureorinducedex2ClassificationSpontaneousAbortionInducedorArtificialAbortionEarlyAbortion(1-12week)andLateAbortion(>12week-<28week)ClassificationSpontaneousAbor3EarlyAbortionEarlyAbortion48weekembryo8weekembryo5LateAbortionLateAbortion6SpontaneousAbortion

Theincidence:15%-25%wasrecognizedclinically.Near80%occursinfirsttrimester.SpontaneousAbortion

Theincid7Etiology:1.Chromosomalabnormalitiesoftheembryoaccountfor50%inearlyspontaneousabortion:trisomymonosomyTriploidytetraploidyaneuploidy,euploidyEtiology:8Etiology2.Maternalinfectiousdiseases,especiallyintrauterineinfections.3.Lutealphasedefect:deficiencyofprogesterone4.Environmentalfactors:Toxins,Radiation,andsoon5.Uterineanomaly:Myoma,Septateuterus,Unicornuateuterus,IntrauterinesynechiaeEtiology2.Maternalinfectious9Etiology:6.Thecouple’sgeneticsabnormal:genedisease,balancedtranslocation/carrier7.Immunologicfactors:antiphospholipidsyndromeAPSEtiology:6.Thecouple’sgeneti10TypesofthespontaneousabortionThreatenedabortion:slightbleeding,lowabdominalpain,closedcervix,ultrasonographshowsintactpregnantsacandalivingfetusThepregnancycancontinuedTypesofthespontaneousabort11ThreatenedabortionThreatenedabortion12TypesofthespontaneousabortionInevitableabortion:severebleeding,muchpain,dilatedcervix,ruptureofmembranePregnancylossisunavoidable.Typesofthespontaneousabort13InevitableabortionInevitableabortion14TypesofthespontaneousabortionCompleteabortion:everythingisexpelled.Bleedingsoonstopsandpaindisappear.Incompleteabortion:theproductofpregnancyispartialexpelled.cervixopening,sometissuefillingthecervix,severebleedingHavehighriskininfectionandshockTypesofthespontaneousabort15CompleteabortionCompleteabortion16IncompleteabortionIncompleteabortion17TypesofthespontaneousabortionMissedabortion:deadembryoretainintheuterusfor>8weeks.Absenceofuterinegrowth,lossofsomeearlypregnancysymptoms,slightbleeding,DICTypesofthespontaneousabort18TypesofthespontaneousabortionRecurrentabortion:morethantwoconsecutivespontaneousabortion,Habitualabortion:3spontaneousabortionEarlyabortion---greatlikelihoodofchromosomalabnormalityLaterabortion---maternalcause:incompetentcervix,immunologicfactors,anatomicdeformitiesTypesofthespontaneousabort19Treatmentofspontaneousabortion

Threatenedabortion:BedrestProscribingintercourseFollowup:bleeding,pain,ifultrasonographshowsanonviableordevelopingtoInevitableabortionevacuationshouldbecarriedout.Treatmentofspontaneousabort20TreatmentofspontaneousabortionIncompleteabortion:immediateevacuationandcontrolbleeding,preventinginfection,emotionalsupportTreatmentofspontaneousabort21TreatmentofspontaneousabortionMissedabortion:Checktheplateletcountandcoagulationfactors.Iftheyarenormalevacuationatonce.IftheyarelowpreventDICfirst.SometimescurretageisdifficultandgiveprostglandtoinduceabortionTreatmentofspontaneousabort22

AnOverviewofAbortion

intheUnitedStates

AnOverviewofAbortion

int23PregnanciesintheUnitedStates

(Approximately6.3MillionAnnually)UnintendedIntendedSource:Henshaw,1998(1994data)PregnanciesintheUnitedStat24

OutcomesofUnintendedPregnancies

(Approximately3.0MillionAnnually)Source:Henshaw,1998(1994data)OutcomesofUnintendedPregna25

IncidenceofPregnancyandAbortion:

·

Unintendedpregnancyandabortionarecommonamongallgroupsofwomen.·

Almosthalfofallpregnanciesareunintended.·

Almosthalfofunintendedpregnanciesendinabortion.

IncidenceofPregnancyandAb26WhoHasAbortions:AgeSource:Jonesetal.,2002Source:Jonesetal.,200220-24岁25-29岁30-34岁15-19岁WhoHasAbortions:AgeSource:27WhoHasAbortions:MaritalStatusSource:Jonesetal.,2002未婚已婚离婚WhoHasAbortions:MaritalSta28WhoHasAbortions:

Race/EthnicitySource:Jonesetal.,2002*Non-HispanicwhiteblackasianhispanicWhoHasAbortions:

Race/Ethni29WhoHasAbortions:

ReligiousIdentificationSource:Jonesetal.,2002protestantcatholicothernonWhoHasAbortions:

ReligiousI30WhoHasAbortions:

PriorPregnancies Source:Jonesetal.,2002PreviousabortionandbirthPreviousabortionnonePreviousbirthWhoHasAbortions:

PriorPreg31

WhoHasAbortions,Whyand

WheninPregnancy:·

Womenhavingabortionsarepredominantlyyoung,single,fromminoritygroupsandlow-income.·

Mostwomenhavemultiplereasonsforchoosingtohaveanabortion.·

Almost90%ofabortionsoccurinthefirsttrimester.

WhoHasAbortions,Whyand

32PercentofAbortionsPerformedby

EachTypeofProviderSource:FinerandHenshaw,2003PercentofAbortionsPerformed33PercentageofMaternalMortalityWorldwideDuetoUnsafeAbortionSource:WHO,1998(Estimatesfor1995–2000)UnsafeabortionOthercausesPercentageofMaternalMortali34AbortionRisksinPerspective

ChanceofdeathRiskfromterminatingpregnancy: peryear:Before9weeks 1in500,000Between9and10weeks 1in300,000Between13and15weeks 1in60,000After20weeks 1in8,000Risktopersonswhoparticipatein:Motorcycling 1in1,000Automobiledriving 1in5,900Power-boating 1in5,900Playingfootball 1in25,000Risktowomenaged15–44from:Havingsexualintercourse(PID) 1in50,000Usingtampons 1in350,000

Source:Gold,1990;Trussell,1998AbortionRisksinPerspective 35AbortionsbyGestationalAge

(WeeksSinceLastMenstrualPeriod)Source:Elam-Evansetal.,2002(1999data)AbortionsbyGestationalAge

36Deathsper100,000

AbortionsorBirthsSource:Gold1990(1981–1985data)Deathsper100,000

Abortions37PercentageDistributionof

AbortionDeathsSource:Lawsonetal.,1994(1983–1987data)PercentageDistributionof

Ab38Thankyou!Thankyou!Thankyou!Thankyou!39AbortionAbortion40DefinitionNatureorinducedexpulsionoffetusfromuterusbeforeitisabletosurvive.≤20weeksfromthefirstdayofthelastperiodorafetusweighing<500g(developedcountries)<28weeksfromthefirstdayofthelastperiodorafetusweighing<1000g(ourcountry)DefinitionNatureorinducedex41ClassificationSpontaneousAbortionInducedorArtificialAbortionEarlyAbortion(1-12week)andLateAbortion(>12week-<28week)ClassificationSpontaneousAbor42EarlyAbortionEarlyAbortion438weekembryo8weekembryo44LateAbortionLateAbortion45SpontaneousAbortion

Theincidence:15%-25%wasrecognizedclinically.Near80%occursinfirsttrimester.SpontaneousAbortion

Theincid46Etiology:1.Chromosomalabnormalitiesoftheembryoaccountfor50%inearlyspontaneousabortion:trisomymonosomyTriploidytetraploidyaneuploidy,euploidyEtiology:47Etiology2.Maternalinfectiousdiseases,especiallyintrauterineinfections.3.Lutealphasedefect:deficiencyofprogesterone4.Environmentalfactors:Toxins,Radiation,andsoon5.Uterineanomaly:Myoma,Septateuterus,Unicornuateuterus,IntrauterinesynechiaeEtiology2.Maternalinfectious48Etiology:6.Thecouple’sgeneticsabnormal:genedisease,balancedtranslocation/carrier7.Immunologicfactors:antiphospholipidsyndromeAPSEtiology:6.Thecouple’sgeneti49TypesofthespontaneousabortionThreatenedabortion:slightbleeding,lowabdominalpain,closedcervix,ultrasonographshowsintactpregnantsacandalivingfetusThepregnancycancontinuedTypesofthespontaneousabort50ThreatenedabortionThreatenedabortion51TypesofthespontaneousabortionInevitableabortion:severebleeding,muchpain,dilatedcervix,ruptureofmembranePregnancylossisunavoidable.Typesofthespontaneousabort52InevitableabortionInevitableabortion53TypesofthespontaneousabortionCompleteabortion:everythingisexpelled.Bleedingsoonstopsandpaindisappear.Incompleteabortion:theproductofpregnancyispartialexpelled.cervixopening,sometissuefillingthecervix,severebleedingHavehighriskininfectionandshockTypesofthespontaneousabort54CompleteabortionCompleteabortion55IncompleteabortionIncompleteabortion56TypesofthespontaneousabortionMissedabortion:deadembryoretainintheuterusfor>8weeks.Absenceofuterinegrowth,lossofsomeearlypregnancysymptoms,slightbleeding,DICTypesofthespontaneousabort57TypesofthespontaneousabortionRecurrentabortion:morethantwoconsecutivespontaneousabortion,Habitualabortion:3spontaneousabortionEarlyabortion---greatlikelihoodofchromosomalabnormalityLaterabortion---maternalcause:incompetentcervix,immunologicfactors,anatomicdeformitiesTypesofthespontaneousabort58Treatmentofspontaneousabortion

Threatenedabortion:BedrestProscribingintercourseFollowup:bleeding,pain,ifultrasonographshowsanonviableordevelopingtoInevitableabortionevacuationshouldbecarriedout.Treatmentofspontaneousabort59TreatmentofspontaneousabortionIncompleteabortion:immediateevacuationandcontrolbleeding,preventinginfection,emotionalsupportTreatmentofspontaneousabort60TreatmentofspontaneousabortionMissedabortion:Checktheplateletcountandcoagulationfactors.Iftheyarenormalevacuationatonce.IftheyarelowpreventDICfirst.SometimescurretageisdifficultandgiveprostglandtoinduceabortionTreatmentofspontaneousabort61

AnOverviewofAbortion

intheUnitedStates

AnOverviewofAbortion

int62PregnanciesintheUnitedStates

(Approximately6.3MillionAnnually)UnintendedIntendedSource:Henshaw,1998(1994data)PregnanciesintheUnitedStat63

OutcomesofUnintendedPregnancies

(Approximately3.0MillionAnnually)Source:Henshaw,1998(1994data)OutcomesofUnintendedPregna64

IncidenceofPregnancyandAbortion:

·

Unintendedpregnancyandabortionarecommonamongallgroupsofwomen.·

Almosthalfofallpregnanciesareunintended.·

Almosthalfofunintendedpregnanciesendinabortion.

IncidenceofPregnancyandAb65WhoHasAbortions:AgeSource:Jonesetal.,2002Source:Jonesetal.,200220-24岁25-29岁30-34岁15-19岁WhoHasAbortions:AgeSource:66WhoHasAbortions:MaritalStatusSource:Jonesetal.,2002未婚已婚离婚WhoHasAbortions:MaritalSta67WhoHasAbortions:

Race/EthnicitySource:Jonesetal.,2002*Non-HispanicwhiteblackasianhispanicWhoHasAbortions:

Race/Ethni68WhoHasAbortions:

ReligiousIdentificationSource:Jonesetal.,2002protestantcatholicothernonWhoHasAbortions:

ReligiousI69WhoHasAbortions:

PriorPregnancies Source:Jonesetal.,2002PreviousabortionandbirthPreviousabortionnonePreviousbirthWhoHasAbortions:

PriorPreg70

WhoHasAbortions,Whyand

WheninPregnancy:·

Womenhavingabortionsarepredominantlyyoung,single,fromminoritygroupsandlow-income.·

Mostwomenhavemultiplereasonsforchoosingtohaveanabortion.·

Almost90%ofabortionsoccurinthefirsttrimester.

WhoHasAbortions,Whyand

71PercentofAbortionsPerformedby

EachTypeofProviderSource:FinerandHenshaw,2003PercentofAbortionsPerformed72PercentageofMat