妇产科学-Abortion-课件

AbortionDept.ofOb/GyofDrumTowerHospitalHuyali1PPT课件DefinitionNatureorinducedexpulsionoffetusfromuterusbeforeitisabletosurvive.≤20weeksfromthefirstdayofthelastperiodorafetusweighing<500g(developedcountries)<28weeksfromthefirstdayofthelastperiodorafetusweighing<1000g(ourcountry)2PPT课件ClassificationSpontaneousAbortionInducedorArtificialAbortionEarlyAbortion(1-12week)andLateAbortion(>12week-<28week)3PPT课件EarlyAbortion4PPT课件8weekembryo5PPT课件LateAbortion6PPT课件SpontaneousAbortion

Theincidence:15%-25%wasrecognizedclinically.Near80%occursinfirsttrimester.7PPT课件Etiology:1.Chromosomalabnormalitiesoftheembryoaccountfor50%inearlyspontaneousabortion:trisomymonosomyTriploidytetraploidyaneuploidy,euploidy8PPT课件Etiology2.Maternalinfectiousdiseases,especiallyintrauterineinfections.3.Lutealphasedefect:deficiencyofprogesterone4.Environmentalfactors:Toxins,Radiation,andsoon5.Uterineanomaly:Myoma,Septateuterus,Unicornuateuterus,Intrauterinesynechiae9PPT课件Etiology:6.Thecouple’sgeneticsabnormal:genedisease,balancedtranslocation/carrier7.Immunologicfactors:antiphospholipidsyndromeAPS10PPT课件TypesofthespontaneousabortionThreatenedabortion:slightbleeding,lowabdominalpain,closedcervix,ultrasonographshowsintactpregnantsacandalivingfetusThepregnancycancontinued11PPT课件Threatenedabortion12PPT课件TypesofthespontaneousabortionInevitableabortion:severebleeding,muchpain,dilatedcervix,ruptureofmembranePregnancylossisunavoidable.13PPT课件Inevitableabortion14PPT课件TypesofthespontaneousabortionCompleteabortion:everythingisexpelled.Bleedingsoonstopsandpaindisappear.Incompleteabortion:theproductofpregnancyispartialexpelled.cervixopening,sometissuefillingthecervix,severebleedingHavehighriskininfectionandshock15PPT课件Completeabortion16PPT课件Incompleteabortion17PPT课件TypesofthespontaneousabortionMissedabortion:deadembryoretainintheuterusfor>8weeks.Absenceofuterinegrowth,lossofsomeearlypregnancysymptoms,slightbleeding,DIC18PPT课件TypesofthespontaneousabortionRecurrentabortion:morethantwoconsecutivespontaneousabortion,Habitualabortion:3spontaneousabortionEarlyabortion---greatlikelihoodofchromosomalabnormalityLaterabortion---maternalcause:incompetentcervix,immunologicfactors,anatomicdeformities19PPT课件Treatmentofspontaneousabortion

Threatenedabortion:BedrestProscribingintercourseFollowup:bleeding,pain,ifultrasonographshowsanonviableordevelopingtoInevitableabortionevacuationshouldbecarriedout.20PPT课件TreatmentofspontaneousabortionIncompleteabortion:immediateevacuationandcontrolbleeding,preventinginfection,emotionalsupport21PPT课件TreatmentofspontaneousabortionMissedabortion:Checktheplateletcountandcoagulationfactors.Iftheyarenormalevacuationatonce.IftheyarelowpreventDICfirst.Sometimescurretageisdifficultandgiveprostglandtoinduceabortion22PPT课件

AnOverviewofAbortion

intheUnitedStates23PPT课件PregnanciesintheUnitedStates

(Approximately6.3MillionAnnually)UnintendedIntendedSource:Henshaw,1998(1994data)24PPT课件

OutcomesofUnintendedPregnancies

(Approximately3.0MillionAnnually)Source:Henshaw,1998(1994data)25PPT课件

IncidenceofPregnancyandAbortion:

·

Unintendedpregnancyandabortionarecommonamongallgroupsofwomen.·

Almosthalfofallpregnanciesareunintended.·

Almosthalfofunintendedpregnanciesendinabortion.26PPT课件WhoHasAbortions:AgeSource:Jonesetal.,2002Source:Jonesetal.,200220-24岁25-29岁30-34岁15-19岁27PPT课件WhoHasAbortions:MaritalStatusSource:Jonesetal.,2002未婚已婚离婚28PPT课件WhoHasAbortions:

Race/EthnicitySource:Jonesetal.,2002*Non-Hispanicwhiteblackasianhispanic29PPT课件WhoHasAbortions:

ReligiousIdentificationSource:Jonesetal.,2002protestantcatholicothernon30PPT课件WhoHasAbortions:

PriorPregnancies Source:Jonesetal.,2002PreviousabortionandbirthPreviousabortionnonePreviousbirth31PPT课件

WhoHasAbortions,Whyand

WheninPregnancy:·

Womenhavingabortionsarepredominantlyyoung,single,fromminoritygroupsandlow-income.·

Mostwomenhavemultiplereasonsforchoosingtohaveanabortion.·

Almost90%ofabortionsoccurinthefirsttrimester.32PPT课件PercentofAbortionsPerformedby

EachTypeofProviderSource:FinerandHenshaw,200333PPT课件PercentageofMaternalMortalityWorldwideDuetoUnsafeAbortion

Source:WHO,1998(Estimatesfor1995–2000)UnsafeabortionOthercauses34PPT课件AbortionRisksinPerspective

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,199835PPT课件AbortionsbyGestationalAge

(WeeksSinceLastMenstr