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 (20~ 28w,500~ 1000g)
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
Etiology
★ Abnormal products of conception
? Over 15% of fertilized ova do not divide
? 15% 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 trimester
? Abnormal karyotype:≥10% ---chromosomal
abnormalities
? genetic 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 demise
? circumvallate 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
Laboratory Findings
? Pregnancy tests β-HCG
? Complete blood count
? Blood type and Rh
? Progesterone- corpus luteum(1st
course),chorioplacental system,
? Ultrasonography- highly accurate in
diagnosing impending spontaneous
abortion,especially transvaginally
临床表现
? 阴道流血
? 腹痛
? 早期流产
? 晚期流产
? 反复阴道流血、贫血、感染
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)
? 复发性自然流产
( recurrent
spontaneous abortion,
RSA)
? 流产合并感染( septic
abortion)
诊断及辅助检查
?病史
?体格检查
?辅助检查,B型超声,β -
HCG、染色体等
Essentials of Diagnosis
? Suprapubic pain and uterine cramping
? Vaginal bleeding
? Cervical dilatation
? Extrusion of products of conception
? Disappearance of symptoms and signs of
pregnancy
? Negative pregnancy test or quantitative β-hCG
that is not properly increasing
? Adverse ultrasonic findings(eg,empty gestational
sac,fetal disorganization,lack of fetal growth).
鉴别诊断
? 先兆流产
? 难免流产
? 不全流产
? 完全流产
? 异位妊娠
? 葡萄胎
? 功能失调性子宫出血
? 盆腔炎
? 阑尾炎
治疗原则
? 先兆流产
? 难免流产
? 不全流产
? 完全流产
? 稽留流产
? 习惯性流产
? 流产合并感染