Abortion
流产
Ⅰ, Definition
? Abortion is termination of pregnancy before
28 weeks of gestation and the fetal weight is
less tan 1000g.
? Abortion, spontaneous,10%~18%
artificial
? The early abortion,occurs before 12w
? The late abortion,occurs after 12w
2.Etiology
? (1)Heredity factors
Abnomalities of chromosomesis the
commonest cause of Spontaneous abortion.
Early abortion 50%~60% is caused by
chromosomal abnormalities,
(2)Maternal factors
? ① the general diseases
? ② endocrine disorder
?③ the genital disease
? A.uterine deformity
? B.pelvic tumor(myoma,ovarian tumor)
? C.cervical incompetence,laceration
?④ abdominal operation during the
pregnancy
? (3)Toxic factors,
lead,mercury,DDT,radiation,X-ray
? (4)Immunologic factors
Blood type in compatibility between
mother and fatus.
Imcompatibilily due to ABO,Rh
3.Pathologic change
? Most commonly,necrotic changes occur in
the decidual tissue about the placentation
site and result in hemorrhage into this area,
As bleeding continues,the sac and the
placenta become detached from the uterine
wall and are expelled by uterine
contractions.
4.Clinical classification and feature
? (1) Threatened abortion
? (2)Inevitable abortion
? (3)Incomplete abortion
? (4)complete abortion
? (5)Missed abortion
? (6)Habitual abortion
? (7)Septic abortion(infect abortion)
Differential diagnosis of varied abortions
Thr e at e n e d I ne vi t abl e I m c om pl e t e C om pl e t e
H i s t or y
Bl e e di ng Sl i ght M i ddl e → s e ve r a Sl i ght → s e ve r a Sl i ght → no
A b dom i nal p ai n N o/ s l i ght A ggr ava t e D e c r e s e No
T i s s ue s ar e
e xpe l l e d
No No Y e s ( par t i al ) C om pl e t e
G yne c ol ogi c e xam i nat i on
C e r vi c al os C l os e O pe n O pe n/ t i s s ue bl oc hk C l os e
U t e r i ne s i z e C ons i s t e nt w i t h = / s l i ght s m al l < = / s l i ght l ar ge r
Pr e gna nc y t e s t + + / - + / - + / -
T r e at m e nt
pr i nc i pl e
Pr ot e c t f e t us C ur e t t age C ur e t t age no
Missed abortion
? It is that pregnancy has been retained for 2
months or more following death of the fetus.
? The abnormally protracted retention of a
dead fetus in uterus in over 2 months that
don’t expelled.
? Missed abortion is manifested by loss of
symptoms of pregnancy and decrease in
uterine size.
Habitual abortion(recurrent)
? Recurrent,or habitual,is the sequential 3 or
more spontaneous abortion.
? Every abortion times is or not same month
of pregnancy,
Early cause
? ① hypofunction of corpus luteum
? ② emotion factor
? ③ hypopituitarism
? ④ chromosomal abonormalities
Late abortion
? (1)incompetence of the cervix
? (2)congenital anomalies of the uterus
? (3)myomas of the uterus
? (4)blood type incompatibility between
mother and fetus
5,Diagnosis
(1)History
? ① amenorrhea,recurrent abortion symptoms
of pregnancy
? ② the degree of abdominal pain,vaginal
bleeding
? ③ the products of gestation were expelled or
not
(2)Examination
? ① general examination,temperature,pulse,
respiration,blood pressure.
? ② vaginal examination,
uterine size,compared to the expected
date of pregnancy
cervical os,open or close
uterine tendeness
(3)anxillary examination
? ① pregnancy test,HCG<625IU/L→abortion
? ② measurement of HPL
5~10w,hpl≤0.01mg/L
? ③ measurement of E2(estroid)
E2<740pmol/L
? ④ measurement of pregnanediol
24h urinary<15.6μ/24h,95%→abortion
? ⑤ B-ultrasound
differential of varieties of abortion
gestation sac,embryo status,fetal heart
tones,fetus movement
Incompetence of the cervix,cervical
os>19mm and have history of abortion
Normal pregnancy
incomplete septic
threatened inevitable infection
proceed complete
delaied
treatment
missed habitual
6,Treatment
(1)Threatened abortion
? Principle,protect fetus treatment
? ① bed rest
forbid sexual intercourse
? ② drug
folic acid 5mg tid,Po.
If corpus luteum or low of uterine
pregnanediol progesterone 20mg Qd,Im.
VE 30~50mg Qd po.
Seditive,valium 2.5mg po,
(2)Inevitable and incomplete
abortion
? At once D&C(curettage) dilatation
? if bleeding is brisk blood transfusion
oxytosin 5~10u iv/im
? incomplete abortion antibiotic used for
preventive infection
tissue examination by a pathologist
(3)Complete abortion
? When the uterus is empty,there are no need
for further interference.
(4)Missed abortion
? After diagnosis of it,as soon as expelled
product of conception is necessary.
? Because the fetus dead,placenta release
thrombocinatse into blood circulation ease
occure in coagulability.lead to disseminated
intravascular coagulation(DIC)
? ② leveral uterine sentition
DES(diethylstibestrol)5~10mg tid po 5d
? ③ before curettage,preparey blood
during opreation,oxytocin 10u im/iv
over than 3 month of pregnancy artificial
inducte,
(5)Habitual abortion
? The first should be examinatin cause of
habitual abortion and treatment.
? 1)rest,increase nutrition,VB,VC,VE…
? 2)medical treatment,hypofunction of
corpus luteum--progesterone
? 3)surgical treatment:
① correction of congenital anomalies of
uterus,removed of myomas
② repair of the incompetent cervix.12~20w
(7)Septic abortion
? The principle of treatment:
bleeding is a few,first treat infection with
broad-spectrum antibiotiss
second D&C
bleeding is sever,we are eryher contract
infection or curettage,
? ※ The producte of conception from the
cervix are removed with a sponge holder.
? Don’t used curette to curettage curettage
uterine wall prevent infection
? avoid hematogeous dissemination od the
infection,
流产
Ⅰ, Definition
? Abortion is termination of pregnancy before
28 weeks of gestation and the fetal weight is
less tan 1000g.
? Abortion, spontaneous,10%~18%
artificial
? The early abortion,occurs before 12w
? The late abortion,occurs after 12w
2.Etiology
? (1)Heredity factors
Abnomalities of chromosomesis the
commonest cause of Spontaneous abortion.
Early abortion 50%~60% is caused by
chromosomal abnormalities,
(2)Maternal factors
? ① the general diseases
? ② endocrine disorder
?③ the genital disease
? A.uterine deformity
? B.pelvic tumor(myoma,ovarian tumor)
? C.cervical incompetence,laceration
?④ abdominal operation during the
pregnancy
? (3)Toxic factors,
lead,mercury,DDT,radiation,X-ray
? (4)Immunologic factors
Blood type in compatibility between
mother and fatus.
Imcompatibilily due to ABO,Rh
3.Pathologic change
? Most commonly,necrotic changes occur in
the decidual tissue about the placentation
site and result in hemorrhage into this area,
As bleeding continues,the sac and the
placenta become detached from the uterine
wall and are expelled by uterine
contractions.
4.Clinical classification and feature
? (1) Threatened abortion
? (2)Inevitable abortion
? (3)Incomplete abortion
? (4)complete abortion
? (5)Missed abortion
? (6)Habitual abortion
? (7)Septic abortion(infect abortion)
Differential diagnosis of varied abortions
Thr e at e n e d I ne vi t abl e I m c om pl e t e C om pl e t e
H i s t or y
Bl e e di ng Sl i ght M i ddl e → s e ve r a Sl i ght → s e ve r a Sl i ght → no
A b dom i nal p ai n N o/ s l i ght A ggr ava t e D e c r e s e No
T i s s ue s ar e
e xpe l l e d
No No Y e s ( par t i al ) C om pl e t e
G yne c ol ogi c e xam i nat i on
C e r vi c al os C l os e O pe n O pe n/ t i s s ue bl oc hk C l os e
U t e r i ne s i z e C ons i s t e nt w i t h = / s l i ght s m al l < = / s l i ght l ar ge r
Pr e gna nc y t e s t + + / - + / - + / -
T r e at m e nt
pr i nc i pl e
Pr ot e c t f e t us C ur e t t age C ur e t t age no
Missed abortion
? It is that pregnancy has been retained for 2
months or more following death of the fetus.
? The abnormally protracted retention of a
dead fetus in uterus in over 2 months that
don’t expelled.
? Missed abortion is manifested by loss of
symptoms of pregnancy and decrease in
uterine size.
Habitual abortion(recurrent)
? Recurrent,or habitual,is the sequential 3 or
more spontaneous abortion.
? Every abortion times is or not same month
of pregnancy,
Early cause
? ① hypofunction of corpus luteum
? ② emotion factor
? ③ hypopituitarism
? ④ chromosomal abonormalities
Late abortion
? (1)incompetence of the cervix
? (2)congenital anomalies of the uterus
? (3)myomas of the uterus
? (4)blood type incompatibility between
mother and fetus
5,Diagnosis
(1)History
? ① amenorrhea,recurrent abortion symptoms
of pregnancy
? ② the degree of abdominal pain,vaginal
bleeding
? ③ the products of gestation were expelled or
not
(2)Examination
? ① general examination,temperature,pulse,
respiration,blood pressure.
? ② vaginal examination,
uterine size,compared to the expected
date of pregnancy
cervical os,open or close
uterine tendeness
(3)anxillary examination
? ① pregnancy test,HCG<625IU/L→abortion
? ② measurement of HPL
5~10w,hpl≤0.01mg/L
? ③ measurement of E2(estroid)
E2<740pmol/L
? ④ measurement of pregnanediol
24h urinary<15.6μ/24h,95%→abortion
? ⑤ B-ultrasound
differential of varieties of abortion
gestation sac,embryo status,fetal heart
tones,fetus movement
Incompetence of the cervix,cervical
os>19mm and have history of abortion
Normal pregnancy
incomplete septic
threatened inevitable infection
proceed complete
delaied
treatment
missed habitual
6,Treatment
(1)Threatened abortion
? Principle,protect fetus treatment
? ① bed rest
forbid sexual intercourse
? ② drug
folic acid 5mg tid,Po.
If corpus luteum or low of uterine
pregnanediol progesterone 20mg Qd,Im.
VE 30~50mg Qd po.
Seditive,valium 2.5mg po,
(2)Inevitable and incomplete
abortion
? At once D&C(curettage) dilatation
? if bleeding is brisk blood transfusion
oxytosin 5~10u iv/im
? incomplete abortion antibiotic used for
preventive infection
tissue examination by a pathologist
(3)Complete abortion
? When the uterus is empty,there are no need
for further interference.
(4)Missed abortion
? After diagnosis of it,as soon as expelled
product of conception is necessary.
? Because the fetus dead,placenta release
thrombocinatse into blood circulation ease
occure in coagulability.lead to disseminated
intravascular coagulation(DIC)
? ② leveral uterine sentition
DES(diethylstibestrol)5~10mg tid po 5d
? ③ before curettage,preparey blood
during opreation,oxytocin 10u im/iv
over than 3 month of pregnancy artificial
inducte,
(5)Habitual abortion
? The first should be examinatin cause of
habitual abortion and treatment.
? 1)rest,increase nutrition,VB,VC,VE…
? 2)medical treatment,hypofunction of
corpus luteum--progesterone
? 3)surgical treatment:
① correction of congenital anomalies of
uterus,removed of myomas
② repair of the incompetent cervix.12~20w
(7)Septic abortion
? The principle of treatment:
bleeding is a few,first treat infection with
broad-spectrum antibiotiss
second D&C
bleeding is sever,we are eryher contract
infection or curettage,
? ※ The producte of conception from the
cervix are removed with a sponge holder.
? Don’t used curette to curettage curettage
uterine wall prevent infection
? avoid hematogeous dissemination od the
infection,
