What`s abortion? Abortion is termination of pregnancy before 28 weeks of gestation and the fetal weight is less than 1000g. 流产是指 妊娠不足28周、胎儿体重不足1000g而终止者。

Presentation on theme: "What`s abortion? Abortion is termination of pregnancy before 28 weeks of gestation and the fetal weight is less than 1000g. 流产是指 妊娠不足28周、胎儿体重不足1000g而终止者。"— Presentation transcript:

1 What`s abortion? Abortion is termination of pregnancy before 28 weeks of gestation and the fetal weight is less than 1000g. 流产是指 妊娠不足28周、胎儿体重不足1000g而终止者。

2 Classification early abortion(早期流产) late abortion (晚期流产)
The time of termination of pregnancy early abortion(早期流产) late abortion (晚期流产) The way of termination of pregnancy Spontaneous abortion (自然流产) induced abortion (人工流产)

3 Spontaneous abortion Incidence： 10％－15％ 80%（early abortion）

4 病因 胎儿因素 母体因素 环境因素

5 胎儿因素 染色体数目异常：三体﹑X单体﹑三倍体及四倍体 染色体结构异常：易位、嵌合体，染色体倒置﹑ 缺失和重叠。

6 母体因素 全身性疾病 内分泌异常 免疫异常 子宫畸形 创伤和不良生活习惯

7 环境因素 接触有毒物质和气体

8 Frist module Pathology 胚胎死亡 底蜕膜与绒毛分离 出 血 胚胎分离 子宫收缩 排出胚胎

9 The character of abortion with the time of gestation
8W～12W < 8W 绒毛发育不成熟，与子宫蜕膜联系不牢固,胚胎绒毛易与底蜕膜分离。 绒毛发育茂盛，与子宫蜕膜联系较牢固，妊娠物不易完整排出。 完全流产 不全流产 12W ～28W 胎盘已完全形成，先出现腹痛，然后排出胎儿、胎盘。

10 Clinical findings 停经amenorrhea 阴道流血vaginal bleeding(hemorrhage )
腹痛abdomenal pain ＜12W，先出现阴道流血，后出现腹痛。 ＞12W，先出现腹痛，后出现阴道流血。

11 Clinical types 自然流产的临床过程 几种特殊类型的流产 习惯性流产（habitual abortion)
pregnancy Threatened abortion Inevitable Complete Incomplete 几种特殊类型的流产 习惯性流产（habitual abortion) 流产合并感染(septic abortion) 稽留流产（missed abortion)

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15 Diagnosis History Physical Examination (gynaecological Examination)
Assisted examinations： Pregnancy test Progesterone value Ultrasonography

16 Ultrasonography

17 treatment Third module 根据类型相应处理 Incomplete abortion
threatened abortion inevitable abortion complete abortion Incomplete abortion 习惯性流产（habitual abortion) 流产合并感染(septic abortion) 稽留流产（missed abortion)

18 Treatment of threatened abortion
卧床休息，禁性生活 (Bed rest, forbid sexual intercourse.) 药物治疗(Drug treatment) 黄体酮、 HCG、VitE或 其他对症治疗 病因治疗 治疗后流血停止，B超提示胚胎存活，继续妊娠 症状加重，B超提示胎儿发育不良，ß-HCG下降或不升，提示流产不可避免， 终止妊娠。

19 Treatment of inevitable abortion or incomplete abortion
尽早刮宫， 检查妊娠物，送病检。 如出血多， 可予缩宫素或米索促子宫收缩 必要时抗炎、抗休克治疗

20 Treatment of Complete abortion
无感染征象，不需特殊处理。 No further treatment

21 habitual abortion 特殊类型的流产
3 or more consecutive pregnancy losses before 28 weeks gestation,each with a fetus weighing less than 1000g. 复发性流产（recurrent abortion) 连续2次或以上的流产 临床特征： 每次流产多发生于同一妊娠月份，其临床经过与一般流产相同。

22 Treatment of habitual abortion
黄体酮或HCG治疗,超过以往发生流产月份； 口服VitE； 卧床休息，禁性生活。 强调病因治疗： 早期流产的常见原因：胚胎染色体异常 孕前夫妻双方检查；免疫治疗； 晚期流产的常见原因：宫颈内口松弛 孕前修补；或于孕12-18w 行内口 环扎术。

23 流产感染(septic abortion)
多见于阴道流血时间较长的流产患者，以及不全流产或不洁流产时。临床表现为下腹痛、阴道有恶臭分泌物，双合诊宫颈摇摆痛。 原则迅速控制感染，尽快清除宫内残留物。 轻度感染或出血较多，抗感染同时刮宫；　　 感染较重出血不多者，控制感染后刮宫。 用卵圆钳夹出残留组织。 广谱抗生素控制感染后彻底刮宫

24 missed abortion implies that the pregnancy has been
retained following death of the fetus.

25 Case 1 of amenorrhoea for more than 5 months and feeling
A 30 year-old woman came to the clinic because of amenorrhoea for more than 5 months and feeling no fetal activity . she had a positive result of a urine pregnancy test on the days after the first day of her last normal menstrual period. At two-month’ pregnancy ,she felt no pregnancy reaction . 停经5月，未觉胎动 停经40多天尿妊免阳性 妊娠2个月时妊娠反应消失

26 Physical examination :
Abdomen was slighter distended . No palpable corpus and no fetal heart sound in the abdomen. Gynecological examination ： External genitalia and cervix looked normal. the uterus was enlarged as with 2+-month. Ultrasonography：empty pregnancy sac,no fetal body and fetal heart sound. 腹部未扪及子宫体和闻及胎心音 外阴和宫颈正常。子宫增大如孕2+月大小。 B超空孕囊，未见胎肢和胎心搏动

27 Treatment of missed abortion
①凝血功能检查 ②可口服雌激素提高子宫对缩宫素的敏感性 刮宫或引产 术后常规B超复查和抗感染治疗

28 Sum up Differential diagnosis of Spontaneous abortion
Clinical findings: Blood loss Abdomenal pain Extrusion of products of conception threatened abortion inevitable abortion complete abortion imcomplete abortion gynecological Examination: Cervical dilatation Uterine size