Abortion

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Abortion

流产
Ⅰ. Definition
 Abortion is termination of pregnancy bfore
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
 The miscariage abortion: occurs in 13~28w
2.Etiology
 (1)Heredity factors
Abnormal gene is the commonest cause of S
pontaneous abortion.
Abnomalities of chromosomes:
number: autosomal trisomies polyploidy
structural: monosomy X
Early abortion 50%~60% is caused by chrom
osomal abnormalities.
 (2)Toxic factors:
lead, mercury, DDT, radiation, X-ray
 (3)Maternal factors
 (4)Immunologic factors

Blood type in compatibility between mot


her and fatus.
Imcompatibilily due to ABO, Rh
①the general diseases
 Acute infections(systemic or local)
 virus infection
 hypertension, typhoid, pneumonia, heart
disease, nephritis
 bacteria, toxin and virus get into fetal blood
circulation by placenta.
②endocrine disorder
 Hyper- or hypothyroidism (hyroidism)

 hypofunction of corpus luteum


③the genital disease
 A.uterine deformity
double uterus
hypoplasia uteri
longitadinal uterine septum
 B.pelvic tumor(myoma, ovarian tumor)
 C.cervical incompetence, laceration
④abdominal operation during the pregnancy
3.Pathologic change
 Most commonly, necrotic changes occur in th
e decidual tissue about the placentation site a
nd result in hemorrhage into this area. As ble
eding continues, the sac and the placenta bec
ome detached from the uterine wall and are e
xpelled by uterine contractions.
 Early pregnancy: abortion is complete
 8~12w: abortion is incomplete
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
Threatened Inevitable Imcomplete Complete
History
Bleeding Slight Middle→severa Slight→severa Slight→no
Abdominal pain No/slight Aggravate Decrese No
Tissues are No No Yes(partial) Complete
expelled
Gynecologic examination
Cervical os Close Open Open/tissue blochk Close
Uterine size Consistent with =/slight small < =/slight larger
Pregnancy test + +/- +/- +/-
Treatment Protect fetus Curettage Curettage no
principle
(5)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.
 The embryo or fetus has been dead at least
2 months but no tissue is passed.
 Middle pregnancy, no fetal movement and
fetus heart tones.
 The cervix closed.
(6)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
 ①hypofunction of corpus luteum
 ②emotion factor nervous factor
 ③hypopituitarism
 ④chromosomal abonormalities
Late abortion
 (1)incompetence of the cervix
 (2)congenital anomalies of the uterus
 (3)myomas of the uterus
 (4)blood type incompatibility between moth
er and fetus
5. Diagnosis
(1)History
 ①amenorrhea, recurrent abortion symptoms
of pregnancy
 ②the degree of abdominal pain, vaginal ble
eding
 ③the products of gestation were expelled or
not
(2)Examination
 ①general examination: temperature , pulse, r
espiration, blood pressure.
 ②vaginal examination:

uterine size: compared to the expected


date of pregnancy
cervical os: open or close
uterine tendeness
(3)ancillary examination
 ①pregnancy test: HCG<625IU/L→abortion
 ②measurement of HPL

5~10w: hpl≤0.01mg/L
 ③ measurement of E2(estroid)

E2<740pmol/L
 ④measurement of pregnanediol

24h urinary<15.6μ/24h, 95%→abortion   


 ⑤B-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 septi
c
threatened inevitable infection
proceed complete
delaied
treatment
miised habitual
6. Treatment
(1)Threatened abortion
 Principle: protect fetus treatment
 ①place the patient at bed rest

forbid sexual intercourse


 ②drug

folic acid 5mg tid. Po.


If corpus luteum or low of uterine pregnanediol proges
terone 20mg Qd. Im.
VE 30~50mg Qd po.
Seditive: valium 2.5mg po.
(2)Inevitable and incomplete abo
rtion
 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 pr
oduct of conception is necessary.
 Because the fetus dead, placenta release thr
ombocinatse into blood circulation ease occ
ure in coagulability.lead to disseminated int
ravascular coagulation(DIC)
 ①examination:
bleeding and coagulation time
placenta count
fibrinogen level
thrombinogen
 ②leveral uterine sentition
DES(diethylstibestrol)5~10mg tid po 5d
 ③before 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 abortio
n and treatment.
 1)rest, increase nutrition, VB,VC,VE…
 2)medical treatment: hypofunction of corpus luteum--pr
ogesterone
 3)surgical treatment:

①correction of congenital anomalies of


uterus,removed of myomas
②repair of the incompetent cervix.12~20w
(7)abortion complication infection
(septic abortion)
 Symptoms:temperature ↑, pulse↑, abdomina
l pain, marked suprapubic tenderness sighs
of peritonitis(guarding indentfy)marke tend
erness of uterus and uterine adnexa.
 Severas:pelvic-peritonitis, septicemia, (endo
toxic shock) intoxication shock
(8)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 infect
ion or curettage.
 ※The producte of conception from the cerv
ix are removed with a sponge holder.
 Don’t used curette to curettage curettage ute
rine wall prevent infection
 avoid hematogeous dissemination od the inf
ection.

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