妇产科学教学课件：流产（英文）

1、 ABORTION 流 产1 Case presentation A woman, 26y, G2P0, menstruation: 5-6/28dChief complaint: 6 weeks of menopause, vaginal spotting for 3 days with slight lower abdominal pain 停经6周，少量阴道流血3天，伴轻微下腹疼痛Pregnancy test (Urine HCG)：positive 尿妊娠试验: 阳性 What is happening? Managements? Take history - Physical exa

2、mination - Assistant detection Diagnosis - Differential diagnosis - Treatment 2 Normal/Abnormal PregnancyNormal Pregnancy：normal duration normal location 正常妊娠：正常时限，正常位置Abnormal Pregnancy: abnormal duration abnormal location 异常妊娠：异常时限，异常位置3 Definition 定义Abortion：spontaneous termination of pregnancy b

3、efore the 28th week of gestation, the weight of fetus less than 1000g流产：妊娠不足28周、胎儿体重不足1000g 而终止者 early abortion (before 12th week) 早期流产 late abortion (12th 28th week) 晚期流产 4 Incidence 发生率 frequency of spontaneous abortion is about 30% 自然流产占全部妊娠的30%左右Approximately 80% is occurring during the first 12

4、 weeks of pregnancy，in which 2/3 are clinically silent miscarriages 80%以上为早期流产；其中2/3 为隐性流产5Etiology 病因6 hysteroscope 宫腔镜7正常宫腔子宫纵隔宫腔粘连子宫粘膜下肌瘤Etiology 病因8PATHOLOGY 病理The process of abortion is the separation and expulsion of pregnancy tissue from uterus 流产是妊娠物从子宫壁剥离、然后排 出子宫的过程death of the embryo 胚胎死亡

5、hemorrhage in the decidua basalis 底蜕膜出血c. uterine contraction & cervical dilatation 子宫收缩、宫颈扩张pregnancy tissue detach & exclude 妊娠物剥离、排出9 clinical presentations 临床表现 amenorrhea 停经 vaginal bleeding 阴道流血 lower abdominal pain 腹痛10 Clinical categories 临床类型threatened abortion 先兆流产inevitable abortion 难免流产i

6、ncomplete abortion 不全流产complete abortion 完全流产special forms: missed abortion 稽留流产 recurrent abortion 重复性流产 septic abortion 流产伴感染 11 A. threatened abortion 先兆流产 symptoms : slight vaginal bleeding 少量阴道流血 with or without lower abdominal pain 轻微下腹痛 signs：cervix remains closed 宫颈口未开prognosis: After treatm

7、ent or rest, some pregnancies may continue 预后：部分可继续妊娠12Symptoms : vaginal bleeding increases more 阴道流血增多 abdominal pain is stronger 腹痛加重signs: cervical dilatation 宫颈口扩张 sometimes cervical os is blocked by tissues 有时可见胚胎组织堵塞于宫颈口Prognosis: pregnancy loss is unavoidable 预后：流产不可避免B. inevitable abortion

8、难免流产13C. incomplete Abortion 不全流产the products of conception are partially expelled 妊娠物部分排出vaginal bleeding is profuse - maybe threatened to life 大量阴道流血，可能危及生命 abdominal pain is stronger - paroxysmal cramp 腹痛加重，阵发性腹痛14D. complete Abortion 完全流产the products of conception are expelled in total 妊娠物已经完全排出

9、vaginal bleeding ceases 阴道流血停止abdominal pain ceases 腹痛消失15 Different stage of abortionstage of abortionhistorypelvic examination vaginal bleedingabdominal pain passage of tissues cervical osthreatened abortionslightabsent or mildabsent closedinevitable abortionmoderate or heavyincreasein intensityab

10、sent dilatedincomplete abortionmoderateor heavydecreasein intensitypartial dilated or blocked by tissuescomplete abortionslight orabsent absentcomplete closed 16 Assistant Examination 辅助检查 A. pregnancy test (-hCG test) 妊娠试验-hCG: pregnant or not -hCG检测确定妊娠urine -HCG: qualitative 定性 serum -HCG: quanti

11、tative 定量Serial -HCG test: Abnormal levels of serum -HCG are predictive of an abnormal pregnancy 血-HCG值下降或低于正常提示异常妊娠17 Assistant Examination 辅助检查 B. Ultrasonography 超声检查Intrauterine pregnancy or not 确定宫内妊娠viable pregnancy or not 判断胚胎是否存活residual of conception tissue or not 宫腔有无妊娠物残留 1819先兆流产：孕囊和胚芽Ul

12、trasonography 超声检查难免流产：孕囊不规则不全流产：妊娠物残留 完全流产：无残留Diagnosis 诊断A. History a missed period amount and duration of vaginal bleeding characteristic of abdominal pain B. SignsGeneral condition (vital signs)Pelvic examinationC. Assistant examinationpregnancy test Ultrasonography 20Differential Diagnosis 鉴别诊断

13、ectopic pregnancy 异位妊娠hydatidiform mole 葡萄胎pelvic inflammatory disease 急性盆腔炎dysfunctional uterine bleeding 功血21Treatment 治疗 A. Threatened abortiontaking rest 休息Progesterone, HCG 孕激素或HCG保胎治疗observe the progress 观察病情变化22Treatment 治疗 B. Inevitable & incomplete abortion D&C (dilatation and curettage) 清宫

14、术 oxytocin be given 缩宫素 blood transfusion may be required 必要时补液输血 antibiotics: risk of infection 预防感染23Treatment 治疗 C. complete abortionNo particular management 不需特殊处理Observation for bleeding 观察阴道流血情况Ultrasound examination 证实宫内无组织残留24A. Missed abortion 稽留流产Fetus dies and still remains in the uterus

15、定义：胚胎死亡未排出Clinical Presentations 表现：胚胎停止生长（超声及血HCG）；早孕反应消失D&C 清宫术Large dosage of estrogen before operation 清宫术前大剂量激素治疗Three special forms 三种特殊类型25B. Recurrent abortion 重复性流产Consecutive loss of three or more pregnancies 定义：连续发生3次及3次以上的自然流产Common cause 常见病因：染色体异常、子宫异常（子宫畸形、宫 腔粘连、宫颈机能不全等）Cause therapy 病因治疗Three special forms 三种特殊类型26C. Septic abortion 流产合并感染Definition: abortion complicated by infectionManifestation: fever, malodorous discharge, cervix pain 临床表现：发热、分泌物臭、腹痛、宫颈举痛Antibiotics; remove infectious tissues