妇产科学课件-流产

流产

Abortion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

conceptionOver

15%

of

fertilized

ova

do

not

divide15%

are

lost

before

implantation

(1st

week

of

gest)25%

are

lost

during

implantation

(2nd

week

of

gest)★ About

60%

of

spontaneous

abortions

occurringduring

1st

trimesterAbnormal

karyotype:≥10%

---chromosomalabnormalitiesgenetic

abnormalities

＞

"unknown"

＞

infection

＞anatomic

defects

＞

endocrine

factors

＞

immunologicfactors

＞

maternal

systemic

disease★ The

major

causes

of

2nd-trimester

abortion:anatomic

defects

of

the

uterus

or

cervix(septum)fetal

demisecircumvallate

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

FindingsPregnancy

testsβ-HCGComplete

blood

countBlood

type

and

RhProgesterone－corpus

luteum(1stcourse).

chorioplacental

system.Ultrasonography－highly

accurate

indiagnosing

impending

spontaneousabortion,

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（threatenedabortion）难免流产（inevitableabortion）不全流产（incompleteabortion）完全流产（completeabortion）稽留流产（missedabortion）习惯性流产（habitualabortion）复发性自然流产（recurrentspontaneous

abortion,RSA）流产合并感染（septicabortion）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

DiagnosisSuprapubic

pain

and

uterine

crampingVaginal

bleedingCervical

dilatationExtrusion

of

products

of

conceptionDisappearance

of

symptoms

and

signs

of

pregnancyNegative

pregnancy

test

or

quantitative

β-hCG

that

is

notproperly

increasingAdverse

ultrasonic

findings(eg,

empty

gestational

sac,

fetaldisorganization,

lack

of

fetal

growt