妇产科学课件：流产（英文版）

1、Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,Abortion,Definition,Termination of pregnancy prior to,28th,week gestation or the weight of fetus less than,1000g,Category,By the way of termination,spontaneous abortion (,自然流产）,artificial abortion,（人工流产）,By the time of termination,early abortion(12th week gestation),clinically silent miscarriages(chemical pregnancy,生化妊娠,):occurs before next menstrual cycle,late abortion(12th 28

2、th week gestation),Incidence,31%of all conceptions abort spontaneously after implantation,80%occur as early abortion,Etiology,Fetal factors,Maternal factors,Paternal factors,Environmental factors,Fetal factors,Chromosomal abnormalities(,number,or structure),Most common in early abortion,50%60%,Autosomal trisomies,常染色体三体,(chromosome 13,16,18,21 or 22),Maternal factors,Systemic disease,Severe infection(TORCH),fever,Anemia,Heart failure,Uterine defects,Uterus deplex,双子宫,uterus bicornis,双角子宫,Large a

3、nd multiple fibroids,Endocrine disorders,Corpus luteum insufficiency,Hypo-thyroidism,Immunologic factors,Physical and mental trauma,Smoking,alcoholic,drugs,Pathology,Death of embryo,Hemorrhage in decidua,Separation of placental villi from decidua,Uterine contraction,Expulsion of fetus,Early abortion before 8 weeks,Pathology,Early abortion between 812 weeks,Advanced development of placental villi,Closer with decidua,Expulsion incomplete,Retained pregnant products,Severe hemorrhage,Pathology,Late

4、abortion,Complete development of placenta,Abdominal pain followed by expulsion of fetus and placenta,Lithopedion(,石胎）,Clinical manifestation,Amenorrhea,停经,Vaginal bleeding,Crampy,（痉挛）,abdominal pain,Occurs after vaginal bleeding in early abortion,Occurs before vaginal bleeding in late abortion,Clinical category,Threatened abortion,Inevitable abortion,Incomplete abortion,Complete abortion,Threatened abortion,Slight vaginal bleeding,Slight lower abdominal pain,Cervix close,unruptured membrane,The

5、size of the uterus corresponds to the gestational age,Pregnancy test:HCG positive,Ultrasonography:normal gestational sac and viable embryo,Progesterone:prognosis,Treatment,Bed rest,Sedative drugs,Progesterone,Corpus luteum insufficiency,1020mg,HCG,Psychological therapy,Clinial observation,Inevitable abortion,Vaginal bleeding increases,Abdominal pain becomes stronger,Membrane rupture,Cervical os dilated,The size of uterus correspond with or smaller than the gestational age,Treatment,Complete expu

6、lsion of pregnant products,Suction curettage,（清宫术）,may be required,oxytocin,（缩宫素）,in late abortion,The tissues removed should be sent for pathologic examination(chromosomal examination if possible),Antibiotics to reduce the risk of infection,Incomplete abortion,Retained pregnant products in uterine cavity or incarceration,嵌顿,at cervical os,Profuse vaginal bleeding,Cervical os,（宫颈口）,is dilated,Size of the uterus is smaller than the gestational age,Treatment,Curettage as soon as possible,Anti-shoc

7、k therapy,Blood transfusion if necessary,Antibiotics to prevent infection,Complete abortion,Vaginal bleeding cease,Abdominal pain cease,Cervix closed again,Uterus of nearly non-pregnant size,Treatment,Ultrasonography:no visible products of conception,No sign of infection,no particular management needed,Process of spontaneous abortion,Differential diagnosis,Category,History,Examination,Vaginal bleeding,Abdominal pain,Tissue expulsion,Cervical os,Size of uterus,Threatened abortion,slight,slight or

8、 none,none,close,correspond to gestational age,Inevitable abortion,mild to heavy,heavy,none,dilated,correspond to or smaller,Incomplete abortion,slight to heavy,slight,part,dilated or obstruction with tissue,smaller than gestational age,Complete abortion,slight to none,none,all,close,same with non-pregnant or bigger,Diagnosis,History,Amenorrhea,morning sickness,vaginal bleeding(volume and lasting time),expulsion of gestational products,abdominal pain(sites,degree),fever,Signs,Signs of anemia,Sig

9、ns of infection,Vaginal examination(with caution when threatened abortion suspicious),hCG test,ultrasonography,Differential diagnosis,ectopic pregnancy,Pregnancy test:positive,No products of conception in uterus,hydatidiform mole,（葡萄胎）,HCG positive,Lab test(DNA analysis,immunohistochemistry),dysfunctional uterine bleeding,Pregnancy test:negative,Special conditions of abortion,Missed abortion,Recurrent spontaneous abortion(RSA),Septic abortion,Missed abortion,Death of fetus or embryo occurs,Reten

10、tion（残留）of products of conception in uterine cavity,Disappear of morning sickness,Closed cervical os,Uterus smaller than gestational age,Treatment,Coagulation,（凝血）,function test,be aware of DIC,Curettage(before 12,th,week gestation)combined with usage of oxytocin,Correct coagulation disorder before curettage,Use large dosage of estrogen before operation to increase the sensitivity of uterus to oxytocin,Preparation for blood transfusion,Induced abortion using oxytoxin or mifepristone,（米非司酮）,misop

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