1. Abortion 流产

2. 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

3. 2.Etiology (1)Heredity factors
Abnormal gene is the commonest cause of Spontaneous abortion.
Abnomalities of chromosomes:
number: autosomal trisomies polyploidy
structural: monosomy X
Early abortion 50%~60% is caused by chromosomal abnormalities.

4. (2)Toxic factors:
lead, mercury, DDT, radiation, X-ray
(3)Maternal factors
(4)Immunologic factors
Blood type in compatibility between mother and fatus.
Imcompatibilily due to ABO, Rh

5. 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.

6. ②endocrine disorder Hyper- or hypothyroidism (hyroidism)
hypofunction of corpus luteum

7. ③the genital disease A.uterine deformity double uterus
hypoplasia uteri
longitadinal uterine septum
B.pelvic tumor(myoma, ovarian tumor)
C.cervical incompetence, laceration

8. ④abdominal operation during the pregnancy

9. 3.Pathologic change
Most commonly, necrotic changes occur in the decidual tissue about the placentation site and result in hemorrhage into this area. As bleeding continues, the sac and the placenta become detached from the uterine wall and are expelled by uterine contractions.
Early pregnancy: abortion is complete
8~12w: abortion is incomplete

10. 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)

11. Differential diagnosis of varied abortions

12. (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.

13. 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.

14. (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.

15. Early cause ①hypofunction of corpus luteum
②emotion factor nervous factor
③hypopituitarism
④chromosomal abonormalities

16. Late abortion (1)incompetence of the cervix
(2)congenital anomalies of the uterus
(3)myomas of the uterus
(4)blood type incompatibility between mother and fetus

17. 5. Diagnosis

18. (1)History ①amenorrhea, recurrent abortion symptoms of pregnancy
②the degree of abdominal pain, vaginal bleeding
③the products of gestation were expelled or not

19. (2)Examination
①general examination: temperature , pulse, respiration, blood pressure.
②vaginal examination:
uterine size: compared to the expected
date of pregnancy
cervical os: open or close
uterine tendeness

20. (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　　

21. 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

22. Normal pregnancy
incomplete septic
threatened inevitable infection
proceed complete
delaied
treatment
miised habitual

23. 6. Treatment

24. (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 progesterone 20mg Qd. Im.
VE 30~50mg Qd po.
Seditive: valium 2.5mg po.

25. (2)Inevitable and incomplete abortion
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

26. (3)Complete abortion
When the uterus is empty, there are no need for further interference.

27. (4)Missed abortion
After diagnosis of it ,as soon as expelled product of conception is necessary.
Because the fetus dead, placenta release thrombocinatse into blood circulation ease occure in coagulability.lead to disseminated intravascular coagulation(DIC)

28. ①examination:
bleeding and coagulation time
placenta count
fibrinogen level
thrombinogen

29. 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.

30. (5)Habitual abortion
The first should be examinatin cause of habitual abortion and treatment.
1)rest, increase nutrition, VB,VC,VE…
2)medical treatment: hypofunction of corpus luteum--progesterone
3)surgical treatment:
①correction of congenital anomalies of
uterus,removed of myomas
②repair of the incompetent cervix.12~20w

31. (7)abortion complication infection (septic abortion)
Symptoms:temperature ↑, pulse↑, abdominal pain, marked suprapubic tenderness sighs of peritonitis(guarding indentfy)marke tenderness of uterus and uterine adnexa.
Severas:pelvic-peritonitis, septicemia, (endotoxic shock) intoxication shock

32. (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 infection or curettage.

33. ※The producte of conception from the cervix are removed with a sponge holder.
Don’t used curette to curettage curettage uterine wall prevent infection
avoid hematogeous dissemination od the infection.