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1、AbnormalVaginal/UterineBleedingZhejiangUniversitySchoolofMedicine,Women’sHospitalWuRuijinAbnormalvaginalbleedingOneofthemostcommongynecologicsymptoms.Includebleedingfromuterus,cervix,vaginal,hymenetc.Mostfromuterine,butcalledvaginalbleedingexceptnormalcycleo
2、fmenstruation.Appearanceofbleedingvaryfromtheircauses.AbnormalUterineBleedingIncludesabnormalmenstrualbleedingandbleedingduetoothercausessuchaspregnancy,systemicdiseases,orcancer.Thediagnosisandmanagementpresentsomeofthemostdifficultproblemsingynecology.Inch
3、ildbearingwomen,acomplicationofpregnancymustalwaysbeconsidered,andmorethanoneentitymaybepresent,eg,uterinemyomasandcervicalcancer.PartIEtiologicalfactorsofabnormalvaginalbleedingOvarianendocrinedysfunctionPregnancy-relatedbleedingInfectionsMalignantLesionsGe
4、nitalsdamage,extraneousmaterialandexogenoushormoneBleedingduetosystemicdiseases1.OvarianendocrinedysfunctionDuetodysfunctionofthehypothalamic-pituitary-ovarianaxis(HPOA).anovulatorydysfunctionaluterinebleeding(无排卵性功能失调性子宫出血)ovulatorymenstrualdysfunction(排卵性月
5、经失调)intermenstrualbleeding(经间期出血)(1)AnovulatorydysfunctionaluterinebleedingPuberty（20%）：unstableHPOAregulationwithgrowingfolliclebutnoLHpeakandovulationdoesnotoccur.Perimenopause（50%）：ovarybecomeslowresponsivetoGnanditsfunctiondeclines.Childbearingperiod（30%
6、）：inside/outsideinterference,suchaspsychologicfactor,environment,stress,etc.(2)OvulatorymenstrualdysfunctionLutealphasedefect(LPD)(黄体功能不全)AbnormalFSH/LHorratio,lowLHpeakorfollowingpulsedefect.Irregularsheddingofendometrium(子宫内膜不规则脱落）HPOAdysfuctionandcorpuslu
7、teumdegenerateuncompletely(3)intermenstrualbleedingWiththeruptureofdominantfollicle,estrogensdeclinesinashorttimeandendometriumbreak-throughbleeding.2.BleedingduetopregnancyAbortion流产Ectopicpregnancy异位妊娠Gestationaltrophoblasticdisease(GTD)妊娠滋养细胞疾病Anomalyofpl
8、acenta胎盘异常---placentapraevia(前置)、abruption(早剥)、adherence(粘连)、implantation(植入)Postpartumpartplacentaremain胎盘部分残留Involutionofuterusunhealthy子宫复旧不良AbortionMorphologicandgeneticabnormalities:Abnorma
