妊娠时限异常-旧课件

《妊娠时限异常-旧课件》由会员上传分享，免费在线阅读，更多相关内容在教育资源-天天文库。

1、妊娠时限异常中山大学附属第二医院妇产科刘颖琳2021/9/1611:14自然流产分类诊断处理主要内容早产诊断处理过期妊娠诊断处理2021/9/1611:14LMP12W28W37W42W可分为人工流产和自然流产自然流产早期流产：流产发生于妊娠12周前晚期流产：流产发生于妊娠12—28周胎儿体重小于1000克流产2021/9/1611:14Etiology1.Geneticdefect–Karotypeabnormality2.Maternalfactors-Systemicdisease,Reproducti

2、vesystemdiseaseormalformation,Endocrine,Trauma,Badhabits3.Immunesystem-Autoimmunedisease,Blockingantibody（生殖微环境不良）4.Environmentalfactors(pollution)自然流产SpontaneousAbortion2021/9/1611:14Pathology早期流产：胚胎死亡→绒毛与蜕膜分离→剥离面出血→妊娠物成为宫腔异物→刺激子宫收缩宫颈扩张G8w前：绒毛发育不完全，易与蜕膜分离，

3、出血不多；G8-12w：绒毛发育繁茂，与蜕膜关系较牢，不易完全分离排出，出血多；G12w后：胎盘已经形成，流产时常先有腹痛，然后排出胎儿、胎盘，与分娩过程相似。自然流产SpontaneousAbortion2021/9/1611:14ClinicalmanifestationHistoryofmenopause,VaginalbleedingandAbdominalpainEnlargeduterus,HCG(+),B-usexam;Earlyabortion—Vaginalbleeding(绒毛与蜕膜分离)

4、beforeAbdominalpain(子宫收缩)Lateabortion—AbdominalpainbeforeVaginalbleeding自然流产SpontaneousAbortion2021/9/1611:14ClassificationandCharacters先兆流产—Threatenedabortion停经—少量阴道流血数小时或数日后，轻微下腹痛或腰骶部痛宫颈口未开，子宫大小与孕周相符转归：治疗后症状消失可继续妊娠症状加重可发展为难免流产自然流产SpontaneousAbortion2021/9

5、/1611:14ClassificationandCharacters难免流产—Inevitableabortion阴道流血增多，腹痛加剧，胎膜破裂，宫口开张偶见妊娠物堵塞宫颈口子宫大小与停经周数相符或略小胚胎停育：B-us检查仅见孕囊，内无胚胎或原始心管搏动。自然流产SpontaneousAbortion2021/9/1611:14ClassificationandCharacters不全流产—Incompleteabortion难免流产发展而来部分妊娠物排出，或胎儿排出后附属物残留子宫收缩不良大量出血，可

6、发展至休克宫颈扩张，可见妊娠物堵塞或活动性出血，子宫小于孕周。自然流产SpontaneousAbortion2021/9/1611:14ClassificationandCharacters完全流产—Completeabortion流产症状妊娠物排出流血逐渐停止腹痛逐渐消失宫颈口关闭子宫恢复正常大小自然流产SpontaneousAbortion2021/9/1611:14自然流产SpontaneousAbortionThreatenedabortionInevitableabortionCompleteabo

7、rtionNormalIncompleteabortionClinicalprocessofabortion2021/9/1611:14自然流产SpontaneousAbortionDifferentiationoftheabortiontypeSYMPTOMSSIGNSTYPEBleedingLowerabdominalpainTissueCervicaloxUterinesizeThreatenedabortionLittleNoorlightNoCloseFitsthegestationalageIne

8、vitableabortionMoreSevereNoDilatedFitsorsmallerIncompleteabortionMassiveNotsoseverePartofthepregnantmassDilated,somethingobstructedSmallerCompleteabortionLittleornoNoAllCloseBasicallynormal2021/9/1611: