流产Abortion课件

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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)

1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、创伤刺激环境因素烟草、饮酒、咖啡因、辐射、避孕、环境毒素

2流产时染色体异常的发生率

3病因二母体因素营养不良感染慢性衰弱性疾病内分泌异常创伤生殖道因素免疫因素自身免疫因素同种免疫因素

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9Etiology★AbnormalproductsofconceptionOver15%offertilizedovadonotdivide15%arelostbeforeimplantation(1stweekofgest)25%arelostduringimplantation(2ndweekofgest)★About60%ofspontaneousabortionsoccurringduring1sttrimesterAbnormalkaryotype:≥10%---chromosomalabnormalitiesgeneticabnormalities＞"unknown"＞infection＞anatomicdefects＞endocrinefactors＞immunologicfactors＞maternalsystemicdisease★Themajorcausesof2nd-trimesterabortion:anatomicdefectsoftheuterusorcervix(septum)fetaldemisecircumvallateplacentation

10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

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17临床表现阴道流血腹痛反复阴道流血、贫血、感染25%的妊娠在早期可以出现阴道出血腹痛蜕膜、胎盘、胎儿排出有关妊娠的症状消失

18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）反复性自然流产（recurrentspontaneousabortion,RSA）流产合并感染（septicabortion）

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20EssentialsofDiagnosisSuprapubicpainanduterinecrampingVaginalbleedingCervicaldilatationExtrusionofproductsofconceptionDisappearanceofsymptomsandsignsofpregnancyNegativepregnancytestorquantitativeβ-hCGthatisnotproperlyincreasingAdverseultrasonicfindings(eg,emptygestationalsac,fetaldisorganization,lackoffetalgrowth).

21LaboratoryFindingsPregnancytestsβ-HCGCompletebloodcountBloodtypeandRhProgesterone－corpusluteum(1stcourse).chorioplacentalsystem.Ultrasonography－highlyaccurateindiagnosingimpendingspontaneousabortion,especiallytransvaginally

22鉴别诊断先兆流产难免流产不全流产完全流产异位妊娠葡萄胎功能失调性子宫出血盆腔炎阑尾炎

23治疗原则先兆流产难免流产不全流产完全流产稽留流产习惯性流产流产合并感染