流产异位妊娠(英文)-AbortianandEctopicPregnancy-尧良清

Etiology
➢ Genetic defect ➢ Maternal factors:
systematic disease; genital organ anomalies; endocrine anomalies; irritation; bad habit
➢ Immune anomalies ➢ Environmental factors
abdominal pain alleviating ➢ cervical os closed ➢ uterus normal for the
presumed gestational week
Different Stages of Abortion
threatened abortion continue pregnancy
➢ Early Abortion：pregnancy loss before 12 gestational weeks
➢ Late Abortion: pregnancy loss during 12～28 gestational weeks
➢ Spontaneous Abortion ➢ Artificial Abortion
Abortion and Ectopic Pregnancy
Liang-Qing Yao
Obstetrics and Gynecology Hospital of Fudan University
Abortion
Concept
A pregnancy loss before 28 weeks of gestation while fetal weight under 1000 grams
inevitable abortion
incomplete abortion
complete abortion
Diagnosis
History
Physical Examination
Laboratory Assessment:
➢ ultrasound ➢ pregnancy test ➢ hormone level: serum progesterone
During 8～12 weeks：with firm
attachment to the basal decidua ➢ Partial expulsion of the products of
conception→ non-ideal uterine contraction, severe bleeding
Pathology
Before 8 wቤተ መጻሕፍቲ ባይዱeks: chorionic villi immature
➢ Fetal death→basal decidual bleeding →uterine contraction→expulsion of all the products of conception, light bleeding
Incomplete Abortion ➢ heavy vaginal bleeding ➢ pregnancy tissue protruding
from the cervical os ➢ uterus small for the presumed
gestational week
Complete Abortion ➢ vaginal bleeding decreasing,
History
Pelvic Examination
Bleeding
Threatened Light Abortion
Abdominal Pain
None/light
Tissue Expulsion
None
Cervical Os Uterus
Closed
Normal
Inevitable Mild to heavy Intensified None Abortion
Inevitable Abortion ➢ bleeding heavier, abdominal pain more
severe, or fluid passed ➢ cervical os open，pregnancy tissue visible ➢ abortion is inevitable
After 12 weeks: placenta fully formed.
➢ Uterine contraction→ expulsion of all the products of conception，light bleeding
Symptoms
Amenorrhea, vaginal bleeding , and abdominal pain
➢ Early abortion：vaginal bleeding preceding abdominal pain
➢ Late abortion：abdominal pain preceding vaginal bleeding
Types of Abortion
Threatened Abortion Inevitable Abortion Incomplete Abortion Complete Abortion
Dilated
Normal or slightly small
Incomplete Light to Abortion heavy
Relieved
Partial
Dilated or Small obstructed
Complete Light to none None Abortion
➢ Missed Abortion ➢ Habitual Abortion ➢ Septic Abortion
Clinical Presentations
Threatened Abortion ➢ light vaginal bleeding with mild abdominal
pain ➢ cervical os closed, fetal membranes unbroken ➢ treatment might work , continue pregnancy