流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清

Septic Abortion
Prolonged bleeding during abortion or retained products of conception lead to intrauterine infection, which might progress into pelvic inflammatory disease, peritonitis or even sepsis if not treated Antibiotic treatment + Prompt evacuation without severe bleeding: management of infection , performance of suction and curettage bleeding： with severe bleeding：management of forceps, infection while applying forceps, with secondary suction and curettage
Management
blood routine examination, coagulation function test defects： correcting coagulation defects： heparin, fibrinogen, etc. uterus： sensitizing the uterus： diethylstilbestrol transfusion preparation; uterus： emptying the uterus： before 12 weeks: suction curettage weeks： after 12 weeks：induction of labor
Types of Abortion
Threatened Abortion Inevitable Abortion Incomplete Abortion Complete 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 Inevitable Abortion bleeding heavier, abdominal pain more severe, or fluid passed open， cervical os open， pregnancy tissue visible abortion is inevitable
Different Stages of Abortion
threatened abortion pregnancy continue
inevitable abortion incomplete abortion
complete abortion
Diagnosis
History Physical Examination Laboratory Assessment: ultrasound pregnancy test hormone level: serum progesterone
During 8～12 8～
weeks： weeks：with
firm
attachment to the basal decidua Partial expulsion of the products of conception→ nonconception→ non-ideal uterine contraction, severe bleeding
Closed Normal or slightly large
Management
Threatened Abortion
bed rest, sedation abortion：progesterone，HCG； anti abortion：progesterone，HCG； E； Vit E；thyroxine supplement monitoring：ultrasound； monitoring：ultrasound；serum HCG→ whether to continue pregnancy
History Examination
Bleeding Threatene d Abortion Inevitabl e Abortion Light Abdominal Pain None/light Tissue Expulsion None Cervical Os Closed
Pelvic
Uterus Normal
Habitual Abortion
The occurrence of 3 or more consecutive spontaneous abortions The occurrence of 2 spontaneous abortions is defined as recurrent abortion Early abortion：chromosomal abnormalities， abortion： abnormalities， immunologic factors，luteal-phase insufficiency, factors，lutealhypothyroidism abortion： anomalies， Late abortion：congenital uterine anomalies， incompetence， etc. cervical incompetence，uterine fibroids, etc.
Pathology
Before 8 weeks:
chorionic villi immature death→ Fetal death→basal decidual bleeding contraction→ →uterine contraction→expulsion of all the products of conception, light bleeding
Management
obtain information on etiology for prior losses before conception genetic counseling incompetence： cervical incompetence：cervical cerclage during 14～18 weeks of 14～ gestation causes： with unclear causes：progesterone therapy until 10 weeks of gestation immunotherapy： active immunotherapy：intradermic injection of lymphocytes
Etiology
Genetic defect Maternal factors: systematic disease; genital organ anomalies; endocrine anomalies; irritation; bad habit Immune anomalies Environmental factors
Inevitable Abortion
once diagnosed，remove the diagnosed， pregnancy tissue as quickly as possible suction curettage
Incomplete Abortion
perform suction curettage promptly bleeding： if with heavy bleeding：blood transfusion； transfusion；preventive antibiotic use
Incomplete Abortion heavy vaginal bleeding pregnancy tissue protruding from the cervical os uterus small for the presumed gestational week Complete Abortion vaginal bleeding decreasing, abdominal pain alleviating cervical os closed uterus normal for the presumed gestational week
After 12 weeks:
placenta fully
formed. contraction→ Uterine contraction→ expulsion of conception， all the products of conception，light
Symptoms
Amenorrhea, vaginal bleeding , and abdominal pain Early abortion： abortion： vaginal bleeding preceding abdominal pain abortion： Late abortion： abdominal pain preceding vaginal
Mild to heavy
Intensifie d
None
Dilat百度文库d
Normal or slightly small
Partial Incomplet e Abortion Light to heavy Relieved
Dilated or obstructed
Small
Complete Light to none Complete Abortion None
Complete Abortion
no retained products of conception confirmed by ultrasound； ultrasound；no infection no need for special management
Missed Abortion
Concept: in utero death of the embryo or fetus with retained products of conception Clinical Manifestation: uterine enlargement ceasing or fetal movement disappearing cervical os closed, uterus small for the presumed gestational age no fetal heartbeat ; embryonic demise suggested by ultrasound findings
Abortion and Ectopic Pregnancy
LiangLiang-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 Early Abortion：pregnancy loss Abortion： before 12 gestational weeks Late Abortion: pregnancy loss 12～ during 12～28 gestational weeks Spontaneous Abortion Artificial Artificial Abortion