ABORTION

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Abortion

• ??

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?. Definition

• Abortion is termination of pregnancy bfore 28
  weeks of gestation and the fetal weight is less
  tan 1000g.
• Abortion spontaneous 1018
• artificial
• The early abortion occurs before 12w
• The late abortion occurs after 12w
• The miscariage abortion occurs in 1328w

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2.Etiology

• (1)Heredity factors
• Abnormal gene is the commonest cause of
  Spontaneous abortion.
• Abnomalities of chromosomes
• number autosomal trisomies polyploidy
• structural monosomy X
• Early abortion 5060 is caused by
  chromosomal abnormalities.

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• (2)Toxic factors
• lead, mercury, DDT, radiation, X-ray
• (3)Maternal factors
• (4)Immunologic factors
• Blood type in compatibility between mother
  and fatus.
• Imcompatibilily due to ABO, Rh

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?the general diseases

• Acute infections(systemic or local)
• virus infection
• hypertension, typhoid, pneumonia, heart disease,
  nephritis
• bacteria, toxin and virus get into fetal blood
  circulation by placenta.

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?endocrine disorder

• Hyper- or hypothyroidism (hyroidism)
• hypofunction of corpus luteum

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?the genital disease

• A.uterine deformity
• double uterus
• hypoplasia uteri
• longitadinal uterine septum
• B.pelvic tumor(myoma, ovarian tumor)
• C.cervical incompetence, laceration

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?abdominal operation during the pregnancy
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3.Pathologic change

• Most commonly, necrotic changes occur in the
  decidual tissue about the placentation site and
  result in hemorrhage into this area. As bleeding
  continues, the sac and the placenta become
  detached from the uterine wall and are expelled
  by uterine contractions.
• Early pregnancy abortion is complete
• 812w abortion is incomplete

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4.Clinical classification and feature

• (1) Threatened abortion
• (2)Inevitable abortion
• (3)Incomplete abortion
• (4)complete abortion
• (5)Missed abortion
• (6)Habitual abortion
• (7)Septic abortion(infect abortion)

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Differential diagnosis of varied abortions
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(5)Missed abortion

• It is that pregnancy has been retained for 2
  months or more following death of the fetus.
• The abnormally protracted retention of a dead
  fetus in uterus in over 2 months that dont
  expelled.
• Missed abortion is manifested by loss of symptoms
  of pregnancy and decrease in uterine size.

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• The embryo or fetus has been dead at least 2
  months but no tissue is passed.
• Middle pregnancy, no fetal movement and fetus
  heart tones.
• The cervix closed.

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(6)Habitual abortion(recurrent)

• Recurrent, or habitual, is the sequential 3 or
  more spontaneous abortion.
• Every abortion times is or not same month of
  pregnancy.

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Early cause

• ?hypofunction of corpus luteum
• ?emotion factor nervous factor
• ?hypopituitarism
• ?chromosomal abonormalities

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Late abortion

• (1)incompetence of the cervix
• (2)congenital anomalies of the uterus
• (3)myomas of the uterus
• (4)blood type incompatibility between mother and
  fetus

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5. Diagnosis
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(1)History

• ?amenorrhea, recurrent abortion symptoms of
  pregnancy
• ?the degree of abdominal pain, vaginal bleeding
• ?the products of gestation were expelled or not

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(2)Examination

• ?general examination temperature , pulse,
  respiration, blood pressure.
• ?vaginal examination
• uterine size compared to the expected
• date of pregnancy
• cervical os open or close
• uterine tendeness

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(3)ancillary examination

• ?pregnancy test HCGlt625IU/L?abortion
• ?measurement of HPL
• 510w hpl0.01mg/L
• ? measurement of E2(estroid)
• E2lt740pmol/L
• ?measurement of pregnanediol
• 24h urinarylt15.6µ/24h, 95?abortion

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• ?B-ultrasound
• differential of varieties of abortion
• gestation sac, embryo status, fetal heart
  tones, fetus movement
• Incompetence of the cervix, cervical
  osgt19mm and have history of abortion

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• Normal pregnancy
• 
  incomplete septic
• threatened inevitable
  infection
• proceed complete
• delaied
• treatment
• miised habitual

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6. Treatment
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(1)Threatened abortion

• Principle protect fetus treatment
• ?place the patient at bed rest
• forbid sexual intercourse
• ?drug
• folic acid 5mg tid. Po.
• If corpus luteum or low of uterine
  pregnanediol progesterone 20mg Qd. Im.
• VE 3050mg Qd po.
• Seditive valium 2.5mg po.

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(2)Inevitable and incomplete abortion

• At once DC(curettage) dilatation
• if bleeding is brisk blood transfusion
• oxytosin
  510u iv/im
• incomplete abortion antibiotic used for
  preventive infection
• tissue examination by a pathologist

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(3)Complete abortion

• When the uterus is empty, there are no need for
  further interference.

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(4)Missed abortion

• After diagnosis of it ,as soon as expelled
  product of conception is necessary.
• Because the fetus dead, placenta release
  thrombocinatse into blood circulation ease occure
  in coagulability.lead to disseminated
  intravascular coagulation(DIC)

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• ?examination
• bleeding and coagulation time
• placenta count
• fibrinogen level
• thrombinogen

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• ?leveral uterine sentition
• DES(diethylstibestrol)510mg tid po 5d
• ?before curettage, preparey blood
• during opreation oxytocin 10u im/iv
• over than 3 month of pregnancy artificial
  inducte.

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(5)Habitual abortion

• The first should be examinatin cause of habitual
  abortion and treatment.
• 1)rest, increase nutrition, VB,VC,VE
• 2)medical treatment hypofunction of corpus
  luteum--progesterone
• 3)surgical treatment
• ?correction of congenital anomalies of
• uterus,removed of myomas
• ?repair of the incompetent cervix.1220w

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(7)abortion complication infection(septic
abortion)

• Symptomstemperature ?, pulse?, abdominal pain,
  marked suprapubic tenderness sighs of
  peritonitis(guarding indentfy)marke tenderness of
  uterus and uterine adnexa.
• Severaspelvic-peritonitis, septicemia,
  (endotoxic shock) intoxication shock

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(8)Septic abortion

• The principle of treatment
• bleeding is a few first treat infection with
  
• broad-spectrum
  antibiotiss
• second DC
• bleeding is sever we are eryher contract
  infection or curettage.

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• ?The producte of conception from the cervix are
  removed with a sponge holder.
• Dont used curette to curettage curettage uterine
  wall prevent infection
• avoid hematogeous dissemination od the infection.