國家級精品課婦產(chǎn)科學(xué)流產(chǎn)

1、流 產(chǎn) Abortion,復(fù)旦大學(xué)附屬婦產(chǎn)科醫(yī)院 隋 龍,定 義,流產(chǎn)(abortion): ＜28w ＜1000g早期流產(chǎn)(＜ 12w)晚期流產(chǎn)(＜28w)有生機兒(20～28w,500～1000g),病 因,胚胎因素 數(shù)目異常、結(jié)構(gòu)異常母體因素 全身性疾病、內(nèi)分泌異常、免疫功能異常、生殖器異常、創(chuàng)傷刺激環(huán)境因素 煙草、飲酒、咖啡因、輻射、避孕、環(huán)境毒

2、素,流產(chǎn)時染色體異常的發(fā)生率,病因二,母體因素營養(yǎng)不良 感染慢性衰弱性疾病內(nèi)分泌異常創(chuàng)傷生殖道因素免疫因素自身免疫因素同種免疫因素,Etiology,★ Abnormal products of conceptionOver 15% of fertilized ova do not divide15% are lost before implantation (1st week of gest)25% ar

3、e lost during implantation (2nd week of gest)★ About 60% of spontaneous abortions occurring during 1st trimesterAbnormal karyotype:≥10% ---chromosomal abnormalitiesgenetic abnormalities ＞ "unknown" ＞ infec

4、tion ＞anatomic defects ＞ endocrine factors ＞ immunologic factors ＞ maternal systemic disease ★ The major causes of 2nd-trimester abortion:anatomic defects of the uterus or cervix(septum)fetal demisecircumvallate pl

5、acentation,病 理,早期流產(chǎn)：無胚胎、結(jié)節(jié)狀胚、圓柱狀胚、發(fā)育阻滯胚、肢體畸形、神經(jīng)管缺陷晚期流產(chǎn)：肉樣胎塊、石胎、壓縮胎兒、紙樣胎兒、浸軟胎兒、臍帶異常,臨床表現(xiàn),陰道流血腹痛反復(fù)陰道流血、貧血、感染,25%的妊娠在早期可以出現(xiàn)陰道出血腹痛蛻膜、胎盤、胎兒排出 有關(guān)妊娠的癥狀消失,臨床分類,先兆流產(chǎn)（threatened abortion）難免流產(chǎn)（inevitable abortion）不全流產(chǎn)（inco

6、mplete abortion）完全流產(chǎn)（complete abortion）,稽留流產(chǎn)（missed abortion）習(xí)慣性流產(chǎn)（habitual abortion）反復(fù)性自然流產(chǎn)（recurrent spontaneous abortion, RSA）流產(chǎn)合并感染（septic abortion）,Essentials of Diagnosis,Suprapubic pain and uterine crampingVa

7、ginal bleedingCervical dilatationExtrusion of products of conceptionDisappearance of symptoms and signs of pregnancyNegative pregnancy test or quantitative β-hCG that is not properly increasingAdverse ultrasonic fin

8、dings(eg, empty gestational sac, fetal disorganization, lack of fetal growth).,Laboratory Findings,Pregnancy tests β-HCG Complete blood countBlood type and RhProgesterone－corpus luteum(1st course). chorioplacental s