4.妊娠时限异常-旧课件.pptx

妊娠时限异常主要内容流产可分为人工流产和自然流产自然流产早期流产：流产发生于妊娠12周前晚期流产：流产发生于妊娠12—28周 胎儿体重小于1000克自然流产Spontaneous AbortionEtiology1.Genetic defect– Karotype abnormality2.Maternal factors-Systemic disease, Reproductive system disease or malformation, Endocrine, Trauma, Bad habits3.Immune system-Autoimmune disease, Blocking antibody（生殖微环境不良）4.Environmental factors (pollution)自然流产Spontaneous AbortionPathology早期流产：胚胎死亡→绒毛与蜕膜分离→剥离面出血→妊娠物成为宫腔异物→刺激子宫收缩宫颈扩张G8w前：绒毛发育不完全，易与蜕膜分离，出血不多；G8-12w：绒毛发育繁茂，与蜕膜关系较牢，不易完全分离排出，出血多；G12w后：胎盘已经形成，流产时常先有腹痛，然后排出胎儿、胎盘，与分娩过程相似。 自然流产Spontaneous AbortionClinical manifestationHistory of menopause,Vaginal bleeding and Abdominal painEnlarged uterus, HCG(+), B-us exam;Early abortion—Vaginal bleeding(绒毛与蜕膜分离) before Abdominal pain(子宫收缩)Late abortion—Abdominal pain before Vaginal bleeding自然流产Spontaneous AbortionClassification and Characters先兆流产—Threatened abortion停经—少量阴道流血数小时或数日后，轻微下腹痛或腰骶部痛宫颈口未开，子宫大小与孕周相符转归：治疗后症状消失可继续妊娠 症状加重可发展为难免流产自然流产Spontaneous AbortionClassification and Characters难免流产—Inevitable abortion阴道流血增多，腹痛加剧，胎膜破裂，宫口开张偶见妊娠物堵塞宫颈口子宫大小与停经周数相符或略小胚胎停育：B-us检查仅见孕囊，内无胚胎或原始心管搏动。自然流产Spontaneous AbortionClassification and Characters不全流产—Incomplete abortion难免流产发展而来部分妊娠物排出，或胎儿排出后附属物残留子宫收缩不良大量出血，可发展至休克宫颈扩张，可见妊娠物堵塞或活动性出血，子宫小于孕周。自然流产Spontaneous AbortionClassification and Characters完全流产—Complete abortion流产症状妊娠物排出流血逐渐停止腹痛逐渐消失宫颈口关闭子宫恢复正常大小自然流产Spontaneous AbortionClinical process of abortion自然流产Spontaneous AbortionDifferentiation of the abortion typeSYMPTOMSSIGNSTYPEBleedingLower abdominal painTissueCervical oxUterine sizeThreatened abortionLittleNo or lightNoCloseFits the gestational ageInevitable abortionMoreSevereNoDilatedFits or smallerIncomplete abortionMassiveNot so severePart of the pregnant massDilated, something obstructedSmallerComplete abortionLittle or noNoAllCloseBasically normal自然流产Spontaneous AbortionSPECIFIC TYPEMissed Abortion—宫内胚胎或胎儿死亡未及时排出正常早孕过程，有或没有先兆流产症状，子宫并不增大或逐渐缩小，早孕反应消失，宫颈未开，质地不软。Habitual Abortion—连续自然流产3次或以上连续自然流产2次或以上称为复发性流产（RSA）病因：染色体异常、内分泌异常、生殖系统异常、宫颈松弛Septi