,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,Abortion and Ectopic Pregnancy,Liang-Qing Yao,Obstetrics and Gynecology Hospital of Fudan University,Abortion and Ectopic,1,Abortion,Abortion,2,Concept,A pregnancy loss before 28 weeks of gestation while fetal weight under 1000 grams,Early Abortion,：,pregnancy loss before 12,gestational weeks,Late Abortion:pregnancy loss,during 12,28,gestational weeks,Spontaneous,Abortion,Artificia,l Abortion,Concept A pregnancy loss befor,3,Genetic defect,Maternal factors:,systematic disease;genital organ anomalies;endocrine anomalies;irritation;bad,habit,Immune anomalies,Environmental factors,Etiology,Etiology,4,Pathology,Before 8 weeks:,chorionic villi immature,Fetal death,basal decidual bleeding,uterine contraction,expulsion of all the products of conception,light bleeding,During 8,12,weeks,：,with firm attachment to the basal decidua,Partial expulsion of the products of conception,non-ideal uterine contraction,severe bleeding,After 12,weeks:,placenta fully formed.,Uterine contraction,expulsion of all the products of conception,，,light bleeding,PathologyBefore 8 weeks:chori,5,Symptoms,Amenorrhea,vaginal bleeding,and abdominal pain,Early abortion,：,vaginal bleeding preceding abdominal pain,Late abortion,：,abdominal pain preceding vaginal bleeding,SymptomsAmenorrhea,vaginal bl,6,Types of Abortion,Threatened,Abortion,Inevitable Abortion,Incomplete,Abortion,Complete Abortion,Missed Abortion,Habitual,Abortion,Septic Abortion,Types of AbortionThreatened Ab,7,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,cervical os open,，,pregnancy tissue visible,abortion is inevitable,Clinical PresentationsThreaten,8,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,Incomplete Abortion,9,Different Stages of Abortion,threatened abortion,continue pregnancy,inevitable abortion incomplete abortion,complete abortion,Different Stages of Abortiont,10,Diagnosis,History,Physical Examination,Laboratory Assessment:,ultrasound,pregnancy test,hormone level:serum progesterone,DiagnosisHistory,11,Bleeding,Abdominal Pain,Tissue Expulsion,Cervical Os,Uterus,Threatened Abortion,Inevitable Abortion,Incomplete,Abortion,Complete Abortion,Light,Mild to heavy,Light to heavy,Light to none,None/light,Intensified,Relieved,None,None,None,Partial,Complete,Closed,Dilated,Dilated or obstructed,Closed,Normal,Normal or slightly small,Small,Normal or slightly large,History Pelvic Examination,BleedingAbdominal PainTissue E,12,Management,Threatened Abortion,bed rest,sedation,anti abortion,：,progesterone,，,HCG,；,Vit E,；,thyroxine supplement,monitoring,：,ultrasound,；,serum HCG whether to continue pregnancy,Inevitable Abortion,once diagnosed,，,remove the pregnancy tissue as quickly as possible,suction curettage,ManagementThreatened Abortion,13,Incomplete Abortion,perform suction curettage promptly,if with heavy bleeding,：,blood transfusion,；,preventive antibiotic use,Complete Abortion,no retained products of conception confirmed by ultrasound,；,no infection,no need for special management,Incomplete Abortion,14,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,Missed Abortion Concept:in ut,15,Management,blood routine examination,coagulation function test,correcting coagulation defects,：,heparin,fibrinogen,etc.,sensitizing the uterus,：,diethylstilbestrol,transfusion preparation;emptying the uterus,：,before 12 weeks:suction curettage,after 12 weeks,：,induction of,labor,Management blood routine exami,16,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,，,immunologic factors,，,luteal-phase insufficiency,hypothyroidism,Late abortion,：,congenital uterine anomalies,，,cervical incompetence,，,uterine fibroids,etc,.,Habitual Abortion The occurren,17,Management,obtain information on etiology for prior losses before conception,genetic counseling,cervical incompetence,：,cervical,cerclage,during 14,18 weeks of gestation,with unclear causes,：,progesterone therapy until 10 weeks of gestation,active immunotherapy,：,intradermic injection of lymphocytes,Managementobtain information o,18,Septic Abortion,Prolonged bleeding during abortion or retained products of conception lead