Abortion

Abortion
[Summary]



Abortion (abortion) is common gynecological diseases, such as improper handling or processing delays may be left genital inflammation, or bleeding, thus jeopardizing the health of pregnant women, and even life-threatening; In addition, some abortion and gynecological diseases easily confused. In the 20 weeks of pregnancy is terminated before the fetal weight of less than 500 grams, known as abortion (WHO 1966). Abortion occurred in the former 12 weeks pregnant, as early abortion. The latter occurred in 12 weeks, as late abortion.



[Diagnosis]




One should first determine whether abortion

(A) asked in detail about history: whether menopause history, whether vaginal bleeding, bleeding volume, nature, whether or not accompanied by abdominal pain and other emissions, such as.

1. Abortion uterine bleeding in general more than ectopic pregnancy with other abnormal pregnancy also different. Some of ectopic pregnancy for more than vaginal bleeding; mole of bloodshed often dark red, can be repeated bloodshed, even large vaginal bleeding, such as careful inspection, and sometimes can be found in the blood blister-like tissue. Dysfunctional uterine bleeding, occurred in the age of fertility period ends, in its more than 40-year-old often stopped by history, although the large number of vaginal bleeding, but have no abdominal pain, a few other miscellaneous discharges. All these circumstances, the history of combining motherhood and availability of contraceptive measures, it is easy to distinguish. If in doubt, viable diagnostic curettage, the pathological examination that can be confirmed; also conducive to the treatment. Many abortion cases, blood is misdiagnosed as reactive. Patients with uterine fibroids no significant history of menopause and infertility have menorrhagia and history, check the uterus, such as touch on the nuclear muscle, the more specific diagnosis.

2. Menstrual bleeding from the end of the time: that is, from beginning to the end of the menstrual vaginal bleeding, ectopic pregnancy often shorter in abortion, while longer hydatidiform mole.

3. Outflow of blood color: bright red at the beginning of abortion, time rectangle into a dark red or brown. Often for a small number of ectopic pregnancy, or brown color Danhong; hydatidiform mole is often dark red.

4. Abdominal pain: abortion, generally less pain hydatidiform mole, paroxysmal more next abdominal Central. Ectopic pregnancy side of the lower abdomen for severe pain may spread to the entire abdomen, and 1 to 2 will gradually reduce. Reactive blood, no more than lower abdominal pain. Uterine fibroids may have pelvic pain or heavy sense of light.

5. Know whether post-menopausal pregnancy and abortion phenomenon of incentives, such as sexual life, load, and tourism.

(B) a dual diagnosis: uterus attention to the location, size, shape, hardness, uterine isthmus is particularly soft, like uterine cervix and the Department of the Ministry of loss of continuity; annex on both sides of whether mass or tenderness, resistance; cervical I erosion there, bleeding, there cervical polyps, and to identify whether the bleeding from the uterus, such as abortion, it must come from uterine bleeding.

(C) examinations.

Second, to determine what abortion

Abortion by various labor through different performance, different from its handling of principle, it must determine what abortion.

Less vaginal bleeding, I did not open the uterus, uterine magnanimous in line with menopause, for threatened abortion. I opened the womb, amniotic sac prominent, or break down, a lot of vaginal bleeding, compared with inevitable abortion. Bleeding, from some organizations, the uterus in less than menopause, incomplete abortion. History has threatened abortion, I did not open the uterus, at the beginning of the bloodshed, embryonic tissues after discharge, vaginal bleeding rapidly reduce or stop, inspection has been closed mouth uterus, uterine contraction good for the complete abortion. Uterus in less than menopause, pregnancy test was negative, compared with late abortion.

Habitual Abortion

First of all understand the reasons for abortion, and his wife at the same time stressed that the diagnosis is not only check the woman, should attach importance to male factors, the hospitals have been set up conditional genetic counselling clinic gifted students. Habitual abortion an important part of their treatment.

(1) Pregnancy asked in detail about past history, past medical history, genetic family history, history should be suspicious of genetic mapping genealogical map.

(B) systemic checks and gynaecological examinations.

(C) carry out the necessary tests and examinations. Man: conventional semen, blood type, such as chromosome. Woman: vaginal cells smear, cervical score, based on body temperature, blood type, chromosome, B-examination of the situation there uterine malformations.

(D), under the circumstances, further examination:

1. Suspected uterine malformations in addition to B-, viable Hysterosalpingography, uterine mirror, laparoscopy.

2. Suspected endocrine abnormalities, fasting blood glucose checks. With the temperature will be based on pathological examination and endometrial RIA investigation progesterone, LH, FSH and PRL, E2, T3, T4, TSH ,17-,17-Cu OH such as inspection and, if necessary, feasible brain CT and understanding of the brain whether micro, such as pituitary adenoma.

3. Special suspected infection can be found cytomegalovirus, toxoplasmosis, chlamydia checks.

4. Adverse environmental exposure history, to SLE, micro-nuclear, chromosome aberrations rate checks.

5. Suspect ABO blood group incompatibility, further examination antibody titer. If a pregnancy examination of the inter-antibody titer whether there is a change. Aftereffect receiving treatment at the decline.

Third, whether abortion complications (detailed later).


[Treatment]




1, threatened abortion clinic for the treatment of the principle of Baotai, about 60 per cent of threatened abortion, as appropriate treatment effective. The first B-scan embryo survival, the absolute bed rest until the symptoms disappeared after appropriate activities. Try to avoid all can cause uterine contractions stimulated, such as vaginal examinations, sexual life. With the thinking of reducing unnecessary tension and concern. Health patients Congyou perspective to understand, the majority of early abortion for a variety of reasons not to normal embryo, abortion is natural selection, not pity.

Pay attention to adequate nutrition, without damage to the foetus sedative drugs such as Luminal 0.03 ~ 0.06 g, 3 times a day. Maintain patency stool, if constipation, taking laxatives, purge Ling (Lo, amber, etc.) 1 ~ 2, a fruit derivative, phenol tincture in the double dose of vinegar on the easy to soften the stool good effect.

Endocrine therapy such as inadequate luteal function, available progesterone 20 mg, 1 to 2 times daily, intramuscular injection may help inhibit uterine decidual muscle growth and activities should be under the guardianship B superb treatment.

Application of estrogen in recent years many scholars reported born baby prone vaginal adenosis, and even adenocarcinoma.

Early application of human chorionic gonadotropin, and promote synthesis of progesterone. Vitamin E (tocopherol) is in favor of Yunkun, 100 mg daily oral. Some authors believe that vitamin E on the uterus is similar to progesterone partial role, and central nervous system effect, each 200 mg, served on the 2nd.

Low basic metabolism, thyroid tablets can be given 0.03 g / d, oral.

In the B-embryo custody understanding, avoid unnecessary Baotai.

Chinese medicine: Chinese medicine that threatened abortion more of the blood weak, the loss Shenqi, fetal yuan is not solid, so blood disorder, not the solid-affected embryo implantation and development, a result of abortion.

(1) weak blood: the first trimester of pregnancy, vaginal bleeding, abdominal sinkers or lumbar acid medium-term pregnancy, fetal movement disturbed, vaginal bleeding, Shenpi weak, short tongue, pulse unable to slip.

Treatment: Yiqi Yangxue tocolysis.

Recipe: Taishan ever drink Modified: Dangshen 10 g, 10 g Baizhu, Astragalus 10 g, 10 g TGP, baicalin 10 g, 10 g-off, orange peel 6 g, steroid 10 g, 10 g Amomum villosum.

(B) kidney deficiency: with a lumbar acid, Tuiruan or history of abortion, pregnancy movements uneasy, very acid, lumbar pain, falling fetal blood, urine frequency, pulse weak Shen tongue Yanhong, less moss.

Treatment: Bushen tocolysis.

Recipe: TING fetal Pill Modified: Dodder 30 g, 10 g Loranthaceae, Dipsacus 10 g, 10 g Eucommia, steroid 10 g, 10 g Ejiao (Chongfu), 3 g Zhigancao.

(C) blood heat: fetal movement disturbed, fall, Louxia color red, dry mouth, upset, palm fever, yellow urine red Shehong, Moss thin yellow slip a few veins.

Treatment: Qingre tocolysis.

Recipe: habitat 10 g, 10 g Hang Shao, baicalin 10 g, 10 g-off yam 10 g, 10 g dry grass-lian.

Second, the inevitable abortion treatment principle should be removed intrauterine embryo. Early pregnancy should be held aspiration of the Palais. More bloodshed can be injected immediately Pituitrin 10 U (or oxytocin) to promote uterine contraction, from the organization, and for absorption Palace. As for the medium-term pregnancy may give Pituitrin (or oxytocin) induction. Methods: ① Pituitrin (or oxytocin) 5 U, a half-hour each time, intramuscular injection, for 4 to 6 times to wait for automatic discharge. But uterine infection or traumatic history, the history should be cautiously uses or not, in order to avoid uterine rupture; ② pituitary high concentration of labor, to a ~ 5% oxytocin (each containing 100 ml, 1 to 5 U) intravenously, from low - concentration, gradually increase to the effective concentration (causing strong uterine reduction RUF), and to maintain this concentration from embryonic tissues.

Bleeding for a long time, I opened the uterus, the embryo can be removed with surgery.

Third, incomplete abortion should be cleared of intrauterine. If bleeding, shock levy should transfusion, blood transfusion to correct shock, static at the same time pushing or intramuscularly oxytocin 10 U, and for removal of uterine cavity. Such as shock to correct that clamp scraping placenta or smoke bleeding from the placenta.

The prevention of postoperative infection. At the same time, iron, Chinese medicine, to correct anemia.

Fourth, complete abortion from embryonic tissues, stop bleeding, abdominal pain disappeared, in addition to Zhuhuanzhe rest, pay attention to postpartum摄生, without special treatment. But embryonic tissue is completely discharged, we must correct judgement. If the check from the organization have seen complete fetal sac, decidual or fetal placenta, with symptoms and inspection and, if necessary, B-ultrasonic inspection confirmed that the complete abortion can be diagnosed if not identified, incomplete abortion should be dealt with in order to make a further curettage for properly.

5, missed abortion views on dealing with different and even opposite views. Some people think that without interference from natural wait. However, it was confirmed that it should be held after surgical removal. Commonly used treatment principles are: within three months of pregnancy has been confirmed as stillbirth can be immediately removed intrauterine. If more than three months pregnant, by using a large number of estrogen, and then use oxytocin induction of labor, and if they fail, surgery may be considered. In the missed abortion, the longer the embryos died, because of organizational machine, the more difficult curettage; and clinical in recent years and reported in the literature of more than 16 weeks pregnant missed abortion, may cause coagulation disorder, causing serious bleeding, the diagnosis is a positive suitable treatment.

Preoperative Yixicifen to estrogen or 5 mg four times daily, a total of 3 to 5 days, the uterine oxytocin sensitive. Preoperative examination blood, blood coagulation time, if conditions should check fibrinogen, and prepared for transfusion.

Less than three months, the possible absorption of the palace or intrauterine to 12 hours before intubation, a further blow with forceps.

In larger, the first B-scan understanding of fetal death size, it has amniotic fluid. If amniotic fluid and amniotic feasible puncture, Lee Rivanol 80 ~ 100 mg amniotic injection induced abortions. If necessary, be applied oxytocin induction of labor is more convenient and safe.

6, habitual abortion a history of habitual abortion, should always be the basis of the temperature measurement, such as the menstrual cycle slightly longer based on the temperature does not drop, pregnancy possible, to start treatment. Avoid physical and mental tension, prohibition of life, and started oral vitamin E100mg / d, and to give vitamin B, C, β-hCG done early and B-scan to confirm the diagnosis. Find out the reasons for the treatment causes:

1. Chromosomal abnormalities: prenatal diagnosis. Man chromosomal abnormalities, and the couple agreed to seek feasible AID. Other genetic factors, according to the genetic approach to consider, obviously genetic tendency, no good method of prenatal diagnosis, termination of pregnancy should be discouraged.

2.ABO incompatible: IgG antibody titer Ⅱ areas above, to Yinchen soup (Yinchen 10 g, 3 g of rhubarb, baicalin 12 g, 10 g licorice) early, middle and late pregnancy of the 10 service pay. Yiwu Pill (Leonurus 500 g, 250 g of Angelica, Chuanxiong 250 g, 300 g TGP, 12 g-costas. Ximo of inquiry, refining honey for the pills, each pill 10 g), each one pill, on the 1st 2 or 3 times. And regular follow-up, with the exception of obstetric cases, the antibody titer to understand whether changes. Shandong Provincial Hospital 228 cases of maternal and fetal blood group incompatibility, the ABO blood group in the merger is not measured in serum IgG anti-A (B) antibody to 214 cases, Rh blood group incompatibility in 12 cases. Pregnant again after treatment in the hospital regularly reviewed, 88 cases of childbirth, and 17 cases of maternal-fetal blood group consistency, and 71 cases of blood group incompatibility, check with cord blood IgG anti-A (B) antibody to 58 cases, there are 10 cases of neonatal damage serious, all survived after treatment; 12 cases of Rh blood group incompatibility pregnant again in nine cases, five cases of survival after treatment. Shandong Provincial Hospital in the treatment of traditional Chinese medicine in addition to the above, the antibody titer in the area over Ⅲ, pregnant early, middle and late on the 10th line therapy: 50% glucose and 40 ml of vitamin C500mg, 1, 1, the intravenous injection . 1st inhaled oxygen 30 minutes a day for 10 days. Vitamin E100mg daily 1. Chinese herbal medicine with the type of material can with relative specificity of the antibody binding should be due to inhibition antibody, titer decreased played prevention ABO hemolytic disease of newborn and the occurrence of abortion.

Rh hemolytic disease of newborns a shake-treatment, prevention shake the occurrence of complications after treatment is the key to success. Suffering from severe Rh hemolytic disease of children of pregnant women, prenatal home with plasma exchange, can reduce maternal antibodies in antibody titers declined, easing antigen-antibody combination can reduce the extent of damage to fetal, neonatal survival increase opportunities.

3. Abnormal uterine: that in the non-pregnant uterus double angle, the double uterus, uterine septate uterus feasible performed. Liaocheng in Shandong Zhang paternity Health report, two cases of uterine double angle (one case of infertility, one case of habitual abortion) hysterectomy were forming shortly after live births. After the original double uterus to avoid the hormones do not reflect synchronization, thereby eliminating the pregnant uterus of the foreign body to stimulate uterine pregnancy, but also an increase of the implantation Yunkun opportunities. Contraception after three months. If pregnancy to term labor should be held before the Caesarean section. For children who prays for more time to allow pregnancy. Because surgery within six months of pregnancy and six months after pregnancy pregnancy was no big distinction between peacekeeping, to watch the uterine scar Caesarean section, six months after surgery, pregnancy and six months after pregnancy, there is no big difference. There is no need for too long contraception.

Habitual abortion no other reason only due to uterine fibroids, in the nuclear non-pregnant muscle resection, but it should be and their families and I explained to him that there may be abortion. Uterine adhesions, viable separation of adhesion. Long after cervical incompetence.

4. Luteal insufficiency: progesterone, human chorionic gonadotropin, such as phenol clomiphene citrate therapy.

5. Immunotherapy: No precise reason for the habitual abortion, wives without husbands in serum antibodies to HLA. Methods of sterile blood from her husband in the isolated lymphocytes, concentration of 3000 to 4000 × 104/ml every three to four weeks to his wife, an intradermal injection of a total of immune 3 ~ 5 times. Her husband is the author of the report lymphocyte immune therapy to achieve better efficacy, 311 cases of pregnancy in 200 cases, of which 124 cases of childbirth, continue to have more than 24 weeks of pregnancy to 23 cases, a total of 73.5%. Shandong Provincial Hospital by immunohistochemistry in 32 cases treated 28 cases of successful pregnancy success rate of 87.5%.

TCM:

1. Blood weak: see rule of threatened abortion. Symptoms improved, at 3 ~ on the 5th one to four months. A morning heat, the more Baicalin by Amomum villosum; Weihan Amomum villosum to use less and baicalin. Have vaginal bleeding, and with Jiaoai soup, sometimes with Eucommia, Loranthaceae two drugs; fetuses Huo-wang, allocated by Huangbai, Anemarrhena.

2. Shenqi not solid:

Treatment: Bushen Guchong.

Recipe: Bushen Guchong Pill: Dodder 75 g, 30 g Dipsacus, Ejiao 45 g, 30 g Lugushuang, steroid 45 g, 30 g Baizhu, Eucommia 30 g, 30 g of Chinese wolfberry, Amomum villosum 10 g, 24 g body of Angelica, Morinda officinalis 30 g, Jujube meat 20. Ximo total refining Miwan per 10 g. Done strictly according to: 1 per pill, three times a day. Stopped serving menstrual cramps, for a two-month course of treatment. Has been conceived to serve drinks Bushen tocolysis Modified: Dangshen 12 g, 10 g Baizhu, Eucommia 12 g, 12 g-off, barometz 12 g, 10 g Ejiao, Artemisia Leaf C 10 g, 10 g Dodder, Loranthaceae, 10 g Fructus alpinia oxyphylla 10g, 10 g psoralen.

Since habitual abortion in the first two weeks begin taking every other day one, and even served in the habit of abortion.


[Etiology:




Abortion lead to the reasons are complex, the different types of early abortion due to the more common chromosomal abnormalities, endocrine abnormalities, dysplasia or uterine malformation.

A chromosome abnormality of chromosome abnormalities, including chromosome abnormalities, such as single, three-, polyploid; structural abnormalities, such as broken, missing, translocation induced abortion can be. Some of spontaneous abortion and therapeutic abortion chromosome study found that in spontaneous abortion of abnormal karyotypes of 60%. Abnormal karyotype each with a fetus or placenta, and other structural anomalies. The normal karyotype more normal fetal abortion.

Second, endocrine disorders estrogen and progesterone over inadequate for early abortion causes. Result in pregnancy from 12 to 14 to replace Zhou Zheng in the placenta formation of pregnancy during the luteal function easily with endocrine disorders, especially luteal insufficiency. In addition, the lack of thyroid hormone, so that the oxidation process of cell obstacles, as well as hyperthyroidism and diabetes-prone Dengjie abortion.

Third, the placenta and placental abnormalities of endocrine less than the decidua of early pregnancy can at the end of inflammation or decidual hemorrhage hyperplasia, villus epithelial cells and decidual cells were dissolved, villous vascular obstruction affect nutrient absorption and transport, resulting Yunkun Separation from the attachment, bleeding and abortion. In addition, if the placental infarction tremendous placental function can reduce the impact of fetal survival, and placenta previa, placenta edema caused by degeneration into abortion were not uncommon. Pregnancy after β-hCG in maternal blood, hPL, P, E2 and estrone, early pregnancy, such as the decline in value of these hormones, 50% of abortion.

4. Incompatible blood transfusion or pregnancy due to the past, to the Rh factor, not the factor in the ABO blood group antibodies in the mother, the pregnancy by the placenta into the fetus and the body produce red blood cell hemolysis and lectin, which abortion.

5, the spirit of factors such as shock, severe mental stimulation can also be induced into abortion. In recent years, through research that noise and vibration on the reproductive has a certain impact.

6, the mother systemic diseases

(1) severe acute communicable diseases and infections: If Lobar Pneumonia, with a high fever caused more uterine contraction, and / or embryos can be killed by abortion.

(2) chronic diseases: severe anemia, heart disease, heart failure can cause fetal hypoxia, suffocation and death from chronic nephritis, a serious hypertension can placental infarction or early stripping caused abortion.

(C) malnutrition or poisoning: such as lack of vitamin, and particularly vitamin E-the lack of reproductive alcohol, mercury, lead, alcohol and morphine, and other chronic poisoning can cause abortion.

7. Genital diseases uterine malformations, such as dual-angle uterus and uterine cavity mediastinum, and often the reasons for abortion. But uterine dysplasia is often the cause of infertility. In addition, uterine fibroids, and in particular to the development of uterine cavity submucosal fibroids or incarcerated in the bone cavity uncle in ovarian cystic tumor, may affect fetal development and lead to abortion. I relaxation womb customary for one of the common causes of abortion. Asherman patients in recent years found that about 14 percent occurred in post-abortion. Intrauterine adhesions cause narrowing, deformation and endometrial area reduced, and there is hardening, the impact of embryo development.

8, immune factors for reasons unknown, the study found that in recent years most closely associated with immunologic factors.

(1) histocompatibility antigen (histocompatibility locus antigen, HLA): HLA complex located in the short arm of chromosome 6 of a section, including at least four and transplantation of gene loci: HLA-A, B, C, D / DR, etc.. HLA normal pregnancy incompatible couples can maintain genetic diversity, and prevent the formation of homozygous lethal. And habitual abortion couples HLA antigens compatible frequency than normal pregnancy, with the same antigen DR more opportunities. There are too many antigens to prevent pregnancy as the mother of allogeneic antigen identification, can stimulate the body to produce antibodies required for the maintenance of pregnancy, the lack of regulation of the antibody. Maternal fetal immune system to produce easy immunological attack which led to abortion.

(B) antiphospholipid antibodies: a group of autoimmune antibodies, including antibodies in lupus anticoagulant (LA) and ACA (acl). Recent studies have found that in autoimmune diseases, certain infections, drugs, or unknown causes of diseases, such as antiphospholipid antibody positive, habitual abortion rate high. Often patients with arteriovenous thrombosis, thrombocytopenia, to consider abortion is due to thrombosis, or placental function caused decidual inadequate. Antiphospholipid not lead role in early pregnancy abortion, but in the role of pregnancy, the late fetal death, antiphospholipid antibodies may be factors in the late abortion.

(C) anti-sperm antibodies: recurrent spontaneous abortion (recurent spontaneous abortion, RSA) and his wife, or both of the man found in the serum of anti-sperm antibodies. Animal experiments have proved that anti-sperm antibodies to kill embryos role. Suggesting that the antibody and the existence of the RSA. Also reported the woman's domestic anti-sperm antibodies positive Most of the sperm on the woman and her husband allograft immune autoimmune are concerned with the RSA.

Anti-sperm antibodies induced abortion, occurred in less than three months of early abortion, that is, sperm agglutination maternal antibodies continuing role in the early embryonic tissues to disease, damage to embryo abortion.

[Pathological changes:




The abortion occurred during different pathological process is inconsistent. Occurred in the past eight weeks of pregnancy, the majority of embryos to death, and then at the end of the sponge layer decidual hemorrhage, necrosis and thrombosis. Therefore villosity hypoplasia not firmly linked with the mother, abortion is the most embryonic and fetal sac and the uterine wall and completely separated from, the little general hemorrhage. This is often overlooked and abortion is a misconception that expired menstruation. The typical outflow Houer opaque specimens for a slightly bloody invasion of the embryo sac. Capsule in the thickest part of the villi of the complexity of Health, placed in water, there are floating villi. Open wall, a small amount of amniotic fluid intracapsular, has been that embryos or embryonic organizations, such as the absorption of a grain of rice, colored gray, gray ties in the amniotic membrane. Occurred in 8 to 12 weeks, because of villi has a complete, and at the end of decidual more solid contact, often only part of the fetus or fetal placental villi outflow, and missed another part of the uterine cavity organizations affected uterine contractions, so much bloodshed . Although some fetal deaths, but did not immediately drained several times around a small number of embryonic bleeding, blood in the plot at the end of decidual villi space, and invasion and fetal sac, blood outflow after condensation, formation of new blood clots bleeding again, surrounded Old blood clots embryos for multi-storey surrounded by blood clots, known as fetal blood block, time after time hemoglobin absorbed, there was a child-like pieces of meat. Blood clots in the villi and decidual between a rugged nodules bar, convex to the amniotic sac, and amniotic sac to be squeezed smaller placental blood circulation interruption, fetal absorbed into nodular fetal block. Placenta have been formed, with the uterine wall firmly linked abortion process and the premature birth, similar to full-term births. RUF began shrinkage, uterus mouth gradually expanded, amniotic membrane rupture, from the fetus, the placenta after stripping themselves from, or missed in the uterine cavity. Can be more bloodshed in less, depending on the circumstances of the placenta peeling different. Such as intrauterine fetal died without infection, into the Baptist soft tyres, fetal skin soft and umbilical cord were Baptist, hemoglobin calmly, and is dark red, with amniotic fluid was blood, time after time, it was brown.

See less of is Anshi. Amniotic fluid is absorbed, fetal skin was affixed to the bone dry on the white carcass was crushed, and a pattern fetus.


[Clinical]




First, abortion is the main symptoms of abdominal pain and bleeding

(1) vaginal bleeding: In three months of pregnancy abortion, at the beginning of villi and decidual separation, sinusoids and opening up, began to hemorrhage. When separated from all embryos, strong uterine contraction sinusoids closed, and bleeding stopped. Therefore, the entire process of early abortion are associated with vaginal bleeding. Late abortion, the placenta have been formed, full-term abortion and premature births and similar small general bloodshed.

(2) abdominal pain: the bloodshed began early abortion, the existence of uterine blood clot in particular, stimulates uterine contractions, a persistent abdominal pain. Late abortion is to have paroxysmal uterine contraction, and then the placenta peeling, vaginal bleeding before it is a pain.

Abdominal pain and bleeding is the most sexual, and their clinical course and the progress.

Second, the clinical classification of abortion

Most abortion to a certain extent the development process, although some stage in the not obvious clinical manifestations, and not necessarily in order of development. But most are no more than several out after the process, that is, clinical classification: threatened abortion, it is inevitable abortion, incomplete abortion and abortion. Abortion Abortion expired for the development of other special circumstances. Habitual abortion from repeated abortions is the name of this feature. But both still in the process of abortion include more clinical classification.

(1) threatened abortion (threatened abortion): It is the performance of abortion, but after the Baotai, may continue to pregnancy to term. Often occur in early pregnancy, only a small amount of vaginal bleeding, with the occasional minor uterine contraction. I did not check opening of the uterus, not amniotic sac rupture, hysterectomy, generous and in line with the menopause, pregnancy test was positive.

(B) inevitable abortion or inevitable abortion (inevitable abortion): There were more than process, but continue to work with embryonic uterine wall separation, bloody long time, the amount of bleeding increased over normal menstrual flow, and from a blood clot, paroxysmal lower abdominal pain aggravated, spastic or Zhuichan flu. I check gradually opening of the uterus, pregnancy in larger, and some have been swelling or amniotic sac rupture; some obstruction in the embryonic tissues of the cervix even seen cervix, mouth open, abortion is bound to happen, pregnancy has been unable to continue.

(C) incomplete abortion (imcomplete abortion): often occur in later pregnancy (after 10 weeks), or development of the placenta is formed, abortion and fetal placental part from the whole part of the placenta or placenta still attached to the uterine wall, the uterus not very good contract, vaginal bleeding so much. It takes time to be remnants of the placenta polyp formation of the placenta, repeated bleeding, and infection-induced.

(D) complete abortion (complete abortion): Threatened and inevitable abortion process in a short time completely from the embryonic tissues, bleeding, abdominal pain stop.

(5) missed abortion (missed abortion): also known as measured by no less than abortion or stillbirth. Still refers to the death of embryos in the uterine cavity missed, and progesterone products generally have more symptoms after 1 to 2 months out. Therefore, all provisions of embryo development stopped after two months out yet natural, as missed abortion. More pregnant women are threatened abortion after early pregnancy after hysterectomy no longer grow up, and anti-gradually reduced, and not as soft as the general pregnancy. Pregnancy test from negative into positive, and the placenta of the uterus wall adhesion close, it is not easy separation. On the other hand due to lack of sex hormones, lower uterine contractility, it is not easy but missed from the uterine cavity. Embryonic after the death of the placenta dissolution, have access to mother-to-live hemolytic blood circulation caused microvascular coagulation, spend a lot of coagulation factors, intrauterine missed the longer coagulation dysfunction caused the greater the likelihood. In recent years B-wide clinical application, stop by between 6 and 7 weeks of exploration and fetal sac can be fetal bud. Such as the suspect and stop embryonic development, can be B-observation, timely diagnosis and treatment. It was raised whether the current term reuse missed abortion, but also on clinical symptoms not obvious, not from patients with attention to attendance at the intrauterine fetal death missed too longer.

(6) habitual abortion (habitual abortion): more than three times in a row called spontaneous abortion habitual abortion, and abortion often occurred in the same month, and the process of abortion can be the clinical experience of the foregoing.


[Complications]




A large loss of blood and sometimes inevitably incomplete abortion or abortion can cause severe hemorrhagic large, and even shock. It should be active. Various measures can be at the same time. Intramuscular injection or intravenous oxytocin or Pituitrin 10 U. For transfusion to patients. In the absence of the blood bank under the condition can be mobilized medical personnel, or their family members to donate blood. 1 is not blood, and can also be temporary infusion dextran. At the same time give curettage, in the embryo removed fetal organizations, often stop bleeding, even in the existence of the infection under chunks of embryonic tissues should be removed. Subsequently should actively create conditions to be blood transfusion.

Second, the above-abortion infection can be co-infection, incomplete abortion, in more. Infection often occurred in using the equipment without a strict disinfection purposes abortion; equipment cervical injury, or intrauterine infection original lesion, surgical abortion or spontaneous abortion can cause spread of the infection. In addition, post-abortion (natural or induced abortion) pay no attention to health, such as premature sexual intercourse can cause infection. Infectious pathogens often for a variety of bacteria, mixed aerobic and anaerobic infection, in recent years various reports to the majority of anaerobes up 60 to 80 per cent.

Infection can be confined to the uterine cavity can be spread to the uterus around the formation of salpingitis, tubal ovarian inflammation, connective tissue pelvic inflammation and even beyond genital mutilation formed peritonitis, sepsis.

Patients with fever, chills, abdominal pain, vaginal bleeding, and sometimes stench secretions, uterine tenderness and annex, uterine involution bad, leukocytosis, and other inflammatory performance. Serious infection can occur shock. Do blood, cervical or uterine secretions smear, culture (aerobic and anaerobic). B-uterine cavity check whether tissue residue.

Treatment:

1. Rapid infection control, application of metronidazole intravenous antibiotics application, type, dosage, route of administration, according to the degree of seriousness to consider. Has been training, drug resistance, can be used for the situation.

2. Early clearance of intrauterine infection, curettage in the 6 hours after intravenous injection, will clamp a large organization.

3. Supportive therapy and, if necessary, to the importation of fresh blood. Various vitamins.

4. TCM treatment of pelvic organ inflammation see chapter.

Third, poor uterine involution uterine contraction can be given drugs such as lysergic flow extract or extract Motherwort flow. Residue suspected placenta, inflammation can be controlled, further curettage. But bleeding, when implemented immediately.

4, acute renal failure due to acute abortion after massive blood loss and shock and severe infection caused acute renal failure.

5, full-term pregnancy and placenta polyps compared abortion to abortion, occurred in the past. Can be induced into serious bleeding, and more than a few weeks after the abortion occurred. Check uterine slightly larger than normal, soft, mouth slightly dilated cervix. Sometimes pregnancy test can be positive. Curettage expansion should be carried out with curettage cervical polyp. To send pathological examination, we can see that complete degeneration of the villi or by blood clots by enveloping the villi.


[Auxiliary]




Clear resolution ultrasound images, various types of abortions carried out in the early transabdominal sonography, consistent with the high percentage of early diagnosis for early treatment of the conditions. Particularly in the last few years vaginal probe in early pregnancy and early abortion, more than superior abdominal examination. In addition, the basal body temperature (such as pregnancy, the body temperature from dropping), pregnancy testing, vaginal smear, cervical mucus crystallization, in a certain sense both diagnosis. Human chorionic gonadotropin levels to the normal range.


[Diagnosis]




(1) Ultrasonographic diagnosis: usually in the 5 to 6 weeks pregnant that fetal sac, 6 to 7 weeks pregnant that fetal bud by transvaginal than transabdominal morning. When there is no clinical signs of abortion, with the ultrasound examination can be found withered Yunkun. Fetal sac> 20 mm without yolk sac or fetal sac> 25 mm without fetal bud, as Wilt Yunkun. Only see a larger image for fetal sac no echo.

What can be diagnosed as abortion:

1. Threatened abortion: Ultrasonography light, because of a small amount of bleeding, fetal sac side echo enveloping the area, in small but clear uterine weight, a vast plot of blood, and fetal membranes can sometimes see the Palace wall dissection , after the fetal membranes echo there, according to different fetus during pregnancy that bud, the original, such as fetal heart beat.

2. Inevitable abortion: Ultrasonic performance: ① fetal sac deformation, fetal sac depression, or has been out of amniotic fluid; ② intrauterine or cervical mouth has been opened, embryonic product plug in the lower cervical intrauterine mouth or tube, such as fetal the film has not been broken cervical or vaginal see cystic dark; ③ fetus has been more death and fetal heart beat.

3. Incomplete abortion: Ultrasonic performance: ① uterine slightly; ② intrauterine a corporation or small irregular-dark zone.

4. Complete abortion: Ultrasound Images: ① normal uterine size or slightly normal; ② intrauterine see rules intrauterine wave, no irregular-Mission.

5. Missed abortion: In recent years ultrasound fetal death can be found in time, without waiting for two months after diagnosis, in recent years been raised "intrauterine fetal death." Ultrasonography: ① uterus less than gestational age; ② No fetal heart beat or fetal movement; ③ womb echo disorder, or difficult to distinguish between fetal placental structure.

(B) vaginal cytology

1. Fitness choriocarcinoma cells in the smear tend to occur in the emergence of abortion. Fitness choriocarcinoma cells ranging from the size of corporations, the cytoplasm is alkaline, contains a different number of deeply stained nucleus, and are often red, surrounded by the WBC, its features.

2. Karyopyknosis index: Pregnancy in the vaginal smear karyopyknosis index increased less than that progesterone, the reasons are: First, ovarian luteal insufficiency, the son of Lu endometrial development and decidual poor, so that leaves in trophoblast defects; one of the nourishment for their own shortcomings. Lutein, or less than natural recovery can be resumed after treatment. If nourishment of the area was abnormal, whether the primary defect in the fertilized egg, or secondary to nourish the leaves separated or decidual defects, miscarriages are will be inevitable. In both cases the prognosis of different, but karyopyknosis index increased, it karyopyknosis index can not identify two different scenarios. Only continuous observation karyopyknosis changes can be meaningful.

(C) cervical mucus crystallization: Estrogen can produce crystalline cervical mucus, and the crystallization of the progesterone inhibited. Therefore, in the cervical mucus crystallization pregnancy checks can be picked abortion prognosis.

(4) basal body temperature: early pregnancy should maintain high-temperature curve, sustained about 16 weeks, the normal gradually. Threatened such as abortion when pregnancy basis with the normal body temperature of the same prognosis is good, if lower than normal pregnancy, poor prognosis.

(E) Determination of hormones: As endocrine abnormalities induced abortion, according to different situations of hormones, such as suspected luteal insufficiency, pregnancy diol observation of dynamic change, select the appropriate method of treatment.