abortion
Introduction
Introduction Abortion is a common disease in obstetrics and gynecology. If it is not properly treated or not treated properly, it may leave genital inflammation, or it may endanger the health of pregnant women due to major bleeding, and even threaten life. In addition, abortion is easily confused with certain diseases of gynecology. Pregnancy is terminated before 28 weeks, and the fetus weighs less than 1000 grams and is called a miscarriage. Abortion occurs before 12 weeks of gestation and is called early abortion. The latter occurred in 12 weeks, called late abortion. Contraception should be made within half a year after abortion, and pregnancy should be repeated after half a year to reduce the occurrence of miscarriage.
Cause
Cause
There are many reasons for abortion, mainly in the following aspects.
Genetic defect
In early spontaneous abortion, chromosomal abnormalities accounted for 50%-60% of embryos, mostly chromosome abnormalities, followed by chromosome structural abnormalities. The number is abnormal, such as trisomy, triploid and X monomer; structural abnormalities have chromosome breaks, inversions, deletions and translocations. The majority of embryos with chromosomal abnormalities are aborted, and very few may continue to develop into fetuses, but some functional abnormalities or malformations may occur after birth. If abortion has occurred, the pregnancy product is sometimes only an empty gestational sac or a degraded embryo.
2. Environmental factors
There are many external adverse factors affecting reproductive function, which can cause damage to the embryo or fetus directly or indirectly. Excessive exposure to certain harmful chemicals (such as arsenic, lead, benzene, formaldehyde, chloroprene, ethylene oxide, etc.) and physical factors (such as radiation, noise and high temperatures) can cause miscarriage.
3. Maternal factors
(1) systemic diseases: acute illness during pregnancy, high fever can cause uterine contraction and cause miscarriage; bacterial toxins or viruses (herpes simplex virus, cytomegalovirus, etc.) enter the fetal blood circulation through the placenta, causing fetal death and miscarriage. In addition, pregnant women suffering from severe anemia or heart failure can cause fetal hypoxia, may also cause miscarriage. Pregnant women with chronic nephritis or high blood pressure, the placenta may have an infarction and cause miscarriage.
(2) genital diseases: maternal factors such as uterine malformations (such as double uterus, mediastinal uterus and uterine dysplasia), pelvic tumors (such as uterine fibroids, etc.), can affect the growth and development of the fetus and lead to miscarriage. Relaxation of the internal cervix or severe laceration of the cervix is prone to late abortion due to premature rupture of the membrane.
(3) endocrine disorders: hypothyroidism, severe diabetes failure to control, luteal function, can lead to miscarriage.
(4) Trauma: Abdominal surgery or mid-pregnancy trauma during pregnancy, especially in early pregnancy, leading to uterine contraction and abortion.
4. Insufficient endocrine function of placenta
In the first trimester of pregnancy, the progesterone of the ovary is secreted by the corpus luteum, and the placental trophoblasts gradually produce progesterone. After 8 weeks of gestation, the placenta gradually becomes the main place to produce progesterone. In addition to progesterone, the placenta also synthesizes other hormones such as -chorionic gonadotropin, placental lactogen and estrogen. In early pregnancy, the above-mentioned hormone value decreases, and it is difficult to continue the pregnancy and cause miscarriage.
5. Immunity factors
Pregnancy is like a transplant, and there is a complex and special immunological relationship between the embryo and the mother, which makes the embryo unrejected. If the mother and child are not immune to the immune system, it may cause the mother to reject the embryo and cause miscarriage. The immune factors mainly include the father's histocompatibility antigen, fetal specific antigen, blood group antigen, maternal cell immune regulation disorder, insufficient maternal blocking antibody during pregnancy and insufficient cytotoxic antibody of maternal anti-parental lymphocytes.
Examine
an examination
Diagnosing abortion is generally not difficult. According to the history and clinical manifestations, many diagnoses can be made, and only a few need to be assisted. After the diagnosis of abortion, the clinical type of abortion should also be determined and the treatment method should be determined.
History
Patients should be asked whether there is a history of menopause and a history of repeated abortion, with or without early pregnancy reaction, vaginal bleeding, should ask about the amount of vaginal bleeding and its duration, whether there is abdominal pain, the location, nature and extent of abdominal pain. It should also be understood that there is no water in the vagina Sample drainage, vaginal discharge color, volume and odor, with or without pregnancy products.
2. Physical examination
Observe the general condition of the patient, whether there is anemia, and measure body temperature, blood pressure and pulse. Under the disinfection conditions, gynecological examination, pay attention to whether the cervix is dilated, whether the amniotic sac bulges, whether the pregnancy product is blocked in the cervix; whether the size of the uterus is consistent with the number of menopause, and whether there is tenderness. The bilateral attachments should be examined for lumps, thickening and tenderness. The operation should be gentle during the examination, especially for suspected abortions.
3. Auxiliary inspection
For those who have difficulty in diagnosis, the necessary auxiliary examinations can be used.
(1) B-mode ultrasound imaging: It is widely used at present, and has practical value for differential diagnosis and determination of abortion type. For suspected threatened abortion, the embryo or fetus can be determined according to the shape of the gestational sac, with or without fetal heart reflex and fetal movement to guide the correct treatment. Incomplete abortion and missed abortion can be determined by B-mode ultrasound.
(2) Pregnancy test: With immunological methods, the clinical use of test strips in recent years is meaningful for the diagnosis of pregnancy. In order to further understand the prognosis of abortion, radioimmunoassay or enzyme-linked immunosorbent assay is used to quantitatively measure HCG.
(3) Determination of other hormones: Other hormones mainly have blood progesterone, which can help determine the prognosis of threatened abortion.
Diagnosis
Differential diagnosis
Abortion must be differentiated from functional uterine bleeding, tubal pregnancy, hydatidiform mole, uterine fibroids, and chorionic epithelial cancer. In addition, various types of abortion should be identified in order to clarify the diagnosis and choose different treatments depending on the type. Therefore, it is also critical to determine the nature of the disease, such as blood HCG examination, abdominal ultrasound monitoring, etc. to determine.
