自然流产.ppt

妊娠时限异常妊娠时限异常 Abnormal Duration of Abnormal Duration of Pregnancy Pregnancy 程苾恒程苾恒武汉大学人民医院产科?第一节自然流产 spontaneous abortion ?第二节早产 premature delivery ?第三节过期妊娠 post-term pregnancy 自然流产自然流产 Spontaneous abortion ? Definition 重点! ? Classification ? Epidemilogy ? Etiology ? Diagnosis 难点! ? Therapy 重点! Definition ? Spontaneous abortion: termination of pregnancy before the 28th week of gestation , the weight of fetus less than 1000g ?自然流产:妊娠不足妊娠不足 28 28周,胎儿体重小于周,胎儿体重小于 1000g 1000g 而终止者而终止者?(美国)妊娠满 20周以前,或体重小于 500g ? Miscarriage VS Abortion Classification ? Early abortion <12weeks ? Late abortion ≥ 12weeks~<28weeks ? Artificial abortion ? spontaneous abortion Epidemiology ? Incidence: 10%~15% ? 80% of abortions: before the 12th week most of these: before the 8th week ?流产发生率 10~15% ,以早期流产居多。? Subclinical abortion: 用尿? hCG 对希望怀孕的妇女进行监测, 有62% 的受精卵在孕 12周之前死亡,其中大多数( 92% )流产是亚临床的。? Embryonic/fetal factors (1) Embryonic factors: inheritance 、 infection 、 drugs → chromosome abnormalities in number or structure → early abortion eg . trisomy 三体 monosomy 单体 triploidy 三倍体 polyploidy 多倍体 translocation 易位(2) Placental abnormalities : villus degeneration 、 placenta previa Etiology Etiology (一)胚胎(或胎儿)因素 1. 胚胎因素:早期流产最常见原因为染色体异常,约占 50 ~60% 。染色体数目异常和结构异常由遗传或感染、药物等因素导致。未必是坏事! 2. 胎盘异常由于滋养层发育不全,胎盘绒毛变性,或胎盘附着位置过低等,可使胎儿胎盘循环障碍,导致流产。? Maternal factors (1) Systemic diseases (2) an abnormalities (3) Endocrine disorders (4) Emotional disturbance (5) harmful habits