ABORTION

one of the diseases of

abnormal pregnancy
 1. BACKGROUND

Definition

Category

Incidence
 Definition

Termination of pregnancy before

the 28th week of gestation, the
weight of fetus less than 1000gm.
 Category
By the way of termination:
Spontaneous abortion 自然 流产
Artificial abortion 人工流 产

By the time of termination:

Early abortion ( ~ 12th week)
Late abortion (12th ~ 28th week)
 Incidence

about 10%~15%

most of them end in early abortion

 2. ETIOLOGY
Hereditary factor 遗传 因
素

Maternal factor 母体 因
素

Immunologic factor 免疫因

素
 Hereditary factor

Chromosomal abnormalities

染 色 体 异
常

50%~60% of early abortion are due

to chromosomal abnormalities
Maternal factor

--Systemic disease

系统疾 病
-- Disease of genital organ

生殖器 官异常
--Endocrine disorder
--Systemic disease
Acute infectious disease
--Disease of genital organ

Uterus septum ovarian tumor

--Endocrine disorder

Corpus luteum insufficiency ( 黄

体功能 不足 ) can decrease
progesterone
 Immunologic factor

The implanted embryo is regarded as an

allograft containing foreign antigens which
come from the paternal genome.

Immunologic incompatibilities due to

HLA, ABO, Rh or other systems.
Environmental factors

Chemical materials

Arsenic 砷 , lead 铅 , etc.

Relationship between Embryo and Uterus
3. PATHOLOGY
death of embryo or fetus

hemorrhage between villi and decidua basalis

villi separate from decidua basalis

retroplacental hematoma

stimulates uterine contractions

cervical dilatation

conceptus is expulsed
4. CLINICAL ASPECTS
 Amenorrhea
 Vaginal bleeding
 Lower abdominal pain
 Cervical os (dilates or not)
 Size of the uterus

 rupture of membrane
Amenorrhea is a missed period .

The patients of abortion usually have

amenorrhea .
＜ 12 week
vaginal bleeding
lower abdominal pain

＞ 12 week
lower abdominal pain
vaginal bleeding
 5. CLINICAL CATEGORY

★ threatened abortion 先兆流

产

★ inevitable abortion 难免 流
产

★ incomplete abortion 不全 流
产
Threatened abortion
 Threatened abortion
 slight vaginal bleeding
 with or without lower abdominal pain.
 cervix is closed
 the size of the uterus corresponds to
the gestational age

After treatment and rest, the pregnancy

usually continues, if the fetus is alive.
♦ spontaneous abortion cannot be stopped

♦the abortion is impending

♦ no conceptus is expulsed
Inevitable abortion
 Inevitable
abortion
 vaginal bleeding is increased
 abdominal pain becomes stronger
 cervical os is dilated

 The size of uterus corresponds with or

smaller than the gestational age

Incomplete
abortion
 Incomplete
abortion

 vaginal bleeding is profuse

 cervical os is dilated
 size of the uterus is smaller than
gestational age.
 Complete abortion

 vaginal bleeding ceases

 abdominal pain ceases
 cervix closes
 uterus becomes smaller than
gestational age
General process of spontaneous
abortion
Pregnancy
continues
Threatened Complete
abortion abortion
Inevitable
abortion
Incomplete
abortion
 In addition, there are
three special cases of
abortion:
1. Recurrent (habitual) abortion- 习惯
性流产
2. Missed abortion- 稽留流产
3. Septic abortion-- 流产感染
Recurrent( habitual) abortion

Recurrent abortion is defined as

three or more consecutive
spontaneous abortion.
Associated factors
Chromosomal abnormality
(present in 3-5% of partners),
Congenital uterine abnormalities,
Cervical incompetence,
Inadequate secretion of
progesterone in the luteal phase,
Autoimmune conditions
Missed abortion

Fetal death before 28 weeks’

gestation without explusion of fetal
or placental tissues for several
weeks.
Embryo or fetus died in uterus and
not being expelled in time.
Abdominal pain and vaginal bleeding
are usually minimal.
Pregnancy symptoms have usually
resolved.
The uterus is smaller than expected for
dates.
The ultrasound scan shows absence of
fetal heart activity.
 Septic abortion

Any abortion with intrauterine

infection.
During the process of abortion–or
after therapeutic termination of a
pregnancy-infection may be
introduced into the uterine cavity.
Offensive vaginal discharge
lower abdominal pain
tender lower abdomen
tender uterus, adnexa
 6. DIAGNOSIS

(1)History
 a missed period
 symptoms of early pregnancy
 amount and duration of vaginal bleeding
 character of abdominal pain
 passage of tissues.
(2) Clinical examination
General condition
Pelvic examination (under
sterilization)

 cervix
 uterus
 adnexa
pelvic examination under sterilization
(3) Assistant examination

. HCG determination.
a simply and common method

. Ultrasound
great value in diagnosis of abortion
 Ultrasound

Normal pregnancy abortion

 7.TREATMENT
(1) Threatened abortion:
Expectant observation

 advise the patient take rest

 forbid intercourse
 observe the patient’s progress.
 Progesterone, HCG
Inevitable & incomplete abortion

 D &C (dilatation and curettage )

 (2)Inevitable & incomplete
abortion
 D&C is necessary
 The tissues removed should be sent
for pathologic examination
 oxytocin be given
 blood transfusion may be required
 antibiotics: prevent infection
(3) Complete abortion

all tissues expelled completely

no particular management
(4) . Missed abortion

D&C should be done, drugs

sensitizing uterus may be given
prior to surgery.
Use large dosage of estrogen
before operation------ In the first
trimester, suction evacuation is
performed.
Check coagulation function
There is a risk of disseminated
intravascular coagulation (DIC) with
a long-standing missed abortion that
has retained in the uterus for 4
weeks or more.
 (5) Recurrent abortion
Investigations
Karyotyping of both partners and
Karyotyping of any fetal tissue.
Pelvic ultrasound to assess ovaries and
uterine cavity.
Treatment according to causes.
Submucous myoma or uterine
septa may be removed by abdominal
surgery or under hysteroscopic
vision.
If cervical incompetence---cervical
cerclage
Cause unexplained:
Progesterone 20mg or hCG3000 U
q2d up to 10 weeks or beyond the
abortive month.
(6) Septic abortion
Antibiotics
a broad-acting antibiotic and one
effective against anaerobes is
selected.
D&C should be done after the
treatment or during antibiotics
treatment
Hysterectomy