Abortion-赵颖_32.ppt medical and surgical abortion
- 1. Abortion Department of Obstetrics&Gynecology The 2nd affiliated hospital of DMU
- 2. Definition Nature or induced expulsion of fetus fr om uterus before it is able to survive. ≤20 weeks from the first day of the last period or a fetus weighing <500g(developed countries) <28 weeks from the first day of the last period or a fetus weighing <1000g (our country)
- 3. Classification Spontaneous Abortion Induced or Artificial Abortion Early Abortion(1-12week) Late Abortion(>12week-<28week)
- 7. Spontaneous Abortion The incidence: 15%-25% was recognized clinically. Near 80% occurs in first trimester.
- 8. Etiology: 1.Chromosomal abnormalities of th e embryo account for 50% in early s pontaneous abortion: trisomy monosomy Triploidy tetraploidy aneuploidy, euploidy
- 9. Etiology 2.Maternal infectious diseases, especially intraute rine infections. 3.Luteal phase defect: deficiency of progesterone 4.Environmental factors: Toxins, Radiation,and s o on 5.Uterine anomaly: Myoma, Septate uterus,Unico rnuate uterus, Intrauterine synechiae
- 10. Etiology: 6.The couple’s genetics abnormal:gene dise ase, balanced translocation/carrier 7.Immunologic factors: antiphospholipid sy ndrome APS
- 11. pathology before 8 weeks the villus is not developed well with an unstable embe dding. embryo becomes a foreign body to stimulate the contr action of the uterus. complete abortion 8-12 weeks the villus developed well to contact to the decidua tigh tly. incomplete abortion after 12 weeks the placenta formed, abdominal pain occurs firstly. the placenta abruption, hemorrhage.
- 12. Types of the spontaneous aborti on Threatened abortion: slight bleeding, l ow abdominal pain, closed cervix ,ultrason ograph shows intact pregnant sac and a livi ng fetus The pregnancy can continued
- 14. Types of the spontaneous abort ion Inevitable abortion: severe bleeding, m uch pain, dilated cervix, rupture of membra ne Pregnancy loss is unavoidable.
- 16. Types of the spontaneous abort ion Complete abortion: everything is expell ed. Bleeding soon stops and pain disappear. Incomplete abortion: the product of pre gnancy is partial expelled. cervix opening , some tissue filling the cervix,severe bleedi ng Have high risk in infection and shock
- 19. special types of the spontaneous a bortion Missed abortion: dead embryo retain in th e uterus for >8 weeks. Absence of uterine growth, loss of some early pregnancy symptoms, slight bleeding, DIC
- 20. special types of the spontaneous ab ortion Recurrent abortion:more than two consecuti ve spontaneous abortion, Habitual abortion: 3 spontaneous abortion Early abortion---great likelihood of chromosomal ab normality Later abortion---maternal cause:incompetent cervix,i mmunologic factors ,anatomic deformities
- 21. diagnosis *history *physical examination *assistant examination B-ultrasound pregnancy test others
- 22. differential diagnosis ectopic pregnancy hydatidiform mole dysfunctional uterine bleeding pelvic infection acute appenditis
- 23. Treatment of spontaneous abor tion Threatened abortion: Bed rest Proscribing intercourse Follow up: bleeding, pain, if ultrasonograph shows a nonviable or develo ping to Inevitable abortion evacuation s hould be carried out.
- 24. Treatment of spontaneous abor tion Incomplete abortion: immediate evacuation and control bleeding,pr eventing infection, emotional support
- 25. Treatment of spontaneous abor tion Missed abortion: Check the platelet count and coagulation facto rs. If they are normal evacuation at once.If they are low prevent DIC first. Sometimes curretage is difficult and give prostaglandin to induce abortion
- 26. Treatment of spontaneous abortio n habitual abortion genetic consulting blood type identify sperm test gestational tract malformation tumor adherence
- 27. An Overview of Abortion in the United States
- 28. Pregnancies in the United States (Approximately 6.3 Million Annually) 52% 48% 0% 10% 20% 30% 40% 50% 60% % of pregnancies Unintended Intended Source: Henshaw, 1998 (1994 data)
- 29. Outcomes of Unintended Pregnancies (Approximately 3.0 Million Annually) 47% 40% 13% 0% 10% 20% 30% 40% 50% 60% % of unintended pregs. Abortions Births Miscarriages Source: Henshaw, 1998 (1994 data)
- 30. Incidence of Pregnancy and Abortion: Unintended pregnancy and abortion are commo n among all groups of women. Almost half of all pregnancies are unintended. Almost half of unintended pregnancies end in a bortion.
- 31. Who Has Abortions: Age 33. 0% 23. 1% 13. 5% 8. 1% 18. 6% 0. 7% 3. 1% Source: Jones et al., 2002 33. 0% 23. 1% 13. 5% 8. 1% 18. 6% 0. 7% 3. 1% Source: Jones et al., 2002 20-24 岁 25-29 岁 30-34 岁 15-19 岁
- 32. Who Has Abortions: Marital Status 67. 3% 17. 0% 15. 6% Source: Jones et al., 2002 未婚 已婚 离婚
- 33. Who Has Abortions: Race/Ethnicity 40. 9% 31. 7% 0. 9% 6. 4% 20. 1% Source: Jones et al., 2002 *Non-Hispanic white black asian hispanic
- 34. Who Has Abortions: Religious Identification 42. 8% 27. 4% 7. 6% 22. 2% Source: Jones et al., 2002 Protestant 新教徒 Catholic 天主教徒 other non
- 35. Who Has Abortions: Prior Pregnancies 36% 25% 27% 12% Source: Jones et al., 2002 Previous abortion and birth Previous abor tion none Previous birth
- 36. Who Has Abortions, Why and When in Pregnancy: Women having abortions are predominantly youn g, single, from minority groups and low-income. Most women have multiple reasons for choosing to have an abortion. Almost 90% of abortions occur in the first trimester.
- 37. Percent of Abortions Performed by Each Type of Provider 0% 10% 20% 30% 40% 50% 60% 70% 80% % of abortions Abortion clinic Other clinic Hospital Physician office Source: Finer and Henshaw, 2003
- 38. Percentage of Maternal Mortality Worldwi de Due to Unsafe Abortion Maternal deaths (600,000 per year) 87% 13% Source: WHO, 1998 (Estimates for 1995–2000) Unsafe abortion Other causes
- 39. Abortions by Gestational Age (Weeks Since Last Menstrual Period) 57. 6% 20. 3% 10. 2% 6. 2% 4. 3% 1. 5% 0% 10% 20% 30% 40% 50% 60% 70% % of abortions <9 9-10 11-12 13-15 16-20 21+ Weeks Source: Elam-Evans et al., 2002 (1999 data)
- 40. Percentage Distribution of Abortion Deaths 29% 18% 16% 14% 23% 0% 10% 20% 30% % of deaths A nesthesia H em orrhage Infection Em bolism O ther Source: Lawson et al., 1994 (1983–1987 data)
- 41. Thank you for your time and attention!