CHAPTER 6 ABNORMAL PREGNANCY
SECTION 1:SPONTANEOUS ABORTION
1. Causes
The embryo factors; maternal factors; abnormal immune function; environmental factors.
2. Diagnosis
2.1 The clinical manifestations
2.1.1 Symptoms: vaginal bleeding and abdominal pain. Divided into the early abortion and late-term abortion.
2.1.2 Signs: According to the different stages of development the following types and signs are manifest:
（1）Threatened abortion: refers to the pregnancy up to 28 weeks with small amount of vaginal bleeding, no pregnancy loss, subsequent paroxysmal abdominal pain or low back pain, cervical os does not open, membranes not ruptured, and uterine size is consistent with pregnancy in weeks.
（2）Inevitable abortion: occurs when vaginal bleeding amount increases, intensifies with abdominal pain or vaginal discharge （rupture of membranes）, the cervix has dilated, sometimes embryonic tissue or embryo sac is visible at the cervical os Uterine size is consistent with pregnancy weeks or slightly smaller.
（3）Incomplete abortion: Where abortion has occurred but not all the products have been expelled. Some portions of the pregnancy are retained. Could present with bleeding and pain.
（4）Complete abortion: pregnancy has completely aborted. Bleeding reduced or stopped, cessation of abdominal pain with return of uterus to its normal size.
（5）Missed abortion: pregnancy symptoms have disappeared, threatened abortion symptoms persist or there are no symptoms, Uterus does not return to normal. Products of conception are not expelled. Amenorrhoea persists. Can be associated with coagulation abnormalities.
（6）Habitual abortion: abortion occuring consecutively for 3 times or more.
2.2 The auxiliary examination:
2.2.1 ultrasonography: TVS: presence of fetal parts and fetal heart determines whether the fetus or embryo is surviving. This influences further treatment.
2.2.2 Pregnancy test: urine pregnancy test confirms pregnancy. Prognosis of abortion, is determined by serial blood beta HCG and ultrasound.
2.2.3 Determination of progesterone: determination of progesterone level, helps to judge the prognosis of threatened abortion.
3. Differential diagnosis
This includes ectopic pregnancy, hydatidiform mole, dys functional uterine bleeding, uterine fibroids, etc.
4. Treatment
It depends on the clinical type:
4.1 Threatened abortion: bed rest, taboo sex, mild sedatives if needed analgesics. For patients with corpus luteum insufficiency, progesterone 10-20 mg, once daily or alternate days. For hypothyroidism low-dose thyroid tablets Attention to the psychological treatment and beta HCG change. Repeat ultrasound to find out the status of embryonic development.
4.2 Inevitable abortion: once diagnosed, facilitate early embryo and placenta tissue to completely discharge. This is done with the help of prostaglandin feravitives. Prescribe antibiotics to prevent infection.
4.3 Incomplete abortion: once confirmed, arrange for immediate evacuation of the uterus with curettage surgery or clamp scraping and removing intrauterine residual tissue. Bleeding leading to shock: should be treated immediately with infusions and blood transfusion, along with antibiotics.
4.4 Complete abortion: confirm symptoms of abortion disappear, ultrasonic examination confirms the absence of intrauterine products. If no sign of infection no need for antibiotics.
4.5 Missed abortion: Surgical evacuation using suction curettage is standard treatment. With availability of effective prostaglandins, escalating oxytocin drip is a thing of the past for second trimester missed abortion. In the rare occurrence of coagulation defect developing, the retained products need to be evacuated immediately with other supportive therapy.Replacement of blood components like packed cells, platelet concentrates, fresh frozen plasma and cryoprecipitate are administered as indicated by lab tests.
4.6 Habitual abortion: first identify cause: treat accordingly. When patients with unexplained habitual abortion get pregnant, bed rest, absolutely taboo sex, vitamin E, intramuscular progesterone or HCG injection 2000 u might be of help.
4.7 Abortion co-infection: active control of infection at the same time removing intrauterine residue as soon as possible.
（易晓芳）