Spontaneous abortion symptoms
Clinical manifestations:
1. Symptoms
(1) menopause: the majority of abortion patients have marked the history of menopause, according to the length of menopause can be divided into early abortion abortion and late abortion.
(2) vaginal bleeding: At 3 months of pregnancy abortion, separation of villus and decidual sinusoids open, so early abortion have vaginal bleeding, and amount of bleeding is often more. Late abortion, the placenta is formed and the process of abortion and premature fetus is similar to the placenta after delivery, following discharge, the general small amount of bleeding.
(3) abdominal pain: Early abortion vaginal bleeding beginning after intrauterine memory there is blood, especially blood clots, stimulate uterine contraction, showing persistent lower abdominal pain. Late abortion is to have paroxysmal contraction of the uterus then the fetus from the placenta, so they are vaginal bleeding before there is abdominal pain.
2. Clinical classification based on the clinical development process in different clinical types can be divided into seven kinds.
(1) threatened abortion (threatened abortion): is the remaining intrauterine pregnancy, but abortion clinical symptoms appear common in early pregnancy, vaginal bleeding small, were bright red, if the plot in the vagina for a longer period, it was brown performance for many guttate, sustainable for several days or weeks. Abdominal pain symptoms dispensable lesser extent, by tocolysis may continue to deal with pregnancy. Gynecological examination: Miyaguchi closure, amniotic sac has not been broken and uterine size with stop
Line by the month. It is worth pointing out, there is a history of threatened abortion in pregnant women usually with adverse perinatal outcome, such as preterm low birth weight, perinatal death.
(2) inevitable abortion (inevitable abortion): is a continuation of threatened abortion, pregnancy can not be sustained, there is the clinical course of abortion, vaginal bleeding time is longer, larger amount of bleeding and blood clots has discharged, under the paroxysmal abdominal pain, or there is amniotic fluid outflow. Gynecological examination: Miyaguchi opening, prominent or amniotic sac has broken down, see there is embryonic tissue obstruction in the cervical canal, even in the cervix exposed outside the mouth.
(3) incomplete abortion (incomplete abortion): abortion when the fetus and part of placenta tissue from, some of the placenta or the entire placenta is still kept in intrauterine called incomplete abortion. 8 weeks ago happened pregnancy miscarriage, fetal placenta can simultaneously from many ingredients; 8 ~ 12 weeks of pregnancy, the placenta has formed the structure and closely connected to the uterine decidua, the product is not easy flow completely stripped from the uterine wall, often incomplete abortion happened. Intrauterine because there is residual embryonic tissue, uterine contraction can not be a good result, vaginal bleeding more easily cause longer intrauterine infection. Gynecological check-up: I have been the expansion of the Palais, and constantly have bloody material spills, and sometimes plug the embryonic tissue can be seen in the cervical part of the mouth or embryonic tissue from the uterus in the vagina is less than the normal number of days of pregnancy.
(4) complete abortion (complete abortion): After threatened abortion and inevitable abortion process of fetal placental tissue completely from a short period of time, cessation of vaginal bleeding and abdominal pain, usually occurs in pregnancy 8 weeks ago. Gynecological check-up: I turn off the cervix, uterus near normal-sized
(5) missed abortion (missed abortion): also known as missed abortion refers to death of embryos more than two month natural discharge of abortion. Missed abortion happened the exact cause is not clear, may be associated with estrogen and progesterone levels and uterine sensitivity; In addition, with threatened abortion too positive relationship Baotai also must have, and sometimes in fact already dead embryos, yet the use of progesterone, such as security fetal medicine, inhibition of uterine contraction, resulting in missed embryos.
(6) habitual abortion (habitual abortion): row 3 times or more than 3 times referred to as spontaneous abortion habitual abortion, but also for someone to be 2 times or 2 times or more known as recurrent spontaneous abortion (recurrent spontaneous abortion) happened pregnancy rate of the total number of 1%, accounting for the number of spontaneous abortion in recent years 15 percent of habitual abortion research more focused on two aspects of habitual abortion First, the immune pathogenesis and immune control study Two are of cervical dysfunction diagnosis and treatment of
(7) infection in spontaneous abortion (infected abortion): is the merger of the reproductive system infection abortion. Various types of abortion may be complicated by infections, including selective or therapeutic abortion, but abortion incomplete abortion and illegal abortion is a common
Complications:
1. Haemorrhage are inevitable abortion or incomplete abortion the most common complications, serious bleeding can lead to hemorrhagic shock.
2. Infected with various types of abortion may be co-infection, but occurred in the incomplete abortion, more often combined pelvic inflammatory disease, abdominal distension inflammation, systemic infection and septic shock.
Differential Diagnosis:
1. Tubal pregnancy
(1) menopause the time: In addition to interstitial pregnancy menopause a long time, the largest are 6 ~ 8 weeks-menopausal history, 20% ~ 30% of menopausal patients with no significant history of irregular vaginal bleeding may be mistaken for are at the end of times because of menstrual or menstrual expired only a few days, do not think it is menopause. And abortion menopause time can be longer.
(2) vaginal bleeding volume and Color: tubal pregnancy has many vaginal bleeding drip color Sepia less, there is generally no more than the volume of dripping menstruation not be associated with decidual cast decidual debris or discharge, vaginal bleeding lesions generally removed after the order to stop. Abortion when the amount of vaginal bleeding is usually less gradually increased, beginning at the bright red, if the bleeding is a long time into a dark red or brown.
(3) abdominal pain: tubal pregnancy or miscarriage does not happen before the breakdown, usually the side of lower abdomen pain or flu, when the abortion happened, or broke down, the side of the lower abdomen in patients with sudden tear-like pain, there is often accompanied by nausea vomiting, severe syncope can happen, shock, meaning they can be accompanied by frequent and anal discomfort. And abortion for the paroxysmal abdominal pain in the lower abdomen for the median, falling from a slight pain to the obvious spastic pain, varying degrees.
(4) gynecological examination: tubal pregnancy, the vaginal dome after the full there is tenderness, cervical pain cite this as a tubal pregnancy obviously one of the major characteristics. Uterus slightly larger and soft. Bleeding for a long time, check the uterus there is a sense of floating. The uterus before or after touching the side of the border ambiguous mass, tenderness obvious.
(5) Supplementary examination: ① vaginal fornix after the puncture is not out of dark red blood that can help the diagnosis of tubal pregnancy; ② but positive urine pregnancy test HCG level in patients was significantly lower than intra-uterine pregnancy; ③ B-mode ultrasound examination revealed increased uterine However, empty cavity,appeared hypoechoic areas and see and the original germ tube heart throb, you can do for tubal pregnancy diagnosis; ④ laparoscopy contribute to improve the accuracy of diagnosis of ectopic pregnancy.
2. Hydatidiform
(1) menopause the time: the majority of patients have 2 to 4 month history of menopause an average of 12 weeks.
(2) vaginal bleeding: hydatidiform mole showed irregular vaginal bleeding, often dark red, the volume of the number of adventitious intermittent, which can be substantial bloodshed has repeatedly showed the majority of anemia in patients with appearance, and sometimes double-check at the outflow of blood available blister-like structures to help diagnosis.
(3) abdominal pain: when the mole has grown rapidly, intrauterine hematocele rapid increases so that the uterus can be caused by paroxysmal pain in the lower abdomen, the general be able to endure. Paroxysmal pain in the lower abdomen after the mole there is often accompanied by intermittent bleeding.
(4) gynecological examinations: the uterus than menopause extremely soft texture of the month of pregnancy the uterus such as 5-month-matrix can not hear when the heart can not touch, do not feel fetal movement should be suspected mole.
(5) Supplementary examinations:
① chorionic gonadotropin (HCG) Determination: normal pregnancy, the fertilized eggs six days after implantation trophoblast cells begin secreting HCG. With the progress of pregnancy, serum HCG value gradually increased to 8 to 10 weeks of pregnancy and reached the peak. After a gradual decline in the value of serum HCG. However, when the mole, a high degree of trophoblastic hyperplasia, resulting in substantial HCG serum HCG values are usually higher than the corresponding value of gestational age in normal pregnancy and menopause at 12 weeks after the HCG continued to rise, the use of such differences can be used as diagnostic aids.
② B-mode ultrasound examination: diagnosis of hydatidiform mole are an important supplementary method of examination for uterine performance than non-menopausal month pregnancy sac, no fetal heart throb Zheng, uterine cavity filled with dense homogeneous strip-shaped or short echo was "like" blisters larger, the performance for the echo area size was "Honeycomb." Low uterine wall, but no focal echo straight through the sound area. Sometimes be detected on both sides or one side of luteinized cysts were many rooms, wall thin, with some thin see separated. Color Doppler ultrasonography of uterine artery blood flow, see the rich, but no myometrial blood flow or only sparse "Star Point" blood flow signal.
③ Doppler examination: hydatidiform mole can only hear when the heart can not hear noises uterine blood flow, and normal pregnancy at the earliest 6 ~ 7 weeks of pregnancy when the fetal heart can be heard.
3. Dysfunctional uterine bleeding can also occur in women of childbearing age.
(1) menopause time: due to the menstrual cycle disorders, is sometimes mistaken for menopause
(2) vaginal bleeding: common symptoms are vaginal bleeding is characterized by irregular menstrual cycle, menstrual disorder of varying lengths, blood volume has been uneven, and even substantial bloodshed continued for 2 ~ 3 weeks or more, is not easy since ended.
(3) abdominal pain: dysfunctional uterine bleeding and abdominal pain-free when many abortion often have lower abdominal pain
(4) gynecological examinations: internal and external genital lesions were not organic.
(5) Supplementary examination: negative pregnancy test; diagnostic curettage, send pathological examination found no pregnancy or gestational endometrial changes, you can rule out the possibility of abortion.
4. Hysteromyoma
(1) menopause the time: patients with no significant history of menopause.
(2) vaginal bleeding: uterine leiomyomas have a typical example of menorrhagia, menstrual cycle shortened, extended menstruation and infertility; submucosal fibroid necrosis associated with infection may have persistent irregular vaginal bleeding or blood samples of purulent fluid.
(3) abdominal pain: abdominal pain usually will not subserous leiomyoma torsion occurs when acute abdominal pain, fibroid changes in the red with intense abdominal pain fever, submucosal fibroids can cause secondary infection lower abdominal pain. Common symptoms in the lower abdomen have, heavier menstrual backaches.
(4) gynecological examinations: increased muscle intramural uterine fibroids, hard texture of the surface has irregular nodular leiomyoma; subserosal fibroids can touch the quality of hard, spherical objects with block uterine pedicle has connected fine, good activity ; submucosal uterine fibroids increase uniformity, and sometimes the cervix expansion, myoma is located within the cervical canal or vaginal prolapse to when the red in real terms, the surface smooth globe, with infection when there is exudate covering the surface or superficial ulcer formed and there is purulent fluid. Happen if the fibroid cystic change, the texture soft, easily misdiagnosed as uterine pregnancy.
(5) Supplementary examination: negative pregnancy test; B-mode ultrasound examination showed round-shaped hypoechoic fibroids and to determine whether the fibroid degeneration.
5. Pregnancy with cervical erosion or polyp bleeding such bleeding without abdominal pain, blood volume with a small but bright red color. Speculum examination showed cervical erosion or polyp Department has hemorrhagic activity. Uterine size consistent with the month of pregnancy. B-ultrasound examination no abnormal signs.
6. Choriocarcinoma and threatened abortion in common is that both women of childbearing age are increased vaginal bleeding and the uterus. Choriocarcinoma vaginal bleeding occurred in hydatidiform mole, abortion or full-term post-natal, prone to lung, vagina, brain and other parts of the transfer. Uterus increased soft, irregular shape. Endometrial histology examination showed a large number of trophoblast cells and hemorrhage, necrosis, there is no structure can be confirmed villous B-mode ultrasound examinations showed signs of intrauterine pregnancy without doubt the transfer of further X-ray film, the CT examination to assist in Diagnosis
7. Pregnancy corpus luteum rupture in the lower abdomen after menopause side of sudden severe pain, no vaginal bleeding without shock or have mild shock. Gynecological check cervical give pain, the side attachment zones have tenderness. Puncture after the dome is not out of dark red blood, B-mode ultrasound examination revealed that the side attachment areas have low-echo area.
8. Membrane-like lower abdominal pain or menstrual menstrual month, after a few days, with the menstrual blood from membrane-like tissue, easily misdiagnosed as abortion. Pregnancy test negative, from organization to send as endometrial biopsy, no villi can be confirmed
9. Pregnancy with cervical cancer manifested as irregular vaginal bleeding or bloody secretions often outflow, especially vaginal bleeding after sexual intercourse inspection or, the gynecologic examination and cervical biopsy for cancer, can be diagnosed.
10. Cervical pregnancy have early menopause and response to the history of history, there is beginning a small number of irregular vaginal bleeding or bloody secretions only the history of the subsequent gradual increase blood volume for lot of intermittent vaginal bleeding, can also lead to sudden massive hemorrhage shock, often substantial bleeding occurred in 3 month of pregnancy bleeding than many of intrauterine pregnancy, when the bottom of the formation of broad ligament hematoma after abdominal pain. Gynecological examination: cervix significantly increased, soft shading, size and hardness of the Palais change was not obvious with the development of pregnancy, the cervix was conical, cervix thinning outer edge of the mouth, hyperemia, was outside the mouth of the hole-shaped invagination, cervical with vaginal bleeding from the mouth closed cervical canal and the outflow hole. B-ultrasonic examination: large or slightly larger than the normal uterus, no intrauterine pregnancy sac, cervical canal increase, in cervical canal to see the pregnancy sac can be confirmed cervical pregnancy diagnostic criteria: ① across from the placenta attached to the Agency must have cervical gland; ② placenta and cervix wall should be close with paste; ③ all or most of placental tissue within the cervix at the mouth following; ④ without intrauterine pregnancy
11. Hysteromyoma red degeneration were more common in pregnancy, there is a history of uterine leiomyoma showed lower abdominal pain with high fever, check the rapid increase fibroid uterine gynecological examinations have tenderness and pain has touched Mass, B-type super - sound check to see that there is degeneration of uterine leiomyoma muscle wall echo.