spontaneous abortion

Spontaneous abortion refers to spontaneous abortion (not caused by human purpose). The causes of spontaneous abortion include chromosome abnormality and embryonic hypoplasia. The bleeding time after spontaneous abortion can be 10- 15 days. Experts suggest that after this period of time, you need to go to the hospital for B-ultrasound to determine whether there is any residue.

What is spontaneous abortion?

If the pregnancy is less than 28 weeks and the fetal weight is less than 1000g, it is called abortion. Among them, spontaneous abortion refers to abortion caused by non-human purposes. It is caused by natural factors (embryo factors, maternal factors, father factors and environmental factors). 3 1% spontaneous abortion after embryo implantation, of which more than 80% early abortion (12 termination of pregnancy before the weekend).

According to the different stages of abortion development, it can be divided into threatened abortion, inevitable abortion, incomplete abortion and complete abortion. There are three special cases, missed abortion, habitual abortion and abortion complicated with infection. Termination before 12 weeks of pregnancy is called early abortion, and termination before 12 weeks of pregnancy is called late abortion. Abortion can be divided into spontaneous abortion and induced abortion, among which spontaneous abortion is mostly early abortion.

Types of spontaneous abortion

1, threatened abortion: refers to a small amount of vaginal bleeding before 28 weeks of pregnancy, often dark red or bloody leucorrhea, without pregnancy discharge. Then there is paroxysmal lower abdominal pain or low back pain. Gynecological examination showed that pelvic cavity was not opened, fetal membrane was not broken, and the size of uterus was consistent with gestational age. After rest and treatment, symptoms can disappear and pregnancy can continue, but if vaginal bleeding increases or lower abdominal pain intensifies, it can develop into inevitable abortion.

2, inevitable abortion: inevitable abortion is inevitable abortion, generally developed from threatened abortion, but vaginal bleeding is more, paroxysmal abdominal pain is more severe, or there is water in the vagina (rupture of fetal membrane). Gynecological examination shows that the cervix has expanded, and sometimes embryonic tissue or fetal sac is blocked in the cervix, and the size of the uterus is basically the same as or slightly smaller than the number of menopausal weeks.

3. Incomplete abortion: It is inevitable that abortion will continue to develop, often occurring in the third trimester of pregnancy (10 weeks later). Placenta is developing or has been formed. When the fetus and part of the placenta are discharged during abortion, the whole placenta or part of the placenta is still attached to the uterine wall, and the uterus cannot contract well, resulting in massive vaginal bleeding and even shock. Gynecological examination showed that the cervix has been dilated, the cervix is blocked by pregnancy and continues to bleed, and the uterus is less than the number of menopausal weeks.

4. Complete abortion: Complete abortion means that the pregnancy has been completely discharged, the amount of vaginal bleeding has decreased, it has gradually stopped, the abdominal pain has disappeared, the cervix has been closed during gynecological examination, and the uterus is close to normal size.

5, missed abortion: missed abortion is also called expired abortion. Refers to an embryo or fetus that has died and remained in the uterine cavity and failed to be discharged naturally in time. It shows that the early pregnancy reaction disappears, with threatened abortion symptoms or no symptoms, and the uterus no longer increases but shrinks. If you have reached the second trimester, you will find that the expectant mother's abdomen has not increased and the fetal movement has disappeared. Gynecological examination showed that the cervix was not opened and the uterus was smaller than the number of menopausal weeks.

6. Habitual abortion: refers to a woman who has had three or more consecutive spontaneous abortions. In recent years, recurrent abortion is often used instead of habitual abortion, and it is changed to two or more spontaneous abortions. Recurrent abortion is mostly early abortion, and a few are late abortion.

7. Abortion complicated with infection: In the process of abortion, if vaginal bleeding lasts for a long time, there is tissue residue in the uterine cavity or illegal abortion, which can cause intrauterine infection, mostly mixed infection of anaerobic bacteria and aerobic bacteria. Severe infection can spread to pelvic cavity, abdominal cavity and even the whole body, complicated with pelvic inflammatory disease, peritonitis, septicemia and septic shock.

Causes of spontaneous abortion

The causes of spontaneous abortion are embryo factor, maternal factor, father factor and environmental factor.

1. Embryonic factors: Embryonic chromosome abnormality is the main cause of abortion. Early abortion offspring examination found that 50%-60% had chromosomal abnormalities. Chromosome abnormalities of either spouse may be passed on to offspring, leading to abortion. Chromosome abnormalities include quantitative abnormalities and structural abnormalities. In addition to genetic factors, infection, drugs and other adverse effects can also lead to chromosome abnormalities in offspring, and abortion often occurs before pregnancy 12 weeks.

2. Maternal factors:

(1) Systemic diseases: High fever can cause uterine contraction and abortion during systemic infection, and infections such as Treponema pallidum, influenza virus, cytomegalovirus, mycoplasma, chlamydia, Toxoplasma gondii and herpes simplex virus can cause fetal chromosome aberration and abortion. Pregnant women with heart failure, severe anemia, hypertension, chronic nephritis and severe malnutrition may also lead to miscarriage.

(2) Endocrine abnormality: Inadequate luteal function can lead to early abortion. Low thyroid function and uncontrolled blood sugar in patients with severe diabetes can also lead to miscarriage.

(3) Abnormal immune function: Immune factors related to abortion include spouse's histocompatibility antigen (HLA), fetal antigen, blood group antigen (ABO and Rh) and maternal autoimmune status. The same frequency of HLA loci in parents is so high that insufficient maternal blocking antibodies can also lead to repeated abortion. Maternal-fetal blood group incompatibility, excessive production of antiphospholipid antibodies in pregnant women, and existence of antisperm antibodies in couples will all lead to rejection and abortion of embryos or fetuses.

(4) Uterine abnormalities: Uterine dysplasia, unicornuate uterus, double uterus, uterine mediastinum, intrauterine adhesions, submucosal or intermuscular myoma and other uterine abnormalities can affect embryo sac implantation and development, leading to abortion. Severe laceration, relaxation and short cervix can all lead to fetal rupture and abortion.

(5) Traumatic stimulation: uterine trauma such as surgery, direct impact and excessive sexual intercourse can also lead to abortion; Excessive stress, anxiety, fear, sadness and other mental trauma may also lead to abortion.

(6) Bad habits: excessive smoking, excessive drinking, morphine, heroin and other drugs can all lead to abortion.

3. Father factor: Studies have confirmed that abnormal sperm chromosomes can lead to spontaneous abortion. However, there is no clear basis whether abnormal sperm rate is related to spontaneous abortion.

4. Environmental factors: Excessive exposure to arsenic, lead, formaldehyde, benzene, chloroprene, ethylene oxide and other chemicals can also lead to abortion.

Symptoms of spontaneous abortion

The main symptoms of spontaneous abortion are postmenopausal vaginal bleeding and abdominal pain. Spontaneous abortion goes through the following processes: villi and decidua peeling-blood sinus opening-vaginal bleeding-vitreous embryo and blood stimulating uterine contraction-excluding embryo-lower abdominal pain.

1. Menopause: Most pregnant women with spontaneous abortion have obvious menopause history. Combined with early pregnancy reaction, uterus enlargement and embryo sac B-ultrasound, pregnancy can be diagnosed. However, it is difficult to distinguish vaginal bleeding caused by early pregnancy abortion from abnormal menstruation, and there is often no obvious history of menopause.

2, vaginal bleeding and abdominal pain: early abortion often has vaginal bleeding first, followed by abdominal pain. Because of the death of embryo or fetus, villi and decidua fall off, blood sinus opens, and vaginal bleeding occurs; Fallen embryos or fetuses and blood stimulate uterine contraction and expel embryos or fetuses, resulting in paroxysmal lower abdominal pain; When the embryo or fetus is completely discharged, the uterus contracts, the blood sinus closes and the bleeding stops.

The clinical process of late abortion is similar to premature delivery and full-term delivery: after paroxysmal uterine contraction, the fetus and placenta are discharged, and vaginal bleeding occurs at the same time. In late abortion, the placenta adheres firmly to the uterine wall. If placental adhesion is only partially detached, the residual tissue will affect uterine contraction and blood sinus opening, which may lead to massive bleeding, shock and even death. Placenta retention time is too long, which can form placental polyps, causing repeated bleeding, anemia and secondary infection.

The symptoms of late spontaneous abortion are similar to premature delivery and full-term delivery. After the placenta and fetus are delivered, there is generally not much bleeding, because abdominal pain occurs first, and then vaginal bleeding occurs.

How to judge spontaneous abortion?

Diagnosis can be made according to medical history and clinical manifestations, but sometimes it needs to be combined with auxiliary examination to make a diagnosis. The type of abortion involves the corresponding treatment and should be determined at the time of diagnosis.

1, medical history: The doctor will ask the expectant mother whether she has a history of menopause, early pregnancy reaction and bleeding time, the amount and duration of vaginal bleeding, the relationship with abdominal pain, the location and nature of abdominal pain, and whether there is pregnancy discharge. Knowing whether vaginal discharge has fever or odor is helpful to diagnose abortion complicated with infection. Asking about the history of recurrent abortion is helpful to the diagnosis of habitual abortion.

2. Physical examination: measure body temperature, pulse, respiration and blood pressure to check for signs of anemia and acute infection. After disinfection of vulva, gynecological examination will find out whether the cervix is dilated, whether there is pregnancy blockage or swelling of amniotic sac, whether the uterus is tender, whether it is consistent with the time of menopause, and whether the double appendages (namely fallopian tube and ovary) are tender, thickened or have lumps. Expectant mothers who suspect threatened abortion should handle it lightly.

3, auxiliary diagnosis:

(1)B-ultrasound examination: It can measure the size and shape of gestational sac and the heartbeat of fetal heart tube, which can help to diagnose the type of abortion. If the gestational sac is abnormal, the pregnancy prognosis will be very poor. The examination of uterine cavity and its accessories is helpful to the differential diagnosis of missed abortion, incomplete abortion and ectopic pregnancy.

(2) Pregnancy test: Continuous determination of the dynamic changes of blood β-hCG is helpful for the diagnosis and prognosis of pregnancy. At 6-8 weeks of pregnancy, blood β-hCG increased at a rate of 66% per day. If the blood β-hCG rises less than 66% every 48 hours, it means that the pregnancy prognosis is poor.

(3) Other diagnosis: routine blood examination can judge the degree of bleeding, and white blood cells and erythrocyte sedimentation rate can judge whether there is infection. Continuous determination of progesterone and HPL is helpful to judge the pregnancy prognosis. Feasibility of pregnancy in patients with habitual abortion and chromosome examination of both husband and wife.

How to treat spontaneous abortion?

How to treat spontaneous abortion? Different types of abortion, drug treatment is unnecessary, should be symptomatic treatment, including drug treatment, surgery and so on.

1, threatened abortion: expectant mothers with threatened abortion should stay in bed, prohibit sexual life and have adequate nutritional support. Maintain emotional stability and give nervous expectant mothers a small amount of sedatives that are harmless to the fetus. Patients with luteal insufficiency can be given progesterone 10-20mg, intramuscular injection once a day or once every other day, and excessive application can lead to missed abortion; Or oral desdrogesterone (Dafutong) tablets, which is an oral progestin and relatively safe. There is no evidence that it cannot be used during pregnancy and lactation. The initial dose of 65438+40mg was taken orally 0 times, and then every 8 hours 10mg until the symptoms disappeared; Or hCG 3000U, intramuscular injection every other day; You can also take vitamin e orally to prevent miscarriage. Expectant mothers with hypothyroidism can take small doses of thyroid tablets orally.

2, inevitable abortion: once the diagnosis is inevitable abortion, the embryo and placenta tissue should be discharged as soon as possible. Curettage is feasible. Curettage should be carefully examined and sent for pathological examination. Late abortion, larger uterus, more bleeding. Oxytocin 10-20U can be added into 500ml 5% glucose solution for intravenous drip to promote uterine contraction. If necessary, curettage is performed to remove intrauterine tissue. It is feasible to check by B-ultrasound after operation, to know whether there is any pregnancy residue, and to give antibiotics to prevent infection.

3, incomplete abortion: incomplete abortion is easy to cause uterine bleeding because some tissues remain in the uterine cavity or are blocked in the cervix. Therefore, curettage or curettage should be performed at the same time as transfusion and blood transfusion, and antibiotics should be given to prevent infection.

4. Complete abortion: Complete abortion means that the pregnancy has been completely discharged, the amount of vaginal bleeding has decreased, it has gradually stopped, abdominal pain has disappeared, the cervix is closed during gynecological examination, the uterus is rapidly retracted, and the size of the uterus is close to normal. If there is no infection, no special treatment can be given.

5, missed abortion: stillbirth and placental tissue are missed in the uterine cavity for too long, which can lead to serious coagulation dysfunction and DIC. The coagulation function should be checked first, and curettage should be performed under the condition of preparing blood transfusion; If the coagulation mechanism is abnormal, heparin, fibrinogen, fresh blood and platelets can be used to correct it before curettage.

When missed abortion occurs, the placenta tissue often adheres closely to the uterine wall, which increases the difficulty of operation. If the coagulation function is normal, diethylstilbestrol 5mg can be taken orally three times a day for five days before curettage, or estradiol benzoate 5- 10U can be added into 500 ml of 5% glucose solution for intravenous drip, or misoprostol 400μg can be placed in the posterior fornix of vagina. If the uterus is larger than 12 gestational weeks, oxytocin should be injected intravenously to promote the expulsion of fetus and placenta. Uterine perforation should be avoided when curettage is performed. After operation, routine B-ultrasound examination should be performed to confirm whether intrauterine residue is completely discharged, and anti-infection treatment should be strengthened.

6. habitual abortion: couples with abnormal chromosomes should have genetic counseling before pregnancy to determine whether they can get pregnant; Husband and wife blood group identification and husband semen examination are also feasible; To determine whether the woman has reproductive tract malformation, tumor and intrauterine adhesions. If the cervix is slack, the cervix should be repaired before pregnancy, or the cervix should be ligated at 12- 18 weeks of pregnancy. In addition, patients with habitual abortion can be routinely injected with hCG3000-5000U, once every other day/kloc-0, and stopped after 8 weeks of pregnancy. Or oral desdrogesterone, twice a day, each time 10mg, until the 20th week of pregnancy.

7. Abortion complicated with infection: The treatment principle is to control infection quickly and remove intrauterine residue as soon as possible. If it is mild infection or bleeding, curettage can be performed at the same time as intravenous drip of effective antibiotics to achieve the purpose of hemostasis; If the infection is serious and the bleeding is not much, curettage can be performed after the infection is controlled by high-efficiency broad-spectrum antibiotics. When curettage, the residual tissue can be removed by oval forceps, and it is forbidden to scrape it with a curette to avoid the spread of infection. Serious infectious abortion can be complicated with pelvic abscess, thrombophlebitis, septic shock, acute renal failure and DIC. , should attach great importance to and actively prevent, if necessary, remove the uterus, remove the source of infection.

What is the effect of spontaneous abortion?

The influence of spontaneous abortion is mainly reflected in the increase of infection rate and easy bleeding, which may lead to acute renal failure in severe cases. The effects of spontaneous abortion are as follows:

1, infection: spontaneous abortion may be complicated with infection, and the incidence of incomplete abortion in women will be higher. Infection can be confined to the uterine cavity, or spread to the periphery of the uterus, even beyond the reproductive organs to produce peritonitis and sepsis.

2, a lot of blood loss: sometimes inevitable abortion or incomplete abortion can lead to serious blood loss, and even shock.

3, placental polyps: can cause severe uterine bleeding, mostly a few weeks after abortion.

4, acute renal failure: after abortion, acute massive blood loss and severe infection shock can cause acute renal failure.

5, uterine involution is not good: the enlarged uterus after abortion may not contract smoothly.

6, irregular menstruation: spontaneous abortion may cause irregular menstruation. However, there are many reasons for irregular menstruation, which may be caused by certain damage to uterine mucosa after abortion. It may also be caused by mental stress, overwork, endocrine disorders and psychological factors.

7. Psychology: Spontaneous abortion will have an impact on maternal psychology. In fact, spontaneous abortion can be considered as a natural elimination in favor of eugenics, so don't worry. A happy mood will accelerate the recovery of the body after abortion, which is beneficial to health.

8. Does the next pregnancy have an impact: Whether the spontaneous abortion in the first pregnancy has an impact on the next pregnancy is not easy to generalize. First of all, we should rule out whether there are some factors that affect this pregnancy, such as physical discomfort before and during pregnancy, strenuous exercise or taking certain drugs. If these factors lead to spontaneous abortion, it will have little effect on the next pregnancy. In addition, some organic problems of female body, such as uterus or birth canal diseases, should be excluded. There are other problems in women's bodies, so the reasons should be found out and properly handled. Generally speaking, if there are no external factors and these lesions, the next pregnancy is not a big problem.

9. Spontaneous abortion is a mechanism to eliminate defective fetus, and it is not completely harmful.

How to prevent spontaneous abortion

1, school-age pregnancy, the best reproductive age for women is 25-29 years old. If you are too young, it is easy to have an abortion because your body is immature. If you are too old, it is easy to cause spontaneous abortion due to the decline of reproductive function and chromosomal mutation.

2. After spontaneous abortion, the interval should be more than half a year, until the uterus is fully recovered and the whole body's qi and blood are restored before pregnancy.

3, do a good job of pre-pregnancy physical examination, especially for women who have a history of abortion in the past. If you find a disease, you should treat it first, and then get pregnant when the disease is cured.

4. Avoid contact with toxic substances after pregnancy; Avoid strenuous exercise; Avoid rude sex life; Don't smoke or drink; Eat less or no irritating food; Avoid bad emotional stimulation and maintain a good attitude; Avoid contact with pets before and after pregnancy; Avoid unclean sex life. At the same time, family members should give pregnant women full understanding and care.

Diet after spontaneous abortion

How should women who have spontaneous abortion pay attention to diet regulation?

First of all, we should ensure the supply of high-quality protein, adequate vitamins and inorganic salts, especially adequate iron, to prevent anemia.

Secondly, food selection should pay attention to nutrition and be easy to digest and absorb. Can supply fresh fish, tender chicken, eggs, animal liver, animal blood, lean meat, bean products, milk, jujube, lotus seeds, fresh fruits and vegetables.

In addition, eat more digestible food. The appropriate time for recuperation is half a month. Those with weak body, poor constitution and excessive blood loss at ordinary times may extend the convalescence time as appropriate.

Also, don't eat or eat less greasy and cold food, and don't eat radish, hawthorn, bitter gourd, oranges and other foods that are reasonable, promote blood circulation and dispel cold.

Recommended diet after spontaneous abortion:

1, candied red dates. 50g of dried red dates, 0g of peanuts100g, 50g of brown sugar. Wash the dried red dates and soak them in warm water. Boil peanuts slightly and peel them for later use. Put jujube and peanuts into a small aluminum pot, add appropriate amount of water, and simmer for 30 minutes. Take out peanuts, add brown sugar, and eat after the brown sugar dissolves and the juice is collected. Has that effect of nourishing blood and regulate asthenia. It is suitable for patients with anemia or low hemogram after abortion.

2, egg jujube soup. 2 eggs, red dates 10, and brown sugar. Boil the water in the pot, then pour in the eggs and lie down and cook. Then boil the red dates and brown sugar in water and simmer for 20 minutes. Has the effects of invigorating middle warmer, benefiting qi and nourishing blood. It is suitable for the aftercare of anemia and deficiency of qi and blood after illness and postpartum.

3, candied red dates. 50g of dried red dates, 0g of peanuts100g, 50g of brown sugar. Wash the dried red dates and soak them in warm water. Boil peanuts slightly and peel them for later use. Put jujube and peanuts into a small aluminum pot, add appropriate amount of water, and simmer for 30 minutes. Take out peanuts, add brown sugar, and eat after the brown sugar dissolves and the juice is collected. Has that effect of nourishing blood and regulate asthenia. It is suitable for patients with anemia or low hemogram after abortion.

Matters needing attention after spontaneous abortion

Spontaneous abortion refers to the natural termination of fetal weight before 28 weeks of pregnancy.

1, live regularly.

Live a moderate life, exercise properly at the same time, and get enough sleep for 8 hours every day. Develop the habit of defecating regularly every day to ensure smooth defecation, but avoid using laxatives.

2. Pay attention to personal hygiene.

Change clothes often and take a bath often, but it is not suitable for bathing and swimming. Pay special attention to pudendal hygiene to prevent bacterial infection. The clothes should be wide and the belt should not be tight. Wear flat shoes at ordinary times.

Step 3 choose a proper diet

Food should be easy to digest. Especially choose foods rich in vitamins and trace elements, such as vegetables, fruits, beans, eggs, meat and so on.

4. Keep a good mood.

Try to be comfortable, avoid all kinds of stimuli, and adopt various methods to eliminate tension, boredom and fear and reconcile emotions.

5, pay attention to abstinence

Sexual life is forbidden within one month after abortion. After spontaneous abortion, the local resistance of the uterus is low, and premature sexual life is easy to bring bacteria in, causing gynecological diseases such as endometritis.

6. Do prenatal check-ups regularly.

Women who have had a history of spontaneous abortion or habitual abortion should go to obstetrics and gynecology for treatment before pregnancy. If there are signs of miscarriage after pregnancy, such as vaginal bleeding and lower abdominal pain, you should seek medical advice promptly.

How harmful is abortion? How long can I have children after abortion? What is threatened abortion?

Threatened abortion is not abortion, this should be distinguished, so what does threatened abortion mean?

Threatened abortion is a sign of miscarriage during pregnancy. Abdominal pain after pregnancy, a small amount of bleeding, ultrasound examination of intrauterine hydrops, but the fetus survived. The above symptoms suggest that threatened abortion needs to be protected or treated under the guidance of a doctor. 1~2 weeks will be reviewed according to the situation.

Threatened abortion refers to some signs of spontaneous abortion before 28 weeks of pregnancy. First there is a small amount of vaginal bleeding, often dark red or bloody leucorrhea, without pregnancy discharge, and then there is paroxysmal lower abdominal pain or lumbago. Do gynecological examination, you will see that the cervix is not wide, the fetal membrane is not broken, and the size of the uterus is consistent with the number of menopausal weeks. After rest and treatment, symptoms can disappear and pregnancy can continue. However, if the abdominal pain is aggravated gradually or the amount of bleeding increases, it may develop into an inevitable abortion.

Repeated abortion

Some women's abortion belongs to habitual abortion, so what is the origin of habitual abortion?

Recurrent abortion is an unexplained abortion that occurs repeatedly in the same month. Further examination is needed, such as chromosomes, cervical anatomy and immune system problems. To find out the reasons and deal with them to prevent recurrent abortion in the next pregnancy.

There are not a few patients with recurrent abortion in the world. Some experts point out that recurrent abortion is not incurable. Generally, it can be treated with combination of traditional Chinese and western medicine, with a success rate of 80-90%, but there will also be 10% patients who feel that the effect is not obvious after treatment. Patients with recurrent abortion should be clear about the causes of their own abortion and take corresponding treatment measures.

incomplete abortion

One kind of abortion is incomplete abortion, so what does incomplete abortion mean?

Incomplete abortion means that after abortion, the embryo and its appendages do not completely flow out of the uterus, resulting in repeated bleeding, infection and other clinical symptoms. Incomplete abortion mostly occurs in the third trimester of pregnancy, usually in 10 weeks or even more 10 weeks, when the placenta gradually develops. During abortion, the fetus and some placental tissues are discharged, but most placentas, even some placentas and membranes, are still attached to the uterine wall, and the uterus cannot contract well, which leads to the failure to close the open blood sinus of the endometrium, resulting in excessive vaginal bleeding and long time. Remaining placenta for too long will form placental polyps, and repeated bleeding will easily lead to infectious diseases, so once it is definitely diagnosed as incomplete abortion, it is necessary to clear the uterus in time.

If there is incomplete abortion, it is suggested to clean the contents of uterine cavity in time to promote uterine contraction and reduce bleeding. Pay attention to rest after abortion. If incomplete abortion occurs for a long time, preventive antibiotics can be given to prevent infection. You can also take some drugs orally to promote uterine contraction, promote uterine recovery and eliminate intrauterine residues.