Understanding of abortion

【Overview】

 Abortion for the Obstetrics and Gynecology common diseases, such as improper handling or processing is not timely, may be left genital inflammation, or because of bleeding which is hazardous to pregnant women, health and even life-threatening; In addition, the abortion easily confused with certain diseases and gynecology. Is terminated before 20 weeks of pregnancy, birth weight less than 500 grams, known as the abortion (1966 WHO). Abortion occurred at 12 weeks of pregnancy to the former, known as an early abortion. Occurred at 12 weeks, the latter, known as the late abortion.

 【Etiology】

 Reasons leading to abortion is very complicated, it is a variety of early abortion, the more common causes of chromosomal abnormalities, endocrine abnormalities, uterine hypoplasia, or malformation.

 First, chromosomal abnormalities, including chromosome number of abnormal chromosomal abnormalities, such as monomers, three body, polyploid; structural abnormalities, such as broken, missing, translocation can be induced miscarriage. Some pairs of spontaneous abortion and therapeutic abortion chromosome study found abnormal karyotypes in spontaneous abortion accounted for 60%. Chromosomal aberrations were associated with the fetus or placenta, etc. for each kind of structural abnormalities. The normal karyotype aborted fetus were normal.

 2, endocrine disorders lack of estrogen excess and progesterone are also the reasons for early abortion. 12 ~ 14 due to pregnancy in the placenta is formed to replace Zhou Zheng pregnancy, corpus luteum function of time, tend to have endocrine disorders, particularly in luteal phase defect. In addition, the lack of thyroid hormone, so that cells subjected to oxidation barriers, as well as hyperthyroidism and diabetes mused prone to miscarriage.

 3, placenta and placental endocrine abnormalities lack of early pregnancy decidual bleeding or inflammation can at the end of decidual hyperplasia, villous epithelial cells and decidual cells were dissolved villus vascular obstruction, affecting nutrient absorption and delivery, resulting in Yunluan separated from the attachment, bleeding and abortion. Moreover, as a huge placenta infarction can reduce placental function and affect fetal survival; and placenta previa, placenta edema and degeneration induced into abortion is not rare. After pregnancy in maternal β-hCG, hPL, P, E2, estrone, early pregnancy, such as when the value of these hormones drop, then 50% of the abortions.

 Fourth, blood group incompatibility in pregnancy or because of previous blood transfusion, caused by Rh factor incompatibility in the ABO blood group factors in the mother’s body produces antibodies to the pregnancy by the placenta into the fetus in vivo and in red blood cell agglutination resulting from hemolysis, resulting in abortion.

 5, mental neurological factors such as shock, severe mental stimulation, also can be induced into a miscarriage. In recent years, through research that the noise and vibration on the human reproductive have a certain influence.

 6, maternal systemic disease

 (A) severe acute infectious diseases and infectious diseases: such as lobar pneumonia and multi-occur with high fever leading to contraction of the uterus, and / or death can be induced embryo abortion.

 (B) Chronic diseases: severe anemia, heart disease, heart failure can cause fetal anoxia, asphyxia and death; chronic nephritis, severe high blood pressure can occur placental infarction or early spin-off caused by abortion.

 (C) malnutrition or poisoning: such as vitamin deficiency, especially vitamin E-tocopherol the lack of mercury, lead, alcohol and morphine and other chronic poisoning, can cause miscarriage.

 7, genital disease, uterine abnormalities, such as the double-horn of uterus, uterine cavity, mediastinum, and often the reason for the abortion. However, uterine hypoplasia is often the cause of infertility. In addition, uterine fibroids, in particular to the development of uterine cavity or submucous fibroids incarcerated uncle cavity in the bone tumor in the ovarian bursa, may affect fetal development and cause miscarriage. I relax the uterus for one common cause of habitual abortion. Patients, intrauterine adhesions discovered in recent years, about 14% occurred in the post-abortion. Intrauterine adhesions caused by narrowing, deformation and endometrial area is reduced, and there is sclerosis, affecting embryo development.

8, the immune factors on the cause unknown, in recent years found that the majority of closely related and immune factors.

 (A) histocompatibility antigens (histocompatibility locus antigen, HLA): HLA complex located in the sixth person on the short arm of a chromosome segment, including at least four and transplant-related loci: HLA-A, B, C, D / DR and so on. Normal pregnancy couple HLA incompatible, we can maintain genetic diversity, to prevent the lethal homozygous generation. The habitual abortion among married couples is greater than the frequency of HLA antigen compatible with normal pregnancy, of which the same opportunities to more DR antigens. A total of excess antigen, preventing the mother of the pregnancy as allogeneic antigen identification, does not stimulate the mother’s body produces antibodies needed to maintain pregnancy, the lack of antibodies in vitro. Maternal immune system easy to learn on the fetal immune attack, which led to abortion.

 (B) anti-phospholipid antibodies: a group of autoimmune antibodies, including lupus anticoagulant antibodies (LA) and anticardiolipin antibodies (acl). Recent studies found that, in autoimmune diseases, certain infections, drugs, or unknown causes of diseases, such as antiphospholipid antibody positive, a high incidence of recurrent spontaneous abortion. Often in patients with arterio-venous thrombosis, thrombocytopenia, consider induced abortion is due to thrombosis, caused by decidual or placental insufficiency. Antiphospholipid antibodies are not acting on the early pregnancy led to abortion, but rather act on pregnancy and late to make fetal death, anti-phospholipid antibodies may be factor in middle and late abortions.

 (C) anti-sperm antibodies: in recurrent spontaneous abortion (recurent spontaneous abortion, RSA) couples, the study found between two or more male anti-sperm antibodies in serum. Animal studies of anti-sperm antibodies that kill embryos role. Suggesting that the presence of antibodies related with the RSA. China also reported the woman’s more common anti-sperm antibodies, indicating the woman of the sperm allogeneic immune and autoimmune husbands were related with the RSA.

 Anti-sperm antibodies induced abortion, mostly occurs within 3 months of early abortion, that is, the mother in the continuing role of sperm agglutination antibody-induced lesions in the early embryonic tissue, so that damage to embryo abortion.

 Pathological changes 【】

 As the abortion took place in different periods, the pathological process is also inconsistent. 8 weeks of pregnancy occurred in the former, the majority of embryos die first, and then at the end of the sponge layer of decidual hemorrhage, necrosis and thrombosis. Therefore, when the hair hypoplasia of the parent can not contact the firm, when the majority of embryo abortion and the fetal sac and uterine wall completely stripped the discharge, so generally not much bleeding. This abortion is often overlooked and mistaken for an expired periods. The typical flow for a thick, opaque specimens slightly bloody invasion of the embryo sac. The thickest part of the pocket for the Traditional Health villi lie into the water, can be seen there floating villi. Cut cyst, intracystic a small amount of amniotic fluid, showing that the embryonic or fetal tissue has been absorbed, such as grain of rice, color gray, contact the amniotic membrane in the gray. Occurred in 8 to 12 weeks who had developed quite completely a result of fluff, with a more solid contact at the end of decidual, often only a part of the fetus or a fetus with the placenta out, while the other part of the organization missed in the uterine cavity, affecting contraction of the uterus, it is very bloody more. Although some fetal deaths, but did not immediately discharged, the embryo is surrounded by many small amount of bleeding, blood product at the end of decidual villi gap, and can invade and fetal sac, blood outflow condensation, the formation of new blood clots can be re-bleeding, surrounded by old blood clot, the embryo is surrounded by multi-layer blood clot, called blood moles long period of time after the hemoglobin is absorbed, then the meat was kind of moles. Blood clots in the villi and decidua, forming nodules uneven tilting, convex to the amniotic sac, amniotic sac has been squeezed to make smaller, placental blood circulation interrupted, the fetus is absorbed into nodular moles. The placenta is formed and a solid contact with the uterine wall, abortion process and the premature birth, similar to full-term. Begin array contraction, uterine mouth gradually expanded, rupture of membranes, fetal discharge, followed by the placenta peeling, self-discharge, or missed in the uterine cavity. Blood volume may be much or as little, depending on the spin-off of the placenta varies. If the fetus died in utero, no infection, then dip into the soft tires, fetal skin and umbilical cord were soaked soft, hemoglobin calm, but is now dark red, amniotic fluid stained with blood by the long period of time after, then brown.

 Less is to see a mummified of. Amniotic fluid is absorbed, the skin of the fetus was attached to the bones dry white matrix was crushed, while the pattern showed the fetus.

 Clinical manifestations 【】

 First, the main symptoms of miscarriage bleeding and abdominal pain

 (A) vaginal bleeding: within 3 months of pregnancy abortion, the beginning of villi and decidua separation, sinus open and began bleeding. When the embryo all the spin-off discharge, uterine strong contraction, sinus closure, bleeding to stop. Therefore, the entire process of early abortion are accompanied by vaginal bleeding. Late abortion, the placenta is formed and full-term abortion and premature delivery are similar in general much bloodshed.

 (B) Abdominal pain: Early start bleeding after the abortion, intrauterine memory, there is blood, especially blood clots, stimulate uterine contraction, showing persistent abdominal pain. Late abortions are first, paroxysmal contraction of the uterus, and then peel the placenta, so that is abdominal pain, vaginal bleeding before.

 Abdominal pain and bleeding are mostly carried out in nature, and its clinical course and progress of the.

Second, the clinical classification of abortion

 Most abortions have a certain process of development, although some phase of the clinical manifestations is not obvious, and not necessarily in the order of development. But in general nothing more than a few post-column process, namely, clinical types: threatened abortion, inevitable abortion, incomplete abortion and complete abortion. Missed abortion for the abortion, the development of another special case. Habitual abortion from recurrent spontaneous abortion and this feature is named. But in terms of abortion, still contains more than the process of clinical classification.

 (A) threatened abortion (threatened abortion): the performance of abortion, but after miscarriage treatment, is likely to continue those pregnancies to term. Often occur in early pregnancy, only a small amount of vaginal bleeding, associated with mild intermittent uterine contraction. Inspection, the uterus does not open big mouth, no rupture of amniotic sac, uterus consistent with the month of generosity and menopause, pregnancy test positive.

 (B) inevitable abortion or inevitable abortion (inevitable abortion): the above process, but continue to work with embryonic uterine wall separation, bleeding a long time, bleeding volume increased more than normal menstrual flow, and there is blood clots discharge, paroxysmal lower abdomen pain got worse, to a sense of spastic or bulge. Check the uterus mouth gradually opened big, big month of pregnancy, and some have already bulging or rupture of amniotic sac; some embryonic tissue in the cervix tube obstruction seen in the cervix or even exposed outside the mouth, abortion is bound to occur, pregnancy can no longer continue.

 (C) incomplete abortion (imcomplete abortion): often occurred in the late period of pregnancy (10 weeks later), the placenta is developing or has formed part of the aborted fetus and placenta, when discharged, the entire placenta or part of the placenta was still attached to the uterine wall, uterine can not be a good shrink, resulting in many vaginal bleeding. Residues can form the placenta placental polyps in the course of time, repeated bleeding, and easy to induce infection.

 (D) complete abortion (complete abortion): threatened and inevitable abortion through the process of embryonic tissue in a short time completely discharge, bleeding, abdominal pain, stop.

 (E) missed abortion (missed abortion): also known as date no less than abortion or stillbirth. Refers to the death of embryos in the uterine cavity who is still missed, and the product of a general multi-symptom pregnant after the election of a ~ 2 months of discharge. Therefore, all the provisions of embryonic development of 2 months after the cessation of spontaneous expulsion of those who have not yet called missed abortion. Pregnant women with threatened abortion in early pregnancy have been, since the uterus is no longer grow up, anti-gradually reduced, and not as soft as normal pregnancy. Pregnancy test from a positive into a negative, the placenta and the uterine wall plane of the close adhesion and difficult to separate. On the other hand due to lack of sex hormones, contraction of the uterus is reduced and difficult to discharge and missed intrauterine. Fetal death, placenta dissolved, resulting in hemolysis of live enzymes into the maternal circulation, causing intravascular coagulation, consumption of a large number of coagulation factors, missed the longer uterine cavity, causing the greater the likelihood of coagulation dysfunction. In recent years, B-widely used in clinical, and stopped after 6 to 7 weeks you can explore and fetal sac, fetal bud. If the suspect and the embryo stops growing, available B-observation, and make timely diagnosis and treatment. Therefore, the current was raised whether the re-use the term missed abortion, but also the clinical symptoms was not obvious, is not caused by patient attention to diagnosis, when a longer duration and intrauterine fetal deaths were missed.

 (Vi) habitual abortion (habitual abortion): more than 3 consecutive spontaneous abortion is called habitual abortion, and abortion tend to occur in the same month, while the abortion procedure can be the clinical experience of the aforementioned type.

 【Complications】

 A large blood loss sometimes abortion or incomplete abortion may cause serious major bleeding, and even shock. It should be actively addressed. A variety of measures can be the same time. Intravenous or intramuscular injection of oxytocin or vasopressin 10U. Fight for transfusion to patients. In the absence of the blood bank conditions, could be mobilized medical personnel or their family members donate blood. That really is not blood, but also a temporary intravenous dextran. At the same time to give curettage, in the removed embryo Organization, bleeding is often stopped, even in the presence of infection should also be taken out large pieces of embryonic tissue. Should actively create conditions to be followed by blood transfusion.

 Second, infection of the above-mentioned various types of abortion Jieke infection, incomplete abortion occurred in more. Infection often occurs in the sterilization of instruments is available without a strict implementation of an abortion; device cervical injury; or intrauterine infection of the original lesion, surgical abortion or natural abortion can cause spread of infection. In addition, post-abortion (natural or artificial abortion) not pay attention to health, such as early sexual intercourse can cause infection. Infectious pathogens often for a variety of bacteria, anaerobic and aerobic mixed infections with anaerobic bacteria in recent years, reported that the majority of Gejia up to 60 ~ 80%.

 Infection may be limited to the uterine cavity can also be spread to the uterus around the formation of salpingitis, tubal ovarian inflammation, pelvic inflammation and even beyond the genital organs of connective tissue formed by peritonitis, sepsis.

 Patients with fever, chills, abdominal pain, vaginal bleeding, sometimes foul-smelling discharge, uterine and accessories tenderness, uterine involution is not good, an increase in white blood cells and other inflammatory manifestations. In severe cases, septic shock may occur. To do blood, cervical, or uterine secretions smear, culture (aerobic and anaerobic bacteria). B-ultrasonic examination of uterine cavity residues in any organization.

Treatment:

 1. Quickly, infection control, intravenous metronidazole, antibiotics use, type, dosage, route of administration may be considered according to severity of the disease. There culture, drug susceptibility results, could use for the situation.

 2. As soon as possible remove infected tissue within the uterine cavity, curettage may be administered intravenously after 6 hours and will clamp a large organization.

 3. Supportive therapy, if necessary, to the importation of fresh blood. A variety of vitamins.

 4. Chinese medicine treatment, see Chapter inflammation of pelvic organs.

 Third, poor uterine involution uterine contraction may be given drugs such as ergot or Motherwort Liquid Extract Liquid Extract. Suspected to have placenta residue, could be inflammation controlled, the re-curettage. However, bleeding who, when the immediate effect.

 4, acute renal failure, post-abortion may be due to acute massive blood loss and severe infection with acute renal failure caused by shock.

 5, placental polyps compared full-term pregnancy and abortion, to occur in a multi-abortion. Can result into serious bleeding, mostly in post-abortion occurred within a few weeks. Inspection, the uterus is slightly larger than normal, soft, cervical mouth slightly expanded. Sometimes pregnancy tests can be positive. Cervical dilatation curettage surgery should be carried out curettage polyps. Must be sent to pathological examination, we can see a complete degeneration of villi or villi are surrounded by a blood clot.

 【Assistant examination】

 Ultrasound image resolution, clarity, various types of abortion in early transabdominal ultrasonography, in line with the high rate of early diagnosis provides the conditions for early treatment. Especially in the last few years, vaginal probe the early detection of pregnancy and early abortion, is more superior than the abdominal examination. In addition, the basal body temperature (such as pregnancy, then the temperature will not decrease), pregnancy test, vaginal smear, cervical mucus crystallization, there is a certain significance in the diagnosis. Human chorionic gonadotropin levels fell to normal range.

 【Diagnosis】

 1, we must first determine whether the abortion

 (A) detailed history: whether the history of menopause, with or without vaginal bleeding, bleeding volume, nature, is accompanied by abdominal pain and other emissions and so on.

 1. Abortion uterine bleeding is generally greater than the amount of ectopic pregnancy for multiple; and other abnormal pregnancy are also different. Ectopic pregnancy, vaginal bleeding, mostly bit by bit; mole often as the dark red of the blood can also be repeated bleeding, or even a large number of vaginal bleeding, such as double-check, and sometimes may be found in the blood blister-like tissue. Dysfunctional uterine bleeding occurred in the reproductive period is more than the two ends of the age, its place in over 40 years of age are often the history of menopause, although a large number of vaginal bleeding, but no more pain, few miscellaneous other emissions. All of these conditions, combined with pregnancy history and whether contraception is not difficult to distinguish. In case of doubt, viable diagnostic curettage by pathological examination, more than can be diagnosed; also beneficial to the treatment. Number of abortion cases, indeed mistaken for uterine bleeding. Uterine fibroids in patients with no significant history of menopause, while menorrhagia and infertility history, check the uterus large, such as palpable muscle nuclear, then the diagnosis clearer.

 2. Menstrual bleeding from the Last Time: that is, from beginning to the end of sub-menstrual vaginal bleeding to the time, in the ectopic pregnancy usually shorter; in abortion, hydatidiform mole is longer.

 3. Outflow of blood color: abortion, the beginning of a bright red, the time rectangle into a dark red or brown. Ectopic pregnancy, often as a small, pale red or brown color; mole is often as dark red.

 4. Abdominal pain: abortion, hydatidiform mole abdominal pain are relatively light, as the episodic, multi-coming central abdomen. To the side of the nature of ectopic pregnancy, abdominal pain may spread to the whole abdomen, 1 ~ 2 in the future gradually reduce. DUB am, no lower abdominal pain. Uterine fibroids may have pelvic pain or heavy feeling light.

 5. To understand the phenomenon of post-menopausal pregnancy and abortion of the availability of incentives, such as sexual life, heavy loads, and tourism.

 (B) The pairs of co-diagnosis: Note the location of the uterus, size, shape, hardness, uterine isthmus are particularly soft, as if the Ministry of uterine corpus and cervical loss of continuity; both sides of the annex to whether mass or tenderness, and resistance; cervical mouth whether erosion, bleeding, with or without cervical polyps; and are required to identify whether the blood from the uterus, such as a miscarriage, then the blood must come from the uterus.

 (C) The assistant examination.

 Second, determine what kind of abortion for

 The performance of a variety of abortion through the various labor and its management principles will also be different, it must be determined what kind of abortion.

 Less vaginal bleeding, uterine mouth does not open big, the uterus through the month of generosity in line with those who stopped for threatened abortion. Uterus mouth opening large, amniotic sac prominent, or has broken, vaginal bleeding volume of many, for the inevitable abortion. Bleeding, discharge some of these bodies, the uterus is less than the month of menopause, for incomplete abortion. There is the history of threatened abortion, uterine mouth does not open big, start bleeding volume, embryonic tissue, after discharge, vaginal bleeding quickly reduce or stop, check the uterus mouth has been closed, good contraction of the uterus, in order to complete abortion. The uterus is less than the month of menopause, pregnancy test was negative, compared with missed abortion.

Habitual abortion

 To first understand the reasons for abortion, emphasizing his wife at the same time the diagnosis, not only to search the woman, should pay attention to male factor, conditions of hospitals have set up a genetic eugenics Counseling. Diagnosis and treatment of habitual abortion is one of its important content.

 (A) asked in detail about the history of past pregnancies, past medical history, family history, there is a history of suspected genetic family tree diagram should be drawn.

 (B) The systemic examination and gynecological examinations.

 (C) carry out the necessary tests and laboratory examinations. Man: semen, blood type, chromosomes. Woman: vaginal smears, cervical score, basal body temperature, blood type, chromosome, B ultrasonic examination of whether the development of uterine malformations.

 (D) in accordance with the situation from further examination:

 1. Suspected uterine anomalies among B-, the possible Hysterosalpingography, Hysteroscopy, Laparoscopy.

 2. Suspected endocrine abnormalities, check fasting blood glucose. Basal body temperature can be combined line of endometrial pathological examination and investigation progesterone radioimmunoassay, LH, FSH, PRL, E2, T3, T4, TSH ,17-OH ,17-Cu and other tests, if necessary, feasible, brain CT, to understand the brain under the such as whether pituitary microadenoma.

 3. Suspected special infection can check cytomegalovirus, toxoplasmosis, chlamydia checks.

 4. There is a history of adverse environmental exposure, line SLE, micronucleus, chromosome aberration rate checks.

 5. Suspected ABO-incompatible, and further examine antibody titer. Inter-segment, such as during pregnancy to check whether there are changes in antibody titer. Whether the decline in prices for medical treatment aftereffect.

 Third, the availability of abortion complications (details later).

 【Differential diagnosis】

 (A) Ultrasound diagnosis: typically 5 to 6 weeks pregnant fetal sac can be seen, 6 ~ 7 weeks pregnant fetal visible bud, transvaginal probe earlier than transabdominal. When there is no clinical signs of abortion, the ultrasound can be found through the withered Yunluan. Fetal sac> 20mm no yolk sac or fetal sac> 25mm tires without buds were, in order to wither Yunluan. Image only see a large echo-free zone within the fetal sac.

 What can be diagnosed as abortion:

 1. Threatened abortion: Ultrasonography of light are due to a small amount of bleeding, fetal sac at the side of the echo-free zone surrounding, the amount of a small but clear; In severe cases, a relatively large number of uterine blood clots, and sometimes can be seen with the palace wall stripping membranes and fetal membranes after the availability of echo area, according to different tire buds can be seen during pregnancy, the original fetal heart beat and so on.

 2. Inevitable abortion: Ultrasonic Performance: ① fetal sac deformation of downward fetal sac, or amniotic fluid have been out; ② uterine or cervical canals have been opened large, the product down to plug in the intrauterine fetal mouth or cervix, such as fetal membrane does not break the cervix or vagina see the dark areas of cystic; ③ are already dead fetus, no fetal heart beat.

 3. Incomplete abortion: Ultrasonic Performance: ① slightly larger than the uterus; ② intrauterine irregular clumps or small dark area.

 4. Complete abortion: Ultrasonic Image: ① the uterus to normal size or slightly larger than normal; ② see the rules of the intrauterine cavity waves, no irregular clumps.

 5. Missed abortion: In recent years application of ultrasound to detect fetal death, without waiting for 2 months after the diagnosis, so it was suggested that in recent years, as “fetal death.” Ultrasonography: ① the uterus is less than weeks of gestation; ② no fetal heart beat or a fetal movement; ③ echo the womb disorder, it is difficult to distinguish structure of the placenta or the fetus.

(B) vaginal cytology

 1. Chorionic syncytial cells in the smears tend to occur in the emergence of abortion. Chorionic syncytial cells and cell clusters of varying sizes, cytoplasm was alkaline, with different numbers of deeply stained large nucleus, and are often red, white blood cells surrounded by its characteristics.

 2. Pyknosis Index: Pregnancy vaginal smear of nuclear pyknosis index increased less than that progesterone, its causes, one ovarian corpus luteum insufficiency, caused by sub-Lu endometrium and decidua poor growth, so that trophoblastic happen defects; one of trophoblastic their own flaws. Natural recovery, or lack of progesterone can be restored after treatment. If trophoblastic showed a large anomaly, then both the primary defect in the fertilized egg, or the separation of secondary trophoblastic or decidua defects, miscarriages and all will be inevitable. The prognosis of these two situations are different, pyknosis index increased, so pyknosis index can not identify the two different situations. Only continuous observation of the changes in nuclear condensation and makes sense.

 (C) The cervical mucus crystallization: Estrogen can produce cervical mucus crystallization, while crystallization of the hormone progesterone can inhibit. Therefore, the crystallization of cervical mucus during pregnancy examination can detect the prognosis of abortion.

 (Iv) basal body temperature: Early pregnancy, high-temperature curve should be maintained and sustained for 16 weeks or so, gradually to normal. Harbinger of abortion, such as basal body temperature when the same as with normal pregnancy, the prognosis is good, if it were lower than normal pregnancy, the prognosis is bad.

 (E) Determination of hormones: As the endocrine abnormalities due to miscarriage, hormones can be measured according to different circumstances, such as suspected luteal insufficiency, pregnancy can be determined diol observe dynamic changes, select the appropriate method of treatment.

 【Treatment measures】

 1, threatened abortion clinic in principle for the treatment of miscarriage, about 60% of threatened abortion by the appropriate effective treatment. By B-ultrasound before embryo survival, absolute bed rest until the symptoms disappear after the appropriate activities. Try to avoid all the stimulation can cause uterine contraction, such as vaginal examination, sex life. Patients thought to reduce unnecessary tension and worries. Favorably to enable patients to understand the health point of view, the majority of early abortion is due to the abnormal embryos induced by a variety of reasons, abortion is the natural selection and should not pity.

 Attention to adequate nutrition, no harm to the fetus sedative drugs such as luminal 0.03 ~ 0.06g, 3 times a day. To maintain smooth stool, if constipation, laxatives can be taken, Tongbianling (Lu will, amber, etc.) 1 ~ 2 capsules, compared with fruit guide, double the dose of the vinegar tincture phenol easy to master, softening stool effect is good.

 Endocrine therapy, such as luteal phase defect who used progesterone 20mg, day 1 ~ 2 times, intramuscular injection, can help inhibit uterine decidual growth and muscle activity, should be treated under guardianship B extra fine.

 The application of estrogen in recent years, many scholars reported prone to a baby girl born in vaginal adenosis, and even cancer.

 Early application of human chorionic gonadotropin to promote progesterone synthesis. Vitamin E (tocopherol) has beneficial Yunluan development, daily 100mg, oral. Some authors believe that part of vitamin E on the uterus similar to the role of progesterone, and central nervous system work, each 200mg, Day served two times.

 The lower basal metabolism may be given thyroid tablets 0.03g / d, orally.

 In B-custody cases to understand embryos, to avoid unnecessary miscarriage.

 Chinese medicine: Chinese medicine, the Department of threatened abortion more blood weakness, kidney qi Fang loss, fetal Without a solid foundation, resulting in blood disorders, Chong and Ren Without a solid, affecting embryo implantation development of an extent which rendered abortion.

 (A) qi weakness: early pregnancy, vaginal bleeding, abdominal lumbar acid, falling or second trimester, fetal movement disturbed, vaginal bleeding, Shenpi fatigue, pale tongue, weak pulse slippery.

 Governing law: Yiqi nourishing tocolysis.

 Recipe: Taishan rock decoction: Codonopsis pilosula 10g, Atractylodes 10g, Radix Astragali 10g, white peony root 10g, Huang Qin 10g, Chuan-off 10g, orange peel 6g, Rehmannia 10g, Amomum 10g.

 (B) The kidney: tied with lumbar acid, Tuiruan or history of miscarriage, pregnancy fetal movement disturbed, then the waist is very acid, abdominal pain, fetal fall of blood, urine frequency, pulse weak, pink tongue, less moss.

 Governing law: Bushen tocolysis.

 Recipe: Shoutai pill Modified: Dodder 30g, Loranthaceae 10g, Dipsacus 10g, Eucommia ulmoides 10g, Rehmannia 10g, donkey-hide gelatin 10g (blunt), Zhigancao 3g.

 (3) Blood Heat: fetal movement disturbed, fall, head leakage color red, dry mouth, upset, palm fever, yellow urine red, red tongue, thin yellow fur, slippery pulse number.

 Governing law: heat tocolysis.

 Recipe: habitat 10g, Hangzhou Shao 10g, Huang Qin 10g, Chuan-off 10g, Chinese yam 10g, Eclipta prostrata 10g.

2, it is inevitable abortion principles of treatment of intrauterine fetal tissue should be removed. Aspiration should be performed in early pregnancy Palace surgery. More bloodshed can then injected pituitrin 10U (or oxytocin) to promote uterine contraction, discharge organizations, and is ready to suck Palace. The case of the medium-term pregnancy can give pituitrin (or oxytocin) induction of labor. Methods: ① pituitrin (or oxytocin) 5U, every half an hour one time, intramuscular injection for 4 ~ 6 times to wait until the automatic discharge. But the history of trauma or infection of the uterus with a history of, or do not have to be used with caution in order to avoid uterine rupture; ② high concentration of pituitary hormone induction of labor, can give a ~ 5% of oxytocin (each containing 100ml Lane 1 ~ 5U) intravenous drip can be obtained from low – concentrations began to gradually increase to the effective concentration (caused by a powerful array of uterine contraction), and to maintain this concentration in fetal tissue to discharge.

 Bleeding for a long time, uterine mouth open big, be compatible with the operation to remove the embryos.

 3, incomplete abortion, uterine cavity should be removed. Such as bleeding more, there is shock syndrome, should transfusion, blood transfusion to correct shock, while static push or intramuscular oxytocin 10U, and is ready to clear the uterine cavity. And other shock to correct, that is, the placenta forceps or suction bleeding placenta.

 Surgery to prevent infection. At the same time to iron, Chinese medicine, to correct the anemia.

 4, complete abortion, embryonic tissue, after discharge, bleeding stopped, abdominal pain disappeared, in addition to Zhu Huanzhe rest, note that outside the post-partum regimen without special treatment. However, embryonic tissue is completely discharged, must be properly judged. If upon inspection organization has seen a complete discharge fetal sac, decidua, or fetal placenta, combined with the symptoms and examination, if necessary, B ultrasonic examination confirmed the diagnosis of complete abortion can be; if they can not determine incomplete abortion should be addressed in order to make one more curettage was duly.

 5, missed abortion deal with disagreements, and even completely opposite views. Some people think that without interference, until their natural discharge. But some people think that should be diagnosed after surgical removal. The current commonly used treatment principles are: within 3 months of pregnancy, such as has been confirmed as stillbirth, intrauterine be immediately removed. If pregnancy more than 3 months, first with plenty of estrogen, and then re-use of oxytocin induction of labor, such as the unsuccessful, surgery may be considered. In missed abortion, embryo death time longer, because of organizational machine-oriented, the more difficult curettage; and reported in the literature in recent years, and the clinical pregnancy above 16 weeks of missed abortion, may lead to coagulation disorders, causing serious bleeding, so as to diagnosis active treatment is appropriate.

 Preoperative given estrogen or diethylstilbestrol 5mg, 4 times a day, a total of 3 to 5 days, so that the uterus of oxytocin-sensitive. Preoperative routine blood test, a blood coagulation time, if conditions should check fibrinogen, and to prepare blood transfusion preparations.

 3 months or less are feasible palace or suction line 12 hours before surgery uterine cavity intubation, re-clamp curettage.

 The greater of the month in advance of B-ultrasonic examination to understand the size of fetal death, whether the amniotic fluid. If the amniotic fluid, viable amniotic cavity puncture, rivanol 80 ~ 100mg intra-amniotic injection of induction of labor. When necessary, should be applied to oxytocin induction of labor, the former is more convenient and safe.

 6, habitual abortion have a history of habitual abortion should always measure basal body temperature, such as the menstrual cycle, a slight extension of the basal body temperature does not drop, there is pregnancy possible, you can begin treatment. To avoid the physical and mental tension, to prohibit sexual life, and began to oral vitamin E100mg / d, and given vitamin B, C, early to do β-hCG, and B-mode ultrasound to confirm the diagnosis. Find out the reasons for the causes of treatment:

 1. Chromosomal abnormalities: prenatal diagnosis. Man chromosomal abnormalities, his wife agreed to seek a viable AID. Other genetic factors, according to the genetic approach to consider, for obvious genetic predisposition, nor a good method of prenatal diagnosis who termination of pregnancy should be discouraged.

 2.ABO blood group incompatibility: IgG antibody titers over zone Ⅱ give Yinchen soup (capillaris 10g, the system rhubarb 3g, Huang Qin 12g, licorice 10g) early, middle and late pregnancy to pay the service 10. Yimoo Pills (Motherwort 500g, angelica 250g, Chuanxiong 250g, TGP 300g, wide wood 12g. A total of inquiry Ximo, refining honey for the pills, each pill weight 10g), each time a pill, 1, 2 or 3 times. And regular follow-up, in addition to obstetric circumstances, to understand whether changes in antibody titer. Shandong Provincial Hospital, 228 cases of maternal-fetal blood group incompatibility, ABO blood type are not merged into the IgG measured in serum anti-A (B) antibodies were 214 cases, Rh blood group incompatibility, 12 cases. Pregnant again after the regular review of the hospital treatment, 88 cases of birth, 17 cases of maternal-fetal blood group consistency, 71 blood group incompatibility, in which cord blood check with IgG anti-A (B) antibodies in 58 cases, there are 10 cases of neonatal damage to serious, all survived after treatment; 12 cases of Rh blood group incompatibility in pregnancy a further nine cases, five cases of survival after treatment. Shandong Provincial Hospital in the treatment of traditional Chinese medicine other than by using the above, the antibody titer in the right zone Ⅲ above, in the pregnancy early, middle and late on the 10th line of therapy: 50% Glucose 40ml plus vitamin C500mg, 1 1 times, intravenous injection . Oxygen inhalation for 30 minutes a day a second consecutive 10 days. Vitamin E100mg, day 1. Chinese herbal medicine has a blood type properties of the substance can be specifically with the corresponding antibody binding, leaving antibody inhibition titer dropped, played to prevent the occurrence of ABO hemolytic disease of newborns, and abortion.

 Rh hemolytic disease of newborns treated with exchange transfusion to prevent the occurrence of complications after exchange transfusion to treat the key to success. Suffering from severe Rh hemolytic disease of children of pregnant women, prenatal home plasma for patients, enabling reduced maternal antibodies within the antibody titer dropped to ease the antigen-antibody binding, can reduce the extent of the damage the fetus and improve survival of newborns opportunities.

3. Uterine anomalies: in the non-pregnancy confirmed the double-angle uterus, double uterus, septate uterus a viable uterus angioplasty. Shandong Liaocheng Zhang paternity of Health report, two cases of pairs of horn of uterus (1 case of infertility, one cases of habitual abortion) are given soon after angioplasty uterine live births. After the original double uterus and right to avoid the hormones are not synchronized to reflect, thereby eliminating the nonpregnant uterus of the pregnant uterus of the foreign body stimulus, but also increased the Yunluan chance of implantation. Contraceptive after 3 months. If pregnancy to term labor should be held before the Caesarean section. For the child who prays for another first pregnancy may be permitted. Because, within 6 months after surgery pregnancy and 6 months after the pregnancy was no big difference between the rate of pregnancy-dimensional, line observation of the uterus during Caesarean section scar, within 6 months after surgery pregnancy and 6 months after the pregnancy is no big difference. There is no need for too long contraception.

 Habitual abortion no other reason only due to uterine fibroids who may be in the non-pregnancy muscle nuclear excision, but it should be and their families, and I made it clear that abortion is still possible. Uterine adhesions, viable adhesion dissection. Long after cervical incompetence.

 4. Luteal phase defect: The progesterone, human chorionic gonadotropin, clomiphene citrate and other treatment.

 5. Immune therapy: the exact cause for the non-habitual abortion, his wife of serum HLA antibodies were without a husband. Methods aseptic method to separate from her husband blood lymphocytes, the concentration of 3000 ~ 4000 × 104/ml every 3 ~ 4 weeks to his wife intradermal injection of a second, a total of immunization 3 ~ 5 times. There are authors reported that application of the husband’s lymphocyte lines to achieve better efficacy of immunotherapy, 311 cases of 200 pregnant women, of which 124 cases of birth and continue to have more than 24 weeks of pregnancy were 23 cases, together accounted for 73.5%. Shandong Provincial Hospital, 32 cases of treatment in 28 cases after the success of immunization, pregnancy success rate of 87.5%.

 Traditional Chinese Medicine:

 1. Qi weakness: Governance Act is threatened abortion. Symptoms improved, repeat 3 to 5, 1 to 4 months. There were morning heat, doubly baicalin by villosum; Wei Han are multi-purpose Amomum villosum, less plus Scutellaria. Those who have vaginal bleeding, and use plastic Ai soup, sometimes with Eucommia, Loranthaceae two drugs; Huo-wang of the child who, with use Treats, Anemarrhena.

 2. Shenqi Without a solid foundation:

 Governing law: Bu Shen Gu Chong.

 Recipe: Kidney solid red pill: Dodder 75g, Dipsacus 30g, donkey-hide gelatin 45g, Lu Jiaoshuang 30g, Rehmannia 45g, Atractylodes 30g, Eucommia ulmoides 30g, wolfberry fruit 30g, Amomum villosum 10g, Chinese angelica body 24g, Morinda 30g, large jujube meat 20. Total refining to fine Honey pill, every weight 10g. Fu Fa: Every time a pill, 3 times a day. Menstrual cramps stop taking two months for a course of treatment. Has been conceived, can be served drinks flavored kidney tocolysis: Codonopsis pilosula 12g, Atractylodes 10g, Eucommia ulmoides 12g, Chuan-off 12g, Woodwardia 12g, donkey-hide gelatin 10g, Artemsia argyi charcoal 10g, Dodder 10g, Loranthaceae 10g, treating diabetes 10g, psoralen 10g.

 Since the first two weeks of the month of habitual abortion began taking it every other day one, even after taking some habits month abortion.