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Abortion

Abortion

Pregnancy termination is refers as Abortion. It is done in first 28 weeks of pregnancy. Fetal weight should be less than 1000g. If it is done in 12 weeks before pregnancy then it is said early abortion. And if it occurrs in 12 weeks to 15 weeks of pregnancy then it is called late miscarriage. It is divided into spontaneous abortion and induced abortion. The occurrence of spontaneous is accounts for about 15% of all pregnancies, mostly for early abortion. There are two special types: missed and habitual abortion.

Genetic factors

Chromosomal abnormalities of embryos accounted for 50% to 60%. The number of abnormalities is triad, triploid and X monomer; structural abnormalities have chromosome breakage, inversion, deletion and translocation. Chromosomal abnormalities majorly cause abortion at the end. A very small number may continue to develop into the fetus. But after birth, some functional abnormalities may found.

Environmental factors

There are many adverse factors affecting reproductive function. They can directly or indirectly damage to the embryo or fetus. Excessive exposure to certain harmful chemicals (such as arsenic, lead, benzene, formaldehyde, chloroprene, ethylene oxide, etc.) and physical factors (such as radiation, noise and high temperature, etc.) can cause abortion.

Maternal factors

Viruses enter through the placenta into the fetal blood circulation. So it causes the death of the fetus and abortion. (1) Systemic disease caused by acute illness during   pregnancy. In addition, pregnant women who are suffering from severe anemia or heart failure can cause fetal hypoxia. It may also cause miscarriage. Pregnant women who are suffering from chronic nephritis or high blood pressure may cause infarction and miscarriage. (2) Genital diseases: Pregnant women, who are suffering due to uterine malformations leads to abortion. And same case is with pelvic tumors patients. These diseases affect the growth and development of the fetus. (3) Endocrine disorders: hypothyroidism, severe diabetes and corpus luteum insufficiency can lead to termination of pregnancy. (4) Traumatic: pregnancy, especially early pregnancy when abdominal surgery or mid-pregnancy trauma, leading to uterine contractions caused by abortion.

Placental endocrine insufficiency

8 weeks after pregnancy the placenta gradually becomes the main place to produce progesterone. In addition to progesterone, the placenta also synthesizes other hormones such as β-chorionic gonadotropin, placenta prolactin and estrogen. In early pregnancy the hormones value is decreases. So pregnancy is difficult to continue and leads to abortion.

Immune factors

Pregnancy is like allogeneic transplantation. There is a complex and special immunological relationship between the embryo and the mother. This relationship makes the embryo not repelled. If both mothers and children immune are incompatible then it can lead to maternal rejection of the embryo caused by abortion.

Clinical manifestations

The main symptoms of miscarriage are vaginal bleeding and abdominal pain. Vaginal bleeding occurs within 12 weeks of pregnancy abortion, the beginning of the villi and decidua separation, sinus open, that is, began to bleeding. When the embryo completely separated from the discharge then due to uterine contraction the bleeding stopped. Early abortion is accompanied by vaginal bleeding.

Examination

Diagnosis of miscarriage is generally not difficult. According to history and clinical manifestations it can be diagnose. Only a few need to carry out auxiliary examination. After the diagnosis of miscarriage determine the clinical type of miscarriage and then determine the treatment.

1. History

Doctor should ask patients about history of recurrent miscarriage and vaginal bleeding. Medical expert should ask the duration of vaginal bleeding. She should also ask patient that either it was with or without abdominal pain. And ask the nature and extent of bleeding. But also should understand whether the vaginal discharge is of water.

2. Check the body

Observe the patient's general condition. Check the patient is with or without anemia. Measure the body temperature, blood pressure and pulse. In the disinfection conditions for gynecological examination pay attention to whether the expansion of the cervix, amniotic sac is bulging, with or without pregnancy products blocked in the cervix; uterine size and menopause is consistent with the number of weeks, with or without tenderness. Check the operation should be gentle, especially for suspected threatened abortion.

3. Auxiliary inspection

For those who have difficulty in diagnosing the necessary auxiliary examination may be use. (1) B-type ultrasound imaging is currently widely uses. It is of practical value for the differential diagnosis and the type of abortion. Incomplete and missed abortion can be identifies by B-type ultrasound. (2) Pregnancy test with immunological methods: clinical multi-purpose test paper is used in recent years. The diagnosis of pregnancy is meaningful. Abortion for obstetrics and gynecology is common disease. Once the miscarriage occurs it should be treats timely and appropriately.

1. Threatened abortion

Should pay attention to rest, taboo life and vaginal examination operation should be gentle. Patients with insufficient function of the corpus luteum can supplement progesterone and have a miscarriage effect. Second, vitamin E and low doses of thyroxine (for patients with hypothyroidism) can also be applied. In addition, the psychological treatment of patients with threatened abortion is also very important. To make it emotional stability and enhance confidence of patient is very necessary. After treatment, the symptoms did not alleviate or aggravated. Suggesting that there may be abnormal embryonic development, B-type ultrasound and β-HCG determination, determine the embryo status. Give the corresponding treatment including termination of pregnancy.

2. Difficult abortion

Once diagnosed, the embryo and placental tissue should be completely discharged as soon as possible. Early abortion should be timely line of negative pressure suction surgery. Pregnancy products use to conduct a serious examination and sent to pathological examination. Late miscarriage due to the larger uterus, suction Palace or curettage has difficulties.

3. Incomplete abortion

Once diagnosed, should be timely line curettage or clamp curettage, to remove residual tissue within the uterine cavity. Bleeding and more shock should also lose blood transfusion, and give antibiotics to prevent infection.

4. Complete abortion

If there are no signs of infection, generally do not need special treatment.

5. Missed abortion

Processing is more difficult. Due to placental tissue timing, close adhesion with the uterine wall, resulting in curettage difficulties. Retention time is too long, it may occurs coagulation dysfunction. It is leading to disseminated intravascular coagulation (DIC). It causes severe bleeding. Before treatment, should check the blood, the clotting time, platelet count, fibrinogen, prothrombin time, blood clot contraction test and plasma protamine coagulation test (3P test), and make blood transfusion preparation. Uterine is less than 12 weeks of gestation. Feasible curettage, intraoperative injection of uterine contractions to reduce bleeding, if the placenta and the wall with a tight wall adhesion, surgery should be particularly careful to prevent perforation. One cannot scratch the net in 5 to 7 days after curettage again.

6. Habitual abortion

A woman with a history of habitual abortion should undergo a necessary check before pregnancy. It includes ovarian function tests, both chromosomal examination and blood type identification of her husband. Her husband's semen examination is also important. The woman still need a detailed examination of the reproductive tract to determine whether the uterus deformity and lesions, and check whether the cervix relaxation and so on. Check the cause. It should be treat before pregnancy.

7. Abortion infection

Mostly incomplete abortion causes infection. Treatment principles should be actively control the infection. If the vaginal bleeding is not much, the application of broad-spectrum antibiotics 2 to 3 days, to be controlled after infection curettage, remove the residual uterine tissue to stop bleeding. If the vaginal bleeding, intravenous infusion of broad-spectrum antibiotics and blood transfusion at the same time, with the oval clamp the uterine cavity residual tissue caught, so that bleeding reduced, cannot be used to scratch the curettage, so as to avoid infection spread. Continue to use antibiotics after surgery, to be controlled after infection completely curettage. If combined with septic shock, should actively correct the shock.

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