Abortion妇产科学-课件.ppt

1、AbortionDefinitionnNature or induced expulsion of fetus from uterus before it is able to survive.n20 weeks from the first day of the last period or a fetus weighing 500g(developed countries)n28 weeks from the first day of the last period or a fetus weighing 12week-8 weeks.Absence of uterine growth,l

2、oss of some early pregnancy symptoms,slight bleeding,DICTypes of the spontaneous abortionnRecurrent abortion:more than two consecutive spontaneous abortion,nHabitual abortion:3 spontaneous abortion Early abortion-great likelihood of chromosomal abnormalityLater abortion-maternal cause:incompetent ce

3、rvix,immunologic factors,anatomic deformitiesTreatment of spontaneous abortion nThreatened abortion:Bed restProscribing intercourse Follow up:bleeding,pain,if ultrasonograph shows a nonviable or developing to Inevitable abortion evacuation should be carried out.Treatment of spontaneous abortionnInco

4、mplete abortion:immediate evacuation and control bleeding,preventing infection,emotional supportTreatment of spontaneous abortionnMissed abortion:Check the platelet count and coagulation factors.If they are normal evacuation at once.If they are low prevent DIC first.Sometimes curretage is difficult

5、and give prostgland to induce abortionAn Overview of Abortion in the United StatesPregnancies in the United States(Approximately 6.3 Million Annually)52%52%48%48%0%0%10%10%20%20%30%30%40%40%50%50%60%60%of pregnanciesUnintendedIntendedSource:Henshaw,1998 (1994 data)Outcomes of Unintended Pregnancies(

6、Approximately 3.0 Million Annually)47%47%40%40%13%13%0%0%10%10%20%20%30%30%40%40%50%50%60%60%of unintended pregs.AbortionsBirthsMiscarriagesSource:Henshaw,1998 (1994 data)Incidence of Pregnancy and Abortion:Unintended pregnancy and abortion are common among all groups of women.Almost half of all pre

7、gnancies are unintended.Almost half of unintended pregnancies end in abortion.Who Has Abortions:Age33.0%33.0%23.1%23.1%13.5%13.5%8.1%8.1%18.6%18.6%0.7%0.7%3.1%3.1%Source:Jones et al.,200233.0%33.0%23.1%23.1%13.5%13.5%8.1%8.1%18.6%18.6%0.7%0.7%3.1%3.1%Source:Jones et al.,200220-24岁25-29岁30-34岁15-19岁W

8、ho Has Abortions:Marital Status67.3%67.3%17.0%17.0%15.6%15.6%Source:Jones et al.,2002未婚已婚离婚Who Has Abortions:Race/Ethnicity40.9%40.9%31.7%31.7%0.9%0.9%6.4%6.4%20.1%20.1%Source:Jones et al.,2002*Non-HispanicwhiteblackasianhispanicWho Has Abortions:Religious Identification42.8%42.8%27.4%27.4%7.6%7.6%2

9、2.2%22.2%Source:Jones et al.,2002protestantcatholicothernonWho Has Abortions:Prior Pregnancies36%36%25%25%27%27%12%12%Source:Jones et al.,2002Previous abortion and birthPrevious abortionnonePrevious birthWho Has Abortions,Why and When in Pregnancy:Women having abortions are predominantly young,singl

10、e,from minority groups and low-income.Most women have multiple reasons for choosing to have an abortion.Almost 90%of abortions occur in the first trimester.Percent of Abortions Performed by Each Type of Provider0%0%10%10%20%20%30%30%40%40%50%50%60%60%70%70%80%80%1980198019821982198419841986198619881

11、988199019901992199219941994199619961998199820002000%of abortionsAbortionclinicOtherclinicHospitalPhysicianofficeSource:Finer and Henshaw,2003Percentage of Maternal Mortality Worldwide Due to Unsafe AbortionMaternal deaths(600,000 per year)87%13%Source:WHO,1998(Estimates for 19952000)Unsafe abortionO

12、ther causesAbortion Risks in PerspectiveChance of deathRisk from terminating pregnancy:per year:Before 9 weeks 1 in 500,000 Between 9 and 10 weeks 1 in 300,000 Between 13 and 15 weeks 1 in 60,000 After 20 weeks 1 in 8,000Risk to persons who participate in:Motorcycling 1 in 1,000 Automobile driving 1

13、 in 5,900 Power-boating 1 in 5,900 Playing football 1 in 25,000Risk to women aged 1544 from:Having sexual intercourse(PID)1 in 50,000 Using tampons 1 in 350,000 Source:Gold,1990;Trussell,1998 Abortions by Gestational Age(Weeks Since Last Menstrual Period)57.6%57.6%20.3%20.3%10.2%10.2%6.2%6.2%4.3%4.3

14、%1.5%1.5%0%0%10%10%20%20%30%30%40%40%50%50%60%60%70%70%of abortions99-1011-1213-1516-2021+WeeksSource:Elam-Evans et al.,2002 (1999 data)Deaths per 100,000 Abortions or Births0.20.20.30.30.60.61.81.83.73.712.712.70.60.66.66.60 02 24 46 68 8101012121414Deaths per 100,000911-1216-20BirthsAbortions by gestationSource:Gold 1990 (19811985 data)Percentage Distribution of Abortion Deaths29%29%18%18%16%16%14%14%23%23%0%0%10%10%20%20%30%30%of deathsAnesthesiaHemorrhageInfectionEmbolismOtherSource:Lawson et al.,1994 (19831987 data)Thank you!