vaginal bleeding with abdominal pain during pregnancy
Introduction
Introduction The main symptoms of abortion are vaginal bleeding and abdominal pain. Abortion is a common gynecological disease. If it is not properly treated or not treated properly, it may leave genital inflammation, or it may endanger the health of pregnant women due to major bleeding, and even threaten life. In addition, abortion is easily confused with certain diseases of gynecology. Pregnancy is terminated before 20 weeks and the fetus weighs less than 500 grams and is called abortion (World Health Organization, 1966). Abortion occurs before 12 weeks of gestation and is called early abortion. The latter occurred in 12 weeks, called late abortion.
Cause
Cause
The causes of miscarriage are complex and diverse. The most common causes of early abortion are chromosomal abnormalities, endocrine abnormalities, uterine dysplasia or deformities.
First, chromosomal abnormalities
Chromosomal abnormalities include abnormal chromosome numbers, such as monomer, trisomy, polyploid, structural abnormalities, such as breaks, deletions, and translocations can cause abortion. Chromosomal studies of spontaneous abortions and therapeutic abortions have found that 60% of karyotype abnormalities occur in spontaneous abortions. A karyotype abnormality is accompanied by a structural abnormality such as a fetus or a placenta. The fetuses with abortion in normal karyotype are more normal.
Second, endocrine disorders
Excessive estrogen and progesterone deficiency are also causes of early abortion. Because it is in the period of placenta formation instead of pregnancy luteal function in the 12-14 weeks of pregnancy, it is easy to have endocrine disorders, especially the luteal function. In addition, the lack of thyroxine, the cell's oxidation process is impeded, and hyperthyroidism and diabetes are prone to miscarriage.
Third, placental abnormalities and insufficient endocrine endocrine
Decidual inflammation in early pregnancy can cause hemorrhage or hyperplasia of the decidua, villus epithelial cells and decidual cells are dissolved, blood vessels in the villi are blocked, affecting the absorption and transport of nutrients, so that the pregnant eggs are separated from the attachment, bleeding and abortion . In addition, such a large infarction in the placenta can reduce the function of the placenta, affecting the survival of the fetus; and the placenta, placental villus edema and degeneration into abortion is not uncommon. In the maternal blood after pregnancy, -hCG, hPL, P, E2, estrone, if these hormone values decrease in early pregnancy, 50% abortion.
Fourth, blood type incompatibility
Due to the previous pregnancy or blood transfusion, the Rh factor and the incompatible ABO blood group factor produce antibodies in the mother. The pregnancy enters the fetus from the placenta and the red blood cells aggregate to produce hemolysis, resulting in miscarriage.
Five, mental and neurological factors
Such as fright, severe mental stimulation, etc. can also cause miscarriage. In recent years, through research, noise and vibration have a certain impact on human reproduction.
6. Maternal systemic diseases
(1) Severe acute infectious diseases and infectious diseases: such as lobar pneumonia, many with high fever leading to uterine contraction, or / and embryo death can cause miscarriage.
(B) chronic diseases: severe anemia, heart disease, heart failure can cause fetal hypoxia, asphyxia and death; chronic nephritis, severe hypertension can cause infarction or early stripping of the placenta and cause miscarriage.
(3) Malnutrition or drug poisoning: such as vitamin deficiency, especially the lack of vitamin E-tocopherol, chronic poisoning such as mercury, lead, alcohol and morphine, can cause miscarriage.
Seven, reproductive organs diseases
Uterine malformations, such as the double-horned uterus, the uterine cavity mediastinum, are often the cause of miscarriage. But uterine dysplasia is often the cause of infertility. In addition, such as uterine fibroids, especially submucosal fibroids that develop into the uterine cavity or ovarian cysts that are embedded in the epiphysis, can affect the development of the fetus and cause miscarriage. Relaxation of the uterus is one of the common causes of habitual abortion. In recent years, about 14% of patients with intrauterine adhesions have developed after abortion. Adhesion causes uterine contraction, deformation, and reduction of endometrial area, and hardening, affecting embryonic development.
Examine
an examination
Related inspection
Obstetric B-double double diagnosis blood routine
First, double diagnosis: pay attention to the location, size, shape, hardness of the uterus, whether the uterine isthmus is particularly soft, as if the uterus body and the uterine neck lose continuity, both sides of the attachment have no mass or tenderness, resistance, cervix Whether there is erosion, bleeding, with or without cervical polyps, and must identify whether the bleeding is from the uterus, such as abortion, then blood must be from the uterus.
Second, auxiliary inspection:
1. Determine what kind of abortion
The performance of various abortions is different, and the treatment principles are different. Therefore, it is necessary to determine which abortion.
The amount of vaginal bleeding is small, the uterus is not open, and the uterus is in accordance with the menopause month, which is a threatened abortion. The uterus opening is large, the amniotic sac is prominent, or has been ruptured, and the vaginal bleeding is very large, which is inevitable abortion. More bleeding, discharge part of the tissue, the uterus is less than the menopause month, for abortion. There is a history of threatened abortion, the uterus is not open, and the amount of bleeding at the beginning is high. After the embryonic tissue is discharged, the vaginal bleeding is rapidly reduced or stopped. The uterus is closed and the uterus is well contracted for complete abortion. If the uterus is less than the menopause month and the pregnancy test is negative, it is an expired abortion.
2, habitual abortion
First understand the cause of abortion, emphasizing the simultaneous diagnosis of couples, not only to check the woman, but also to pay attention to the male factor, the conditional hospital has established a genetic eugenics consultation clinic. The diagnosis and treatment of habitual abortion is one of its important contents.
(1) Inquire about the history of past pregnancy, past medical history, family history, and family history of suspicious genetic history.
(2) Perform a systemic examination and a gynecological examination.
(3) Carry out the necessary tests and auxiliary inspections. Male: semen routine, blood type, chromosome, etc. Female: vaginal cell smear, cervical score, basal body temperature, blood type, chromosome, B-ultrasound to check whether the uterus is developing or not.
(4) Further inspection according to the situation:
a, suspected uterine malformation in addition to B ultrasound, feasible hysterosalpingography, hysteroscopy, laparoscopy.
b, suspected endocrine abnormalities, check fasting blood sugar. Can be combined with basal body temperature endometrial pathology and radionuclide examination, progesterone, LH, FSH, PRL, E2, T3, T4, TSH, 17-OH, 17-Cu, etc., if necessary, can be brain CT, understand the brain There are no adenomas in the pituitary.
c. Suspected special infection can be checked for cytomegalovirus, toxoplasma and chlamydia.
d. Those with a history of adverse environmental exposure should be examined for SLE, micronucleus, and chromosome aberration rate.
e, suspected ABO blood group incompatibility, further check the antibody titer. If the interval is checked during pregnancy, the antibody titer is changed. Whether the titer decreased after receiving treatment.
Diagnosis
Differential diagnosis
Painless vaginal bleeding in late pregnancy or in labor: the main symptoms of abortion are vaginal bleeding and abdominal pain. Abortion is a common gynecological disease. If it is not properly treated or not treated properly, it may leave genital inflammation, or it may endanger the health of pregnant women due to major bleeding, and even threaten life. In addition, abortion is easily confused with certain diseases of gynecology.
Sustained abdominal pain or back pain during pregnancy: The severe symptoms of placental abruption are mainly sudden persistent abdominal pain and/or backache and low back pain. After 20 weeks of gestation or during childbirth, the placenta in the normal position is partially or completely detached from the uterine wall before the delivery of the fetus, called placental abruption. Placental abruption is a serious complication in the third trimester of pregnancy. The onset is urgent and progresses rapidly. If it is not treated in time, it can endanger the mother and child. The incidence of domestic reports is 4.6 to 21 , and the incidence rate abroad is 5.1 to 23.3 . The incidence is related to whether the placenta is carefully examined after delivery. Some patients with mild placental abruption can have no obvious symptoms before labor. Only when the placenta is examined after delivery, it is found that there is clot blockage in the early exfoliation. Such patients are easily overlooked.
