Complete abortion

　　The causes of abortion are diverse and complex. The most common causes of early complete abortion are chromosomal abnormalities, endocrine abnormalities, uterine maldevelopment or malformation, and mainly include the following aspects:

　　One, chromosomal abnormalities include chromosomal number abnormalities, such as monosomy, trisomy, and polyploidy; structural abnormalities, such as breaks, deletions, and translocations, can all lead to abortion. Some people have studied the chromosomes of spontaneous and therapeutic abortions, and found that 60% of spontaneous abortions have chromosomal abnormalities. Those with chromosomal abnormalities often have structural abnormalities in the fetus or placenta. While those with normal karyotypes have normal fetuses more often.

　　Two, endocrine disorders excessive estrogen and insufficient progesterone are also causes of early abortion. Because at 12-14 weeks of pregnancy, it is the period when the placenta is forming and replacing the function of the corpus luteum of pregnancy, it is easy to have endocrine disorders, especially insufficient corpus luteum function. In addition, thyroid hormone deficiency causes obstacles in the oxidation process of cells, as well as hyperthyroidism and diabetes, which are prone to cause abortion.

　　Three, abnormal placenta and insufficient placental endocrine secretion can cause endometritis during early pregnancy, which may cause bleeding or hyperplasia of the basal decidua, dissolution of trophoblastic epithelial cells and decidua cells, obstruction of blood vessels in the villi, affecting the absorption and transportation of nutrients, resulting in the separation and bleeding of the embryo from the attachment site and abortion. In addition, if there is a large thrombosis in the placenta, it can reduce placental function and affect fetal survival; and placenta previa, villous edema and degeneration can also cause abortion. If the levels of β-hCG, hPL, P, E2, and estrone in the maternal blood decrease during early pregnancy, 50% of the abortions occur.

　　Four, incompatibility of blood types due to previous pregnancy or blood transfusion, Rh factor and incompatibility of ABO blood type factors produce antibodies in the mother, this pregnancy enters the fetal body through the placenta and causes agglutination with red blood cells, resulting in hemolysis and abortion.

　　Five, factors such as shock and severe mental stimulation can also lead to abortion. In recent years, research has shown that noise and vibration have a certain impact on human reproduction.

　　Six, there are three types of early complete abortion caused by maternal systemic diseases.

　　1. Severe acute infectious diseases and infectious diseases: Such as lobar pneumonia, often accompanied by high fever, which can cause uterine contraction or and/or embryonic death, leading to abortion.

　　2. Chronic diseases: Severe anemia, heart disease, and heart failure can cause fetal hypoxia and asphyxia, leading to death; chronic nephritis and severe hypertension can cause placental infarction or early detachment, leading to abortion.

　　3. Malnutrition or drug poisoning: Deficiencies in vitamins, especially vitamin E, mercurial, lead, alcohol, and morphine can all cause abortion due to chronic poisoning.

　　Seven, reproductive organ diseases: Uterine malformations, such as bicornuate uterus and uterine cavity septum, are often the cause of abortion.

　　Eight, immune factors: For those with unknown causes, recent research has found that most of them are closely related to immune factors.

      Complete abortion (complete abortion) is the complete expulsion of embryonic tissue in a short period of time during the process of threatened and inevitable abortion, with the cessation of bleeding and abdominal pain. Complications mainly include complications during the procedure, long-term complications, and complications of subsequent pregnancy.

　　1. Complications during the procedure:Uterine bleeding of more than 200 milliliters; surgical abortion syndrome, also known as cardio-cerebral syndrome, with an incidence of 12%. The patient suddenly experiences bradycardia, arrhythmia, blood pressure drop, pale complexion, profuse sweating, and a series of symptoms. In severe cases, fainting and convulsions may occur; uterine perforation; missed abortion, where the embryo tissue is not fully aspirated, leading to the continuation of pregnancy.

　　2. Long-term complications:Chronic pelvic inflammatory disease; menstrual abnormalities; secondary infertility; endometriosis.

　　3. Complications of subsequent pregnancy:Infertility; a higher incidence of late abortion; a higher incidence of preterm labor; a higher perinatal mortality rate; increased rates of antepartum and postpartum hemorrhage; increased incidence of neonatal hemolytic disease.

　　The main symptoms of complete abortion are vaginal bleeding and abdominal pain. Vaginal bleeding occurs in the first 12 weeks of pregnancy in those who have an abortion, starting with the separation of the villi and decidua, the opening of blood sinuses, and the beginning of bleeding. When the embryo is completely separated and expelled, bleeding stops due to uterine contraction. The entire process of early abortion is accompanied by vaginal bleeding; in late abortion, the placenta has formed, and the process is similar to preterm labor. The placenta is expelled after the fetus is delivered, usually with little bleeding. The characteristic is that abdominal pain often occurs before vaginal bleeding. Abdominal pain during abortion is episodic uterine contraction-like pain. After the appearance of vaginal bleeding in early abortion, the separation of the embryo and the stimulation of the blood clots in the uterine cavity cause uterine contraction, resulting in episodic lower abdominal pain. The characteristic is that vaginal bleeding often occurs before abdominal pain. In late abortion, there is first an episodic uterine contraction, followed by placental detachment, so vaginal bleeding occurs after abdominal pain. During abortion, the size of the uterus, whether the cervical os is dilated, and whether the amniotic membrane is ruptured should be checked, which varies with the gestational age and the process of abortion.

　　Abortion is a common disease in the field of gynecology and obstetrics. The main preventive measures for complete abortion are as follows:

　　1. Contraception should be used within half a year after an abortion to reduce the occurrence of subsequent abortions. After half a year, a new pregnancy can be expected to occur, which may decrease the likelihood of another abortion.

　　2. Genetic examination should be conducted, with both partners undergoing chromosomal tests simultaneously.

　　3、做血型鉴定包括Rh血型系统。

　　3. Blood typing, including the Rh blood group system.

　　4. Computer workers should work less than 20 hours a week.

　　5. The duration of drug use for treating luteal insufficiency should exceed the previous abortion's gestational period.

　　6. Those with hypothyroidism should maintain normal thyroid function before pregnancy and take antithyroid drugs during pregnancy.

　　7. Pay attention to rest, avoid sexual activity, maintain emotional stability, and live a regular life with rhythm.

　　8. The male should undergo a reproductive system examination. Those with bacterial seminal vesiculitis should be treated thoroughly before their wife becomes pregnant.

      What laboratory tests are needed for complete abortion

　　The diagnosis of complete abortion is generally not difficult, and it can be diagnosed based on medical history and clinical manifestations. Only a few cases require auxiliary examinations.

　　1. Ultrasound images

　　1. The uterus is of normal size or slightly larger than normal;

　　2. Intrauterine regular uterine waves are observed, and irregular light spots are not seen.

　　1. Blood chorionic gonadotropin levels decrease.

　　2. Urine pregnancy test gradually becomes weakly positive or negative.

　　3. Blood routine examination

　　3. Gynecological examination

　　Vaginal bleeding often decreases or stops, and abdominal pain also diminishes or disappears.

　　More than 50% of spontaneous abortions are due to chromosomal abnormalities, and early fetal spontaneous abortion can reduce the birth of malformed children. Therefore, it is necessary to investigate the cause as much as possible, such as chromosome examination,封闭抗体检查, and four examinations for eugenic health. It is necessary.

　　After abortion, it is necessary to replenish fluids, with attention to taking small amounts multiple times. After painless induction abortion surgery, due to the body being relatively weak, sweating is common. A large amount of water-soluble vitamins is excreted in sweat, especially vitamin C, vitamin B1, and vitamin B2. Therefore, it is advisable to eat more fresh vegetables and fruits, which is also beneficial for preventing constipation. After abortion, appropriate protein should also be supplemented because protein is an important component of antibodies. Insufficient intake can lead to a decrease in the body's resistance. Within half a month after painless induction abortion, one can eat more chicken, lean pork, eggs, milk, beans, and bean products. After abortion, it is appropriate to limit the intake of fat. During the first week after painless induction abortion, fat intake should be controlled at about 80 grams per day. Patients with menstrual irregularities should also avoid刺激性 food, such as chili, alcohol, vinegar, pepper, ginger, etc. At the same time, women after abortion should pay attention to both nutrition and ease of digestion and absorption in food selection: avoid or eat less greasy and cold foods. The period for nourishment should be about half a month, and those with weak bodies and poor physical condition should be nourished appropriately. It is necessary to ensure the supply of high-quality protein, sufficient vitamins and inorganic salts, especially to supplement sufficient iron to prevent the occurrence of anemia. Food selection should be both nutritious and easy to digest and absorb. Fresh fish, tender chicken, eggs, animal liver, animal blood, lean meat, soy products, milk, jujube, lotus seeds, fresh fruits and vegetables can be provided. Avoid or eat less greasy and cold foods. It is not advisable to eat radish, hawthorn, bitter melon, tangerine, and other food with properties of promoting Qi, activating blood, and being cool. It is advisable to eat more easily digestible food. The period for nourishment should be about half a month, and for those with weak bodies, poor physical condition, and excessive blood loss, the period for nourishment can be appropriately extended.

　　Abortion is a common disease in gynecology and obstetrics. Once abortion symptoms occur, appropriate treatment should be carried out in a timely manner according to the different types of abortion. Patients with complete abortion need necessary anti-inflammatory treatment to prevent postoperative infection and avoid complications. After washing the vulva and putting on clothes, you can go home. For those with a relaxed internal os of the uterus, internal os suture can be performed. After abortion, you should rest for four weeks. If there are no signs of infection, no special treatment is generally required.

　　For complete abortion with infection, the treatment principle should be to actively control infection. If there is not much vaginal bleeding, apply broad-spectrum antibiotics for 2 to 3 days, and then perform curettage after the infection is controlled to remove the retained tissue in the uterine cavity for hemostasis. If there is a lot of vaginal bleeding, while intravenous infusion of broad-spectrum antibiotics and blood transfusion, use a forceps to remove the retained tissue in the uterine cavity to reduce bleeding, and never use a curette to scrape the uterine cavity completely to avoid the spread of infection. Continue to apply antibiotics after surgery, and perform a thorough curettage after the infection is controlled. If there is a shock due to infection, it should be actively corrected. If the infection is severe or there is abscess formation in the abdomen or pelvis, surgical drainage should be performed, and the uterus may need to be removed if necessary.