小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 阴道出血，伴有或不伴有血块
其他诊断因素
- 耻骨弓上疼痛
- 腰痛
- 近期性交后出血
- 子宫结构异常
- 外伤史
危险因素
- 老年
- 子宫畸形
- 细菌性阴道病
- 血栓形成倾向
- 父母染色体异常
- 维生素 D 缺乏
- 既往自然/人工流产
- 不孕症/辅助受孕
- 非甾体抗炎药 (NSAID)
- 咖啡因
- 酒精
- 吸烟
- 超重/肥胖
- 甲状腺功能障碍
- 糖尿病
诊断性检查
首要检查
- 经阴道超声扫描
- 血清 β-hCG 滴度
需考虑的检查
- 经腹超声扫描
- 血清孕酮
- 尿妊娠试验
- 全血细胞计数（FBC）
- RH 血型
- 狼疮抗凝物/抗心磷脂抗体
- 盆腔超声检查
- 妊娠产物的细胞遗传学分析
- 双亲核型
- 阴道拭子
治疗流程
先兆流产
难免/不完全/稽留流产
完全流产
复发性流产
撰稿人
作者
Ida Muslim, MBChB, MRCOG
Consultant Obstetrician & Gynaecologist
The Women’s Centre
Gloucestershire Royal Hospital
Gloucester
UK
利益声明
IM declares that she has no competing interests.
Jothi Doraiswamy, MBBS, MRCOG
Consultant in Obstetrics and Gynaecology
Gloucestershire Royal Hospital
Gloucester
UK
利益声明
JD declares that she has no competing interests.
鸣谢
Dr Ida Muslim and Dr Jothi Doraiswamy would like to gratefully acknowledge Dr Isaac Babarinsa and Professor Tim Draycott, previous contributors to this topic.
利益声明
IB and TD declare that they have no competing interests.
同行评议者
Jo Trinder, MD
Consultant Obstetrician and Gynaecologist
St Michael's Maternity Wing
Bristol Royal Infirmary
Bristol
UK
利益声明
JT is the primary author of one randomised controlled trial cited in this topic. This trial was funded by an NHS Research and Development Grant and a donation from Exelgyn, the manufacturer of misoprostol. JT has accepted honoraria for speaking to groups of midwives and doctors about miscarriage management.
John Bachman, MD
Consultant in Family Medicine
Parker D Sanders and Isabella Sanders Professor of Primary Care
Rochester
MN
利益声明
JB declares that he has no competing interests.
鉴别诊断
- 异位妊娠/双胎异位妊娠
- 葡萄胎
- 部分性葡萄胎
更多 鉴别诊断指南
- 宫外孕和流产：诊断和初始管理
- ACR 适宜性标准：异常子宫出血
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