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防患于未然：关于预防“先兆流产”

发布日期：2024-07-04 09:56:25编辑：秩名


就像船舶航行会遇到礁石一样，女性在怀孕后也会遇到礁石，那就是先兆流产！
 

◎ 出现先兆流产的原因

 
阴道流血是先兆流产的最直接症状，引起阴道流血的原因是胚胎的绒毛从母体的子宫肌壁上剥离。若胚胎绒毛剥离的面积小，则阴道出血量少，胚胎的存活尚无大碍，有保胎的希望，医学上称之为“先兆流产”。如果剥离的面积大，则阴道出血量多，胚胎的营养供应受到严重影响，此时，保胎的希望就很小了。
 
在孕8周以前，因为胚胎的绒毛发育幼稚，与母体联系不牢固，稀疏的绒毛很容易从母体剥离。在这个时期若有激烈的性生活，或者过度的劳累，负重，搬扛重物，撞击腹部，长途旅行颠簸等，就会突然引起剥离。
 
由于剥离出现的突然性，没有一个发展过程，所以先兆流产的阴道出血起初总呈鲜红色，再逐渐变成暗红。血的颜色和通常的月经不同，月经是子宫内膜逐渐萎缩的结果，经过长时间的氧化，所以出血的颜色一般比较深。
 

◎ 出现先兆流产的对策

 
一旦发现阴道有鲜红的血液流出，你应该马上意识到出现先兆流产了，这时候要立即去医院检查。
 
在这里要告诉大家一个医疗统计数字：在妊娠前3个月阴道出血发生率是20%，也就是说每5个孕妇中，会有一个出血现象；另外，在出现先兆流产的女性中，约有50%的人保胎成功。
 
阴道出血的孕妇中，首先要做的鉴别诊断是排除异位妊娠，排除了异位妊娠才能采取保胎措施。而采取保胎措施的孕妇中，有一半的人是会成功的，所以大家行动一定要早，千万不能犹豫不决，放弃机会！
 
先兆流产实际上是流产发展各阶段中的第一个阶段。当出现少量阴道流血和下腹痛，此时，如果宫颈口未开，胎膜未破，妊娠产物尚未排出，你及时采取了保胎措施，而且措施很得当，休息很充分，一段时间后，如流血停止，腹痛消失，说明保胎已经接近成功！相反，如果你忽视了先兆流产的征兆，延误了采取措施的时间，听之任之，不适当休息，发展下去就难免流产了！
 
我现在来提供一些方法和数据，这些方法和数据对大家或许有用。出现阴道流血，说明胚胎出问题了，但是问题严重到什么程度？是不是应该采取保胎措施？必须做一个评判。
 
医生首先要做的是排除患者异位妊娠。
 
只要有腹部痉挛或腹痛及阴道出血，就存在异位妊娠的可能，此时应尽早进行超声检查，以确定妊娠位置。若血HCG水平大于2000mIU/ml，则通过阴道超声检查可以见到宫内妊娠；若血HCG水平大于6000mIU/ml，则通过腹部超声就可以见到宫内妊娠。另外，还可以通过孕激素水平来判别为是否为异位妊娠。异位妊娠的孕激素水平比较低，若孕激素小于5ng/ml，则胚胎一定为异常胚胎；若孕激素大于15ng/ml，则可以确定为正常妊娠。
 
排除了异位妊娠后，可以通过以下的一些方法来判断是否应该保胎，估计保胎的成功率，并预测后期的胚胎发展。这些方法，大家不一定要了解得很透彻，但是应该了解基本的原理。
 
◎ 宫颈黏液结晶检查；
 
◎ 阴道细胞涂片检查；
 
◎ 核固缩指数测定；
 
◎ 内分泌测定；
 
◎ B超检查；
 
◎ 基础体温测定。
 
上面提到的几种检查方法中，我们比较熟悉的是内分泌测定和B超检查内分泌测定：孕妇黄体功能不全，分泌的孕激素少，可引起先兆流产或习惯性流产，在做内分泌测定时要重点测定黄体激素的代谢产物——孕二醇，如果孕二醇值低，则说明黄体功能不全。
 
B超检查：做B超检查可以观察宫内胎儿发育情况，若通过动态观察发现胎儿按正常规律发育，则说明继续保胎大有希望；如果发现胎儿发育受阻，经保胎治疗勉强存活下来的胎儿，多体弱低能；如果发现胚芽枯萎，或胎盘暗区（胎盘后出血）逐渐扩大，那么只能放弃保胎。
 
上述方法中的前5个只能够在医院里进行检查，唯有第6个是我们自己就能够做的，因此大家在未准阶段养成的一个好习惯——测基础体温，还应该继续！
 
毕竟在孕激素的作用下，体温的高温状态达16周之久。即使阴道见红，出现了先兆流产的迹象，但只要你体温不下降，保胎就极有希望，如果体温下降了，危险程度就增加了很多。因此怀孕以后，大家仍要密切注意自己的基础体温。
 
先兆流产的治疗原则当然是保胎，最主要的方法是卧床休息，避免刺激，禁止性生活。
 

接下来，我们来看看医生开出的典型药方：

 
◎ 处方1：用于黄体功能不足者，黄体激素 20mg im qd；
 
◎ 处方2：用于一般先兆流产孕妇，维生素E 100mg qd或bid；
 
◎ 处方3：用于孕妇情绪较为紧张者，地西泮（安定） 2.5mg qd；
 
◎ 处方4：中医固肾安胎药物，安胎饮。
 
上面处方中：mg代表毫克，“im”表示肌肉注射，“qd”表示一天一次，“bid”表示一天两次。
 

◎ 对待流产，防病胜于治病

 
在这里，我有必要强调一个观点：对于流产，也像其他疾病一样，防病胜于治病。到出现先兆流产迹象的时候，再慌忙地去采取保胎措施，成功的希望就只有一半，如果提前采取措施，可防患于未然，获得事半功倍的保胎效果。
 
对于有习惯性流产倾向的孕妇以及过去有过人工流产史的姐妹，在计划妊娠阶段，要坚持每天测量基础体温，一旦发现基础体温上升，即使月经尚未过期，也应按先兆流产保胎来治疗，而且这个保胎措施，最好要做到上次流产日期以后。因为子宫是有记忆的，再次流产或者胎停育往往会发生在上次流产日子的前后。
 
那么，所谓提前采取措施是不是必须到医院去才能做呢？
 
那倒不必，经过对医生通常开出的处方分析，其实处方2——服用维生素E， 是我们自己就能够做的。当你发现自己排卵后出现高温，又很及时地同房过，加之，你过去有过流产史，那么就应当及时地每天补充2颗100毫克的天然维生素E，这是一个既可靠而又省力的方法。

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