流產(chǎn)異位妊娠趙愛民

1、Ectopic pregnancyAbortion,Zhao aimin M.D., Ph.D., Professor Department Of Obstetrics & Gynecology Renji Hosp

2、ital Affiliated to SJTU School of Medicine,2024/3/24,2,Abortion and Ectopic pregnancy,Ectopic pregnancyDefinitionImplantation outside of the uterine cavity is termed ectopic pregnancyIt is a condition that significant

3、ly jeopardizes the mother because catastrophic bleeding may occur when the implanting pregnancy erodes blood vessels or ruptures of the tubal wall,2024/3/24,3,Abortion and Ectopic pregnancy,,Implant locationsTubal 95%

4、(80% ampullary portion)Ovarian <1%Abdominal 1-2%Cervical 0.15%Cornual 2%,2024/3/24,4,Abortion and Ectopic pregnancy,EtiologySalpingitis have 6-fold increase the risk of ectopic pregnancy

5、Operation of tubalIUD(intrauterine device)Dysfunction of tubalOrther: endometriosis,2024/3/24,5,Abortion and Ectopic pregnancy,Outcomes of ectopic pregnancyTubal abortion 8-12 Weeks ampullary portionRupture of

6、tubal pregnancy 5 weeks isthmic portionTubal abortion with subsequent implantation on an intraperitoneal structure for example liver pregnancy,2024/3/24,6,Abortion and Ectopic pregnancy,Clinical manifestation o

7、f ectopic pregnancyAmenorrhea 70-80% 6-8 weeksAbdominal and pelvic pain the most common symptom,which is present in nealy all patients. Pain is a result of distented of tubal and irritation of peritoneum by blood

8、Irregular vaginal bleeding results from the sloughing of the deciduaShock result from amount of blood loss Abdominal mass,2024/3/24,7,Abortion and Ectopic pregnancy,Physical findings in tubal pregnancyGeneral findin

9、gs: Anemic or pale face pulse increased BP decreased T< 38 degree,2024/3/24,8,Abortion and Ectopic pregnancy,Abdominal examinationdistention and tenderness with or without reboundDecreased bowel soundSh

10、ifting dullness positivemass,2024/3/24,9,Abortion and Ectopic pregnancy,Pelvic examinationSlightly open cervix with bleedingCervical motion tenderness Adnexal tendernessAdnexal massThe uterus size may be normal or

11、 enlarged,2024/3/24,10,Abortion and Ectopic pregnancy,Diagnostic proceduresTypical cases can be determined easyEarly ectopic pregnancy or unrupture type difficultyIt is nessesary to need assistant examination,2024/3/2

12、4,11,Abortion and Ectopic pregnancy,HCG test 80-100% positiveUrinary HCG levelBlood HCG levelIf HCG negative,ectopic pregnancy does not be rule out Type B Utrasound CuldocentesisAid in the identification of perito

13、neum bleedingPositive (noncloting blood)ectopic pregnancy may be confirmedNegative ectopic pregnancy does not be depletion,2024/3/24,12,Abortion and Ectopic pregnancy,LaproscopyIt is a direct visualization and accur

14、te method to diagnosis ectopic pregnancyEven laproscopy,however,carries 2-5% misdiagnosis rate, because an extremely early tubal pregnancy gestation may not be identified,2024/3/24,13,Abortion and Ectopic pregnancy,Poth

15、ology of endometriunCurettage of the uterine cavity can also help rule out ectopic pregnancyIdentification of chorionic villi in curetting may identify an intrauterine pregnancy,2024/3/24,14,Abortion and Ectopic pregna

16、ncy,Differential diagnosisAbortionAcute salpingitisAcute appendicitisRupture of corpus luteumTorsion of ovarian cyst,2024/3/24,15,Abortion and Ectopic pregnancy,Treatment of ectopic pregnancySurgical treatmentSalp

17、ingectomyConservative operation Salpinggostomy Segmantal resection and tubal reanatomosis,2024/3/24,16,Abortion and Ectopic pregnancy,Nonsurgical therapyChinese traditional medicineChemical therapy Drug:MTX

18、 Indication The diameter of the mass <3cm Unrupture Not significantly bleeding HCG level <2000U/L,Abortion,,2024/3/24,18,Abortion and Ectopic pregnancy,Definition Abortion is the termination of a

19、pregnancy before 28 weeks from the first day of the last menstrual period and the fetus weight <1000g,2024/3/24,19,Abortion and Ectopic pregnancy,ClassificationEarly abortion <12WLate abortion 12-28WSpontaneou

20、s abortionArtificial abortion,2024/3/24,20,Abortion and Ectopic pregnancy,EtiologyGenetic factorsMaternal factorsInfectionsystemic factors heart disease sever anemia endocrineReproductive tract abnormalityImmunol

21、ogic factorsEnviromental factors Toxin Radiation smoking alohol,2024/3/24,21,Abortion and Ectopic pregnancy,Pathology1.Haemorrhage occurs in the decidua basalis leading to local necrosis and inflammation.,2024/3/24,22,

22、Abortion and Ectopic pregnancy,2. The ovum, partly or wholly detached, acts as a foreign body and irritates uterine contractions. The cervix begins to dilate.,2024/3/24,23,Abortion and Ectopic pregnancy,3. Expulsion comp

23、lete, The decidua is shed during the next few days in the lochial flow.,2024/3/24,24,Abortion and Ectopic pregnancy,Clinical manifestation,Haemorrhage is usually the first sign and may be significantly if placental separ

24、ation is incomplete.Pain is usually intermittent, ‘like a small labrur’. It ceases when the abortion is complete.,2024/3/24,25,Abortion and Ectopic pregnancy,Threatened abortion,Low abdominal Pain company vaginal bleed

25、ingCervix is closedunrupture of membraneEmbryo survive,2024/3/24,26,Abortion and Ectopic pregnancy,Inevitable abortion,Bleeding increasedPain developmentRuputure of membraneCevix dilationEmbryo tissue incarcerated

26、 in the cervix,2024/3/24,27,Abortion and Ectopic pregnancy,Complete abortionUterine contractions are felt, the cervix dilates and blood loss continues. The fetus and placenta are expelled complete, the uterus contracts

27、 and bleeding stops. No further treatment is needed.,2024/3/24,28,Abortion and Ectopic pregnancy,Incomplete abortionIn spite of uterine contractions and cervical dilatation, only the fetus and some membranes are expelle

28、d. The placenta remains partly attached and bleeding continues. This abortion must be completed by surgical methods.,2024/3/24,29,Abortion and Ectopic pregnancy,Missed abortionIs the retention of a failed intrauterine

29、pregnancy for a extended period, usually defined as more than two menstrual cyclesRecurrent abortionIt is a term used when a patient has had two or more consecutive spontaneous abortionsSeptic abortion,2024/3/24,30,Ab

30、ortion and Ectopic pregnancy,,Treatment of abortionIncomplete abortionRemove the embryo and placenta as soon as possibleNegative pressure suctionEmbryulciaMissed abortion Notice blood clot function prevent DICSep

31、tic abortion Broad-spectrum antibiotics,2024/3/24,31,Abortion and Ectopic pregnancy,Removal of placental tissue with ovum forceps.,2024/3/24,32,Abortion and Ectopic pregnancy,2024/3/24,33,Abortion and Ectopic pregnancy,

32、Key words today Concept of ectopic pregnancy Clinical manifestation, diagnosis,differential diagnosis and treatment of ectopic pregnancy Concept of abortion Classification of abortion Clinical manifestation, di

33、agnosis,differential diagnosis and treatment of abortion,Zhao aimin M.D., Ph.D., Professor Department of Obstetrics & Gynecology