妇产科：流产、异位妊娠（英文课件）

1、Abortion,Definition,Abortion:Pregnancy terminated before 28 weeks gestation with fetal weight 1000 gram. Early abortion：pregnancy terminated before 12 weeks gestation Late abortion：pregnancy terminated between 12 and 28 weeks gestation,Etiology,Embryo factor Chromosomal anomaly is the chief agent. M

2、ore than 80 percent of abortions occur in the first 12 weeks of pregnancy At least half result from chromosomal anomalies After the first trimester, both the abortion rate Sign of mass Pelvic signs,Auxiliary examination,Blood HCG B-ultrasound examination Abdominal paracentesis/ culdocentesis Laparos

3、cope Diagnostic curettage,Tubal Pregnancy at USG,Ultrasound showing uterus and tubal pregnancy 2D scan Uterus outlined in red Uterine lining in green Ectopic pregnancy yellow Fluid in uterus at blue circle is called a pseudogestational sac,Diagnosis,Early diagnosis of an ectopic pregnancy is critica

4、lly important There is no uniformly accepted diagnostic protocol History Physical examination (pain, adnexal mass, enlarged uterus) Transvaginal or transabdominal ultrasound Quantitative hormone tests (HCG, -hCG, progesterone) Occasionally culdocentesis (thin needle is inserted at the top of the vag

5、ina, between the uterus and the rectum, to check for blood in CD) Sometimes dilatation and curettage (exclude intrauterine pregnancy or incomplete abortion),Abortion Acute salpingitis Acute appendicitis Rupture of corpus luteum Torsion of pedicle of oval cyst Rupture of oval cyst,Differential diagno

6、sis,Principles Generous hemorrhage complicating with shock: Emergency operation Otherwise: synthetic assessment; appropriate treatment,Management,Management,Expectant management - proportion of all ectopics will not progress to tubal rupture, but will regress spontaneously and be slowly absorbed Lev

7、el of hCG must falling and a woman becomes clincally well. Situation needs daily hCG, TVS. If hCG increases or sonographic findings are suspicious active management Medical treatment (methotrexate) given by injection ;in form of systemic or local administration Open surgery (laparotomy) - involves a

8、 5-8 cm incision at the top of the pubic hairline The affected tube is brought out and either salpingotomy or ectomy is performed,Criteria for Expectant Management,Decreasing hCG titers (less than 1000 mIU/mL ) No evidence of rupture or significant bleeding Ectopic mass with size less than 3 cm High

9、ly motivated patient with strong desire to avoid both surgery and medical management Hemodynamically stable healthy woman Absence of fetal heart tones,PZ,Methotrexate Treatment,Anti-metabolite drug Inexpensive, easy to obtain, well tolerated folic acid antagonist The initial dose regimen MTX (1 mg/k

10、g IM ) or single IM dose of 50 mg/square meter Dont exceed 4 doses 70-95% efficiency of cases treated,Operation,Salpingectomy Cutting the tube out Salpingotomy Making an incision on the tube and removing the pregnancy Choosing operation modes according to patients condition.,Other types of EP,Ovaria

11、n pregnancy Abdominal pregnancy Broad ligment pregnancy Cervical pregnancy,A right tubal ectopic pregnancy seen at laparoscopy The swollen right tube containing the ectopic pregnancy is on the right at E The stump of the left tube is seen at L - this woman had a previous tubal ligation,Close view of

12、 the same ectopic,After laparoscopic resection of the tube, the tubal stump is seen at S,Right tubal ectopic pregnancy in 11 th week of gestation,Same situation after rupture,Laparoscopist must try to remove the ectopic pregnancy, preserve the fallopian tube, and early send the patient home Diagnost

13、ic LSK picture below,DIAGNOSIS & TREATMENT OPERATIVE LAPAROSCOPIC SURGERY,The first step of this technique involves making a linear slit into the fallopian tube over the ectopic with a monopolar needle tip.,Hyperemesis Gravidarum,Prolonged and severe nausea/ vomiting associated with dehydration, wei

14、ght loss, or electrolyte disturbances when pregnancy。 1.0 of 1000 pregnancies。,Cause： Hormonal, neurological, metabolic, toxic, and psychosocial factors (underlying emotional disorder) Degree of biochemical hyperthyroidism The level of beta-HCG,Lab : Ketonuria Increased urine specific gravity Elevat

15、ed hematocrit and BUN level Hyponatremia Hypokalemia Hypochloremia Metabolic alkalosis,Check： Urine Blood (CBC/DC, electrolyte, ABG) Serum Beta-HCG Thyroid function Hyperthyroidism Transient hyperthyroidism : self-limiting Resolving by 18 weeks Sonar,Management （Severity of Symptom） Indication for hospitalization Intractable emesis Correction of any electrolyte abnormalities Hypovolemia IV hydration Anti-emetic drug (ex: Metoclopramide) Parental nutrition Electrolyte supplement,Vitamin