Ectopic Pregnancy 异位妊娠.ppt

Ectopic Pregnancy 异位妊娠 Jun Ma 马军 Dept. of Obstetrics & Gynecology The First Hospital of Xian Jiaotong Univ Ectopic : (Ektopos) out of place Definition Ectopic pregnancy: fertilized embryo implanted outside the uterine cavity intrauterine implantation Animation of intrauterine implantation Animation of ectopic implantation 95% Classification of ectopic pregnancy Overview nLeading cause of maternal deaths in the first trimester nConstituting 1-2% of all conceptions nSubsequent infertility nIncidence increasing nMortality decreasing with better detection Tubal pregnancy 输卵管妊娠 Incidence of tubal pregnancy by location Incidence of tubal pregnancy by location Interstitial 2-3% isthmic 12% Ampullary 78% Fimbrial 5% Which women are at higher risk for tubal pregnancy? High-risk Factors nPrior history of PID (pelvic inflammatory disease) High-risk Factors nPrior history of PID (pelvic inflammatory disease) nTubal Surgery nPrevious Ectopic Pregnancy nIUD (intrauterine device)? nOther tubal abnormalities Pathology & outcomesPathology & outcomes nTubal abortion Outcome s 2. Rupture of tubal pregnancy 3. 3. Secondary abdominal pregnancySecondary abdominal pregnancy 4. Tubal mole & pelvic hematoma Other pathological changes HCG Corpus luteum Endometrium Vaginal bleeding Uterus Intact embryo maintain maintain decidua - slightly enlarged drop regress decidua shedding +/ irregular slightly enlarged or normal size Rupture or abortion Question nHow to explain the situation when a woman with ectopic pregnancy claimed that she had expelled an “intra- unterine embryo-like tissue”? Endometrium Vaginal bleeding Vaginal pass of tissue Pregnancy test Histology (Intrauterine villi) Tubal abortion decidua shedding +/ irregular + + _ decidua +/ irregular + + + Intrauterine abortion Summary IWhat is ectopic pregancy? IWhich pat