流产异位妊娠赵爱民.ppt

Ectopic pregnancy Abortion,Zhao aimin M.D., Ph.D., Professor Department Of Obstetrics & Gynecology Renji Hospital Affiliated to SJTU School of Medicine,2019/9/29,2,Abortion and Ectopic pregnancy,Ectopic pregnancy Definition Implantation outside of the uterine cavity is termed ectopic pregnancy It is a condition that significantly jeopardizes the mother because catastrophic bleeding may occur when the implanting pregnancy erodes blood vessels or ruptures of the tubal wall,2019/9/29,3,Abortion and Ectopic pregnancy,Implant locations Tubal 95% (80% ampullary portion) Ovarian 1% Abdominal 1-2% Cervical 0.15% Cornual 2%,2019/9/29,4,Abortion and Ectopic pregnancy,Etiology Salpingitis have 6-fold increase the risk of ectopic pregnancy Operation of tubal IUD(intrauterine device) Dysfunction of tubal Orther: endometriosis,2019/9/29,5,Abortion and Ectopic pregnancy,Outcomes of ectopic pregnancy Tubal abortion 8-12 Weeks ampullary portion Rupture of tubal pregnancy 5 weeks isthmic portion Tubal abortion with subsequent implantation on an intraperitoneal structure for example liver pregnancy,2019/9/29,6,Abortion and Ectopic pregnancy,Clinical manifestation of ectopic pregnancy Amenorrhea 70-80% 6-8 weeks Abdominal 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 Irregular vaginal bleeding results from the sloughing of the decidua Shock result from amount of blood loss Abdominal mass,2019/9/29,7,Abortion and Ectopic pregnancy,Physical findings in tubal pregnancy General findings: Anemic or pale face pulse increased BP decreased T 38 degree,2019/9/29,8,Abortion and Ectopic pregnancy,Abdominal examination distention and tenderness with or without rebound Decreased bowel sound Shifting dullness positive mass,2019/9/29,9,Abortion and Ectopic pregnancy,Pelvic examination Slightly open cervix with bleeding Cervical motion tenderness Adnexal tenderness Adnexal mass The uterus size may be normal or enlarged,2019/9/29,10,Abortion and Ectopic pregnancy,Diagnostic procedures Typical cases can be determined easy Early ectopic pregnancy or unrupture type difficulty It is nessesary to need assistant examination,2019/9/29,11,Abortion and Ectopic pregnancy,HCG test 80-100% positive Urinary HCG level Blood HCG level If HCG negative,ectopic pregnancy does not be rule out Type B Utrasound Culdocentesis Aid in the identification of peritoneum bleeding Positive (noncloting blood) ectopic pregnancy may be confirmed Negative ectopic pregnancy does not be depletion,2019/9/29,12,Abortion and Ectopic pregnancy,Laproscopy It is a direct visualization and accurte method to diagnosis ectopic pregnancy Even laproscopy,however,carries 2-5% misdiagnosis rate, because an extremely early tubal pregnancy gestation may not be identified,2019/9/29,13,Abortion and Ectopic pregnancy,Pothology of endometriun Curettage of the uterine cavity can also help rule out ectopic pregnancy Identification of chorionic villi in curetting may identify an intrauterine pregnancy,2019/9/29,14,Abortion and Ectopic pregnancy,Differential diagnosis Abortion Acute salpingitis Acute appendicitis Rupture of corpus luteum Torsion of ovarian cyst,2019/9/29,15,Abortion and Ectopic pregnancy,Treatment of ectopic pregnancy Surgical treatment Salpingectomy Conservative operation Salpinggostomy Segmantal resection and tubal reanatomosis,2019/9/29,16,Abortion and Ectopic pregnancy,Nonsurgical therapy Chinese traditional medicine Chemical therapy Drug:MTX Indication The diameter of the mass 3cm Unrupture Not significantly bleeding HCG level 2000U/L,Abortion,2019/9/29,18,Abortion and Ectopic pregnancy,Definition Abortion is the termination of a pregnancy before 28 weeks from the first day of the last menstrual period and the fetus weight 1000g,2019/9/29,19,Abortion and Ectopic pregnancy,Classification Early abortion 12W Late abortion 12-28W Spontaneous abortion Artificial abortion,2019/9/29,20,Abortion and Ectopic pregnancy,Etiology Genetic factors Maternal factors Infection systemic factors heart disease sever anemia endocrine Reproductive tract abnormality Immunologic factors Enviromental factors Toxin Radiation smoking alohol,2019/9/29,21,Abortion and Ectopic pregnancy,Pathology 1.Haemorrhage occurs in the decidua basalis leading to local necrosis and inflammation.,2019/9/29,22,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.,2019/9/29,23,Abortion and Ectopic pregnancy,3. Expulsion complete, The decidua is shed during the next few days in the lochial flow.,2019/9/29,24,Abortion and Ectopic pregnancy,Clinical manifestation,Haemorrhage is usually the first sign and may be significantly if placental separation is incomplete. Pain is usually intermittent, like a small labrur. It ceases when the abortion is complete.,2019/9/29,25,Abortion and Ectopic pregnancy,Threatened abortion,Low abdominal Pain company vaginal bleeding Cervix is closed unrupture of membrane Embryo survive,2019/9/29,26,Abortion and Ectopic pregnancy,Inevitable abortion,Bleeding increased Pain development Ruputure of membrane Cevix dilation Embryo tissue incarcerated in the cervix,2019/9/29,27,Abortion and Ectopic pregnancy,Complete abortion Uterine contractions are felt, the cervix dilates and blood loss continues. The fetus and placenta are expelled complete, the uterus contracts and bleeding stops. No further treatment is needed.,2019/9/29,28,Abortion and Ectopic pregnancy,Incomplete abortion In spite of uterine contractions and cervical dilatation, only the fetus and some membranes are expelled. The placenta remains partly attached and bleeding continues. This abortion must be completed by surgical methods.,2019/9/29,29,Abortion and Ectopic pregnancy,Missed abortion Is the retention of a failed intrauterine pregnancy for a extended period, usually defined as more than two menstrual cycles Recurrent abortion It is a term used when a patient has had two or more consecutive spontaneous abortions Septic abortion,2019/9/29,30,Abortion and Ectopic pregnancy,Treatment of abortion Incomplete abortion Remove the embryo and placenta as soon as possible Negative pressure suction Embryul