流产异位妊娠英文AbortianandEctopicPregnancy ppt完美版课件

1、AbortionConcept A pregnancy loss before 28 weeks of gestation while fetal weight under 1000 gramsEarly Abortion：pregnancy loss before 12 gestational weeks Late Abortion: pregnancy loss during 1228 gestational weeks Spontaneous AbortionArtificial AbortionGenetic defectMaternal factors: systematic dis

2、ease; genital organ anomalies; endocrine anomalies; irritation; bad habitImmune anomaliesEnvironmental factorsEtiologyPathologyBefore 8 weeks: chorionic villi immature Fetal deathbasal decidual bleeding uterine contractionexpulsion of all the products of conception, light bleedingDuring 812 weeks：wi

3、th firm attachment to the basal deciduaPartial expulsion of the products of conception non-ideal uterine contraction, severe bleedingAfter 12 weeks: placenta fully formed. Uterine contraction expulsion of all the products of conception，light bleedingSymptomsAmenorrhea, vaginal bleeding , and abdomin

4、al painEarly abortion：vaginal bleeding preceding abdominal painLate abortion：abdominal pain preceding vaginal bleedingTypes of AbortionThreatened AbortionInevitable AbortionIncomplete AbortionComplete AbortionMissed AbortionHabitual AbortionSeptic AbortionClinical PresentationsThreatened Abortion li

5、ght vaginal bleeding with mild abdominal paincervical os closed, fetal membranes unbrokentreatment might work , continue pregnancy Inevitable Abortion bleeding heavier, abdominal pain more severe, or fluid passedcervical os open，pregnancy tissue visibleabortion is inevitableHabitual Abortionvaginal

6、bleeding decreasing, abdominal pain alleviatingHabitual AbortionHabitual Abortionrupture：1216 weeksperform suction curettage promptlyComplete AbortionMissed abortion, cervical pregnancy?Incomplete AbortionConcept：implantation of the developing conceptus in the cervical canalPelvic examination：cervic

7、al motion tenderness，sensation of a floating uterus ，adnexal mass, etc.A pregnancy loss before 28 weeks of gestation while fetal weight under 1000 gramsVaginal bleedingadnexal cardiac activity or ultrasonographic lucency ; presence of cul-de-sac fluidLaboratory AssessmentMissed abortion, cervical pr

8、egnancy?Pain mild，bleeding light；IntensifiedPregnancy mass3cm or undetected；Incomplete Abortionheavy vaginal bleedingpregnancy tissue protruding from the cervical osuterus small for the presumed gestational week Complete Abortionvaginal bleeding decreasing, abdominal pain alleviatingcervical os clos

9、eduterus normal for the presumed gestational week Different Stages of Abortionthreatened abortion continue pregnancyinevitable abortion incomplete abortioncomplete abortionDiagnosisHistoryPhysical ExaminationLaboratory Assessment:ultrasound pregnancy testhormone level: serum progesteroneComplete Abo

10、rtionDescribe the clinical presentations of different stages of abortion？No intraabdominal bleeding；Light to noneConcept：implantation of the developing conceptus in the cervical canalultrasound：the empty uterus sign；Before 8 weeks: chorionic villi immatureBefore 8 weeks: chorionic villi immaturevagi

11、nal bleeding decreasing, abdominal pain alleviatingBefore 8 weeks: chorionic villi immatureone of the main causes of acute abdomen and deathMissed abortion, cervical pregnancy?abortion：812 weeksprevious tubal surgery：for infertility, tubal pregnancy, etc.Summarize the treatment for tubal pregnancy a

12、nd its choice？Abdomen examinationThe occurrence of 3 or more consecutive spontaneous abortionsMild to heavyPain mild，bleeding light；culdocentesis：nonclotting bloodmonitoring：ultrasound；Partial expulsion of the products of conception non-ideal uterine contraction, severe bleedingBleedingAbdominal Pai

13、nTissue ExpulsionCervical OsUterusThreatened AbortionInevitable AbortionIncomplete AbortionComplete AbortionLightMild to heavyLight to heavyLight to noneNone/lightIntensifiedRelievedNoneNoneNonePartialCompleteClosedDilatedDilated or obstructedClosedNormalNormal or slightly smallSmallNormal or slight

14、ly large History Pelvic ExaminationManagementThreatened Abortionbed rest, sedationanti abortion：progesterone，HCG；Vit E；thyroxine supplement monitoring：ultrasound；serum HCG whether to continue pregnancyInevitable Abortiononce diagnosed，remove the pregnancy tissue as quickly as possible suction curett

15、age Incomplete Abortionperform suction curettage promptlyif with heavy bleeding：blood transfusion；preventive antibiotic useComplete Abortionno retained products of conception confirmed by ultrasound；no infectionno need for special managementMissed Abortion Concept: in utero death of the embryo or fe

16、tus with retained products of conception Clinical Manifestation:uterine enlargement ceasing or fetal movement disappearingcervical os closed, uterus small for the presumed gestational ageno fetal heartbeat ; embryonic demise suggested by ultrasound findingsManagement blood routine examination, coagu

17、lation function testcorrecting coagulation defects：heparin, fibrinogen, etc.sensitizing the uterus： diethylstilbestroltransfusion preparation; emptying the uterus： before 12 weeks: suction curettage after 12 weeks：induction of laborHabitual Abortion The occurrence of 3 or more consecutive spontaneou

18、s abortionsThe occurrence of 2 spontaneous abortions is defined as recurrent abortionEarly abortion：chromosomal abnormalities，immunologic factors，luteal-phase insufficiency, hypothyroidismLate abortion：congenital uterine anomalies，cervical incompetence，uterine fibroids, etc.Managementobtain informat

19、ion on etiology for prior losses before conceptiongenetic counselingcervical incompetence：cervical cerclage during 1418 weeks of gestationwith unclear causes：progesterone therapy until 10 weeks of gestationactive immunotherapy：intradermic injection of lymphocytesSeptic Abortion Prolonged bleeding du

20、ring abortion or retained products of conception lead to intrauterine infection, which might progress into pelvic inflammatory disease, peritonitis or even sepsis if not treatedAntibiotic treatment + Prompt evacuationwithout severe bleeding: management of infection , performance of suction and curet

21、tagewith severe bleeding：management of infection while applying forceps, with secondary suction and curettage Ectopic PregnancyConcept Ectopic Pregnancy: implantation of the fertilized ovum in tissue other than the endometriumExtrauterine Pregnancyincluding：tubal pregnancy (95), ovarian pregnancy, c

22、ornual pregnancy, cervical pregnancy, abdominal pregnancy, etc.one of the main causes of acute abdomen and deathConcept：implantation of the developing conceptus in the cervical canalLate Abortion: pregnancy loss during 1228 gestational weeksWhat conditions should be differentiated from tubal pregnan

23、cy their respective differential points？Treatment principle：transfusion preparation; curretage or suction curretage ; MTX and/or uterine curretageHabitual AbortionPelvic examinatioonabortion：812 weeksComplete AbortionNo intraabdominal bleeding；Septic AbortionSpontaneous Abortioncorrecting coagulatio

24、n defects：heparin, fibrinogen, etc.Ovarian PregnancyBefore 8 weeks: chorionic villi immatureIncidence：1：18000Inevitable AbortionGenetic defectClinical PresentationsProtocol：MTX150 mg，give a second dose on day 7 if necessaryTypes of AbortionPartial expulsion of the products of conception non-ideal ut

25、erine contraction, severe bleedingInevitable AbortionEtiology and Risk Factorstubal inflammation, pelvic inflammation previous tubal surgery：for infertility, tubal pregnancy, etc.IVFfailure of contraception：current use of IUD or oral contraceptives tubal undergrowth or dysfunctionother factors：endom

26、etriosis, hysteromyoma, smoking, etc.Endings of tubal pregnancyabortion：812 weeks rupture：1216 weeks secondary abdominal pregnancyChronic ectopic pregnancyPersistent ectopic pregnancyPathology of the Uterusenlargement and softeningamenorrhea vaginal bleeding the Arias-Stella reaction of the endometr

27、ium but no chorionic villiClinical Presentations-SymptomsAmenorrheaAbdominal pain：time, characteristicsVaginal bleedingFaint/shockClinical Presentations-SignsGeneral conditionAbdomen examinationPelvic examination：cervical motion tenderness，sensation of a floating uterus ，adnexal mass, etc.Laboratory

28、 Assessment HCG: urinary HCG；the rise in the serum -HCG level over 48 hours66serum progesterone：only 1.5%25ng/mlultrasound：the empty uterus sign；adnexal cardiac activity or ultrasonographic lucency ; presence of cul-de-sac fluidculdocentesis：nonclotting bloodlaparoscopy：gold standard，diagnosistreatm

29、ent early diagnosis missed in 34 of patients use with caution：to avoid anesthetic and surgical risks；medical therapy as an optionUterine curretage：profuse vaginal bleeding; intrauterine pregnancy lossDifferential DiagnosisEctopic pregnancyabortionAdnexal inflammationAppendicitisCorpus luteum rupture

30、Ovary cyst torsion1.Amenorrhea2.Abdominal pain3.Bleeding4.Shock 5.Body temperature6.Pelvic examinatioon7.WBC8.Hb9.HCG10.Ultrasound11.CuldocentesisSurgical TreatmentRadical operation：hemodynamically unstable ; interstitial pregnancy; tubal ruptureConservative operation：with wishes to retain potential

31、 for fertility milking or linear salpingostomyMTXMedical Treatmentprinciple：inhibiting proliferation of trophoblastic tissueindication：no contraindication to chemotherapy ；no rupture or abortion；mass4cm；serum -HCG 2000U/L；no obvious internal bleeding；no demonstration of cardiac activity or embryonic

32、 budMedical TreatmentProtocol：MTX150 mg，give a second dose on day 7 if necessaryMonitoring therapeutic effectiveness：if decline in serum hCG level on day 725%； 15% or symptoms worsening or internal bleeding occurring; 2 weeks until negativeExpectant treatmentPain mild，bleeding light；No evidence of t

33、ubal rupture；No intraabdominal bleeding；Serum -HCG 1000U/L，and continue declining;Pregnancy mass3cm or undetected；Follow-up reliableThreatened AbortionGenetic defectHabitual Abortionpregnancy testInevitable AbortionNo intraabdominal bleeding；Clinical presentations：amenorrhea, abdominal pain and vagi

34、nal bleeding；no demonstration of cardiac activity or embryonic budHabitual Abortionbefore 12 weeks: suction curettageTissue Expulsionpreventive antibiotic useExtrauterine PregnancyInevitable Abortioncervical os closed, fetal membranes unbrokentubal pregnancyGenetic defectAbdominal pain：time, charact

35、eristicsserum HCG whether to continue pregnancyFollow-up reliableFaint/shockabortion：812 weeksNontubal Ectopic PregnancyCervical PregnancyConcept：implantation of the developing conceptus in the cervical canalIncidence：1：18000Clinical feature：painless vaginal bleedingDiagnostic criteria：the uterine s

36、ize is comparable to that of an unpregnant one; the presence of pregnancy tissue related exclusively to the cervical canal；curretage of the endometrial cavity is nonproductive of pregnancy tissueTreatment principle：transfusion preparation; curretage or suction curretage ; MTX and/or uterine curretag

37、eOvarian PregnancyA condition in which an ectopic pregnancy implants within the ovarian cortexDiagnostic criteria：the fallopian tube on the affected side must be intact；the fetal sac must occupy the position of the ovary；ovarian tissue must be located in the sac wall；the ovary and fetal sac must be

38、connected to the uterus by the ovarian ligamentOvarian PregnancyClinical presentations：amenorrhea, abdominal pain, vaginal bleeding，shock, etc.Differentiated from：ruptured corpus luteum；tubal pregnancyTreatment principle：surgical treatmentAbdominal PregnancyThe presence of a pregnancy related to a p

39、eritoneal surface other than fallopian tube, ovary or broad ligament， 1：15000 Classification：primary, secondaryClinical presentations：amenorrhea, abdominal pain and vaginal bleeding；fetus.Treatment principle：remove the fetusplacenta managementtransfusion, prevent infection attached to the uterus, fa

40、llopian tube attached to peritoneum , mesenterium（4 weeks; long been dead）QuestionsDescribe the clinical presentations of different stages of abortion？Summarize treatment principles of habitual, septic and missed abortions？What conditions should be differentiated from tubal pregnancy their respectiv

41、e differential points？What does laboratory assessment for Ectopic pregnancy include？Summarize the treatment for tubal pregnancy and its choice？Missed abortion, cervical pregnancy?sensitizing the uterus： diethylstilbestrolpregnancy tissue protruding from the cervical osPelvic examination：cervical mot

42、ion tenderness，sensation of a floating uterus ，adnexal mass, etc.Differential DiagnosisHabitual AbortionPregnancy mass3cm or undetected；Incidence：1：18000What does laboratory assessment for Ectopic pregnancy include？Late abortion：congenital uterine anomalies，cervical incompetence，uterine fibroids, et

43、c.abortion：812 weeksNo evidence of tubal rupture；Pain mild，bleeding light；curretage of the endometrial cavity is nonproductive of pregnancy tissueExpectant treatmentSpontaneous AbortionLaboratory AssessmentSeptic Abortionculdocentesis：nonclotting bloodpreventive antibiotic useabortion：812 weeksInevi

44、table AbortionGenetic defectThank you！PathologyBefore 8 weeks: chorionic villi immature Fetal deathbasal decidual bleeding uterine contractionexpulsion of all the products of conception, light bleedingDuring 812 weeks：with firm attachment to the basal deciduaPartial expulsion of the products of conc

45、eption non-ideal uterine contraction, severe bleedingAfter 12 weeks: placenta fully formed. Uterine contraction expulsion of all the products of conception，light bleedingTypes of AbortionThreatened AbortionInevitable AbortionIncomplete AbortionComplete AbortionMissed AbortionHabitual AbortionSeptic

46、AbortionHabitual Abortion The occurrence of 3 or more consecutive spontaneous abortionsThe occurrence of 2 spontaneous abortions is defined as recurrent abortionEarly abortion：chromosomal abnormalities，immunologic factors，luteal-phase insufficiency, hypothyroidismLate abortion：congenital uterine ano

47、malies，cervical incompetence，uterine fibroids, etc.Endings of tubal pregnancyabortion：812 weeks rupture：1216 weeks secondary abdominal pregnancyChronic ectopic pregnancyPersistent ectopic pregnancyExpectant treatmentPain mild，bleeding light；No evidence of tubal rupture；No intraabdominal bleeding；Ser

48、um -HCG 1000U/L，and continue declining;Pregnancy mass3cm or undetected；Follow-up reliableCervical PregnancyConcept：implantation of the developing conceptus in the cervical canalIncidence：1：18000Clinical feature：painless vaginal bleedingDiagnostic criteria：the uterine size is comparable to that of an

49、 unpregnant one; the presence of pregnancy tissue related exclusively to the cervical canal；curretage of the endometrial cavity is nonproductive of pregnancy tissueTreatment principle：transfusion preparation; curretage or suction curretage ; MTX and/or uterine curretageOvarian PregnancyA condition i

50、n which an ectopic pregnancy implants within the ovarian cortexDiagnostic criteria：the fallopian tube on the affected side must be intact；the fetal sac must occupy the position of the ovary；ovarian tissue must be located in the sac wall；the ovary and fetal sac must be connected to the uterus by the

51、ovarian ligamentmonitoring：ultrasound；abortion：812 weeksDifferential DiagnosisInevitable AbortionHabitual AbortionEctopic pregnancyHabitual AbortionSeptic AbortionDescribe the clinical presentations of different stages of abortion？Complete AbortionPain mild，bleeding light；Threatened Abortionone of t

52、he main causes of acute abdomen and deathFollow-up reliableManagementlaparoscopy：gold standard，diagnosistreatmentFetal deathbasal decidual bleeding uterine contractionexpulsion of all the products of conception, light bleedingSpontaneous AbortionConcept：implantation of the developing conceptus in th

53、e cervical canalpregnancy tissue protruding from the cervical osWhat does laboratory assessment for Ectopic pregnancy include？Ovarian PregnancyClinical presentations：amenorrhea, abdominal pain and vaginal bleeding；What conditions should be differentiated from tubal pregnancy their respective differe

54、ntial points？No evidence of tubal rupture；What does laboratory assessment for Ectopic pregnancy include？enlargement and softeningIntensifiedindication：no contraindication to chemotherapy ；Light to nonePhysical Examinationtubal inflammation, pelvic inflammationSummarize the treatment for tubal pregna

55、ncy and its choice？Nontubal Ectopic Pregnancythe fetal sac must occupy the position of the ovary；cervical os closed, fetal membranes unbrokenThreatened Abortionno retained products of conception confirmed by ultrasound；Management15% or symptoms worsening or internal bleeding occurring; 2 weeks until

56、 negativecurretage of the endometrial cavity is nonproductive of pregnancy tissuebefore 12 weeks: suction curettagetubal inflammation, pelvic inflammationPhysical ExaminationEnvironmental factorsEctopic Pregnancypreventive antibiotic useafter 12 weeks：induction of laborWhat conditions should be differentiated from tubal pregnancy their respective differential points？Follow-up reliableGeneral conditionClinica