医学英语课件资料：Ectopic Pregnancy

1、Ectopic PregnancyEctopic Pregnancy9TH GROUPEctopic PregnancyCONTEXTS04Prevention02Diagnosis01Basic Knowledge03TreatmentWhat is it？ Definition & ClassificationWhat causes it？ PathogenesisRisk Factors & susceptible people Preventive measuresHow popular it is？ Epidemiology01Basic KnowledgeEctopic Pregn

2、ancyDefinitionDefinitionAcomplication of pregnancyin which the embryo attaches outside theuterusNo.1 killer of women in the first trimester ofpregnancyClassificationClassificationTubal pregnancyNontubal ectopic pregnancyCervical pregnancyOvarian pregnancyAbdominal pregnancyCesarean scar pregnancyHet

3、erotopic pregnancyPregnancy of unknown locationClassificationTubal pregnancyNontubal ectopic pregnancyClassificationHeterotopic pregnancy1 inside the uterus，1 outside the uterusPregnancy of unknown location（PUL）Positive pregnancy test but no pregnancy has been visualized using transvaginal ultrasono

4、graphyPersisting PULSmall ectopic pregnancy? retained trophoblast in the endometrial cavity?PathogenesisFallopian tube blockageInfection or inflammation e.g. Pelvic inflammatory diseaseEndometriosisScar tissueBirth defectFallopian tube damageCiliaEpidemiologyEpidemiologyIncidence4.5cases 19.7 cases

5、per 1000 pregnanciesBetter diagnosticsMortality35.5 maternal deaths 3.8 maternal deaths per 10000 ectopic pregnancies Higher risk among non-white women02Clinical ManifestationsAnd DiagnosisEctopic PregnancyClinical Manifestations and Diagnosis01020304Physical ExaminationClinical ManifestationsAuxili

6、ary ExaminationMultimodality DiagnosisClinical Manifestations and DiagnosisAppendicitisUrinary Tract InfectionPelvic Inflammatory DiseaseEnlarging LeiomyomaMiscarriageEctopic PregnancyMore than 95% of patients chief complaintClinical Manifestations- Classic Triad SymptomsMenopauseEasily covered by v

7、aginal bleedingAsk for more details when taking historyVaginal BleedingLess VolumeDarker ColorDistinguish vaginal bleeding from menstruationAbdominal PainUnruptured tubal pregnancy- distending pain Tubal rupture- severe lower abdominal and pelvic pain described as sharp, stabbing or tearingPhysical

8、Examination01Abdominal Examination02Bimanual Pelvic ExaminationAbdominal ExaminationModerate bleedingLower abdominal muscle tension, tenderness and rebounded painSignificant intraabdominal hemorrhageComplete abdomen tenderness and rebounded painBimanual Pelvic ExaminationCervical motion cause exquis

9、ite painPosterior vaginal fornix bulge from bloodTender, boggy mass to one side of uterusUterus slightly enlargedAuxiliary ExaminationsTransvaginal sonography (TVS)Serum -hCG level measurementDiagnositic surgeryUterine curettage 刮宫术Laparoscopy 腹腔镜检查Laparotomy 剖腹探查术Apply only to hemodynamically stabl

10、e womenPresumed rupture- prompt surgical therapyMultimodality Diagnosis03Clinical ManagementEctopic PregnancyManagement 01 02 03Surgical managementMedical managementExpectant management Medical management010203asymptomatic motivatedcompliantMethotrexate 01 02 03administrationdosetoxicityPredictors 0

11、1 02 03Ectopic pregnancy sizeInitial serum -hCG levelFetal cardiac activity contraindicationsIntrauterine pregnancyBreast feedingPulmonary diseaseBlood dyscrasiaPeptic ulcer diseaseImmunodeficiencyalcoholismChronic hepaticRenal diseaseSurgical managementD-antigen must be considered at first!Sensitiz

12、ation incitedRed cell antigen isoimmunization incitedSurgical managementLaparotomy v.s Laparoscopy No differences in overall tubal patencySimilar number of subsequent uterine pregnanciesShort operative timeLess analgesic requirementsShorter hospital staysLess costBut less successful slightlySalpingo

13、stomy 输卵管切开术Linear incisionProducts removingSurgical management Salpingectomy 输卵管切除术ConditionOther oviduct normal AdvantagesPrevent the recurrencePrevent the persistent Surgical management Persistent ectopic pregnancyBellyache after surgery Small pregnanciesEarly therapySerum -hCG levelsImplantation

14、 medial to the salpingostomy siteSurgical management Expectant management Self-absorbabilitySide-effect of medical managementButExpectant management Disadvantage Anxiety attack04Risk factors & PreventionEctopic PregnancyRisk factorsTubal pathologyPelvic inflammatoryChlamydial infectionsSmokingAssist

15、ed reproductive technologygamete intrafallopian transfercryopreserved embryo transferin vitro fertilization (IVF)Age ContraceptionRisk factorsSTD sexually transmitted diseasePID pelvic inflammatory disease IUD intrauterine deviceRisk factorsthree to four foldfallopian tube is directly affectedalter

16、oocyte cumulus complex pick-up and embryo transporteffects on ciliary function and smooth muscle contractionSmokingRisk factors0.8-percent per transfer2.2-percent per clinical pregnancythe highest rates：gamete intrafallopian transfer (3.7 percent)cryopreserved embryo transfer (3.2 percent)in vitro f

17、ertilization (IVF) (2.2 percent)Assisted reproductive technologyRisk factorstubal factor infertility and hydrosalpinges“atypical” implantation：interstitialabdominalcervicalovarianheterotopicIn vitro fertilization (IVF) Risk factors35 to 44 years three fold riskage-related hormonalalter tubal functio

18、nAgeRisk factorsIntrauterine device(IUD)Levonorgestrel-releasing intrauterine system (LNGIUS)Progestin-only contraceptive pillsTubal sterilizationContraceptionRisk factors & Preventionscreen high-risk populations for asymptomatic infectionssexually active women 25 years or women with risk factorsPreventionSummary & Hot spotsAdenosine deaminase activity play a role in the early diagnosis of ectopic pregnancy.( J Obstet