《妇产科学》异位妊娠-课件

异位妊娠

EctopicPregnancy1ppt课件DefinitionandOverviewDefinitionIncidence:onein100pregnanciesTheincresingtendencyInducedfactors:infertilelowersocioeconomicgrouppreviousectopicpregnancy,10-20%salpingitisandtuboplasty

2ppt课件Unruptruedtubalpregnancy(L)CASEONE3ppt课件ElectrocoagulationandSection4ppt课件LoopLigature5ppt课件Whydiditimplantoutsideuterinecavity?UnclearExplanationofMechanism6ppt课件EtiologyTubalFactors(salpingitis

)ZygoteAbnormalities(chromosomalabnormalities)OvarianFactors(unextrudedovum)ExogenousHormones(progestin-onlyoralcontraceptives)OtherFactors(endometriosis,IUD)7ppt课件ClassificationandSpecificIncidenceTubalPregnancy:99%AbdominalPregnancyCompoundorhysterotrophicpregnancyCervicalPregnancyOtherabnormalpregnancies8ppt课件

LocationsofEctopicPregnancy55%25%Isthmic17%Interstitial2%<0.5%0.1%VeryrareAmpullaryFimbrial9ppt课件10ppt课件

AbdominalPregnancyomentumPlacenta11ppt课件Tubalpregnancy

(99%)Ampullary(55%)Isthmic(25%)Fimbrial(17%)Interstitial(2%)BilateralDistalwithsegmentalabsenceofthetube12ppt课件OvarianPregnancy

(<0.5%)OvarianTubo-ovarianAbdominal-ovarian(secondaryabdominalpregnancy)13ppt课件AbdominalPregnancy

(0.1%)PrimarySecondaryAbdomino-ovarianTubo-abdominal14ppt课件CompoundorHeterotrophicCombinedwithintrauterinepregnancy1in17,000～30,000pregnancies15ppt课件CervicalPregnancyVeryrareIntraligamentousInthevesicovaginalspaceFollowinghysterectomy:inacervicalstump,inauterinetubeInaprolapseduterinetube(fimbrialorabdominal)16ppt课件OtherdisplacementofPregnancyinUterusCornual(角)(OneEx)Angular(畸形角)Withinauterinediverticulum(憩室)Inauterinesacculation(囊)Inarudimentaryhorn(始基角)Intramural(肌壁间)17ppt课件PathologyLackageofresistancetoinvasionbythetrophoblastMinimaldefenseagainstthepenetratingtrophoblastAbdominalpregnancy:1:15,000pregnanciesMortalityrate:90%Enlargeduterus:circulationandendometriumchanges18ppt课件EndometrialChanges&VaginalBleedingBleeding←endometrialinvolutionandsloughofdeciduaAtypicalendometrialchangesarenotdiagnosticofectopicpregnancyTheArias-Stellareaction(hormonaloverstimulation)Occasionally,endometrialtissuemaybepassedasaso-calleddecidualcast

Notrophoblasticcells19ppt课件TerminationofthePregnancyTubal:abortionormissedabortionInterstitial,Angular,Cornual:ruptureintotheuterinecavity;thebroadligamentortheperitonealcavity.Cervical:ruptureintothecervicalcanalAbdominal:ruptureintotheperitonealcavity,intotheretroperitonealspace,orintoavitalorgan.Ovarian:ruptureintotheperitonealcavityCombined:Thetubalpregnancymayabortorrupture,andtheuterinepregnancymayabort,terminateprematurely,orcontinuetoterm20ppt课件RuptureoftubepregnancyAbortionoftubepregnancy21ppt课件22ppt课件ClinicalFindingsNospecificsymptomsorsignsarepathognomonicofectopicpregnancyCombinationoffindingsmaybesuggestiveSymptomsofearlypregnancy(amenorrhea,breasttenderness,andnausea)Bleeding(usuallyspotting)DiffuselowerabdominalpainOver16%ofectopicgestationspresentassurgicalemergencies.23ppt课件

SymptomsPelvicorlowerabdominalpain:99%Abnormaluterinebleeding:75%Secondaryamenorrhea:68%Generalizedpain:44%Unilaterallowerabdominalpain:33%Subdiaphragmaticpainorsharpshoulderpain:22%Syncope(晕厥):37%Uterinecast:7%24ppt课件SignsAbdominaltenderness－80%Adnexaltenderness－75%.ThepainmaybeexquisitelysevereonpalpationorslightmovementofthecervixanduterusAdnexalmass－Aunilateraladnexalmass:53%;boggyandpoorlydelineatedUterinechanges－normalsize:71%;6-8weeks'size:26%,9-12weeks'size:3%Fever－onlyabout2%ofpatients25ppt课件LaboratoryFindingsPregnancytests－β-hCGpositivein82.5%ofectopicpregnanciesandnegativeinonly17.5%※anegativetestdoesnotruleoutanectopicgestation.HematocritWhitebloodcellcountReticulocytes(网状红细胞).26ppt课件27ppt课件SpecialExaminationsUtrasonicallyScanningCuldocentesis

Laparoscopy

Dilatationandcurettage

Exploratorylaparotomy28ppt课件Culdocentesis

LithotomypositionanAllisclamporatenaculumposteriorfornix18-gaugespinalneedlepunctureintheshortestdistanceintothecul-de-sac29ppt课件30ppt课件DifferentialDiagnosisWhatkindsofdiseasesshouldbedifferentiated:■appendicitis■salpingitis■rupturedcorpusluteumcyst■ovarianfollicle■uterineabortion■twistedovariancyst■urinarytractdisease■degeneratingleiomyomas■normalintrauterinepregnancywithotherabdominalorpelvicproblems31ppt课件EssentialsofDiagnosisAmenorrheafollowedbyirregularvaginalbleedingAdnexaltendernessormassUltrasonographicevidenceofadnexalmassandnointrauterinegestationPositive-hCG32ppt课件ComplicationsAbout1in1000ectopicpregnanciesresultinmaternaldeathUntreatedormistreatedrupturedectopictubalpregnancy→8-12%ofallmaternaldeathsThemajorityofthesedeathsarepreventable.ChronicsalpingitisInfertilityorsterilityIntestinalobstructionandfistulasmaydevelopafterhemoperitoneumandperitonitis33ppt课件TreatmentEmergencyTreatment:

Immediatesurgery,anti-shockmeasures(warm,oxygen,applymoderatelysnugtourniquetsaroundtheupperlegs)Surgicaltreatment:

laparoscopictechniques.laparotomyMedicalTreatment:MTX.ItappearsverypromisingSupportiveTreatment:broad-spectrumantibiotics,oralorintravenousirontherapy,ahigh-proteindiet34ppt课件Indicationsfor