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Ectopicpregnancy

Abortion

Zhaoaimin

M.D.,Ph.D.,ProfessorDepartmentOfObstetrics&Gynecology

RenjiHospitalAffiliatedtoSJTUSchoolofMedicine1/2/20261AbortionandEctopicpregnancy1/2/20262AbortionandEctopicpregnancyImplantlocationsTubal95%(80%ampullaryportion)Ovarian<1%Abdominal1-2%Cervical0.15%Cornual2%1/2/20263AbortionandEctopicpregnancyEtiologySalpingitis

have6-foldincreasetheriskof

ectopicpregnancyOperationoftubalIUD(intrauterinedevice)DysfunctionoftubalOrther:endometriosis1/2/20264AbortionandEctopicpregnancy1/2/20265AbortionandEctopicpregnancyClinicalmanifestationofectopicpregnancyAmenorrhea

70-80%6-8weeksAbdominalandpelvicpain

themostcommonsymptom,whichispresentinnealyallpatients.PainisaresultofdistentedoftubalandirritationofperitoneumbybloodIrregularvaginalbleeding

resultsfromthesloughingofthedeciduaShock

resultfromamountofbloodlossAbdominalmass1/2/20266AbortionandEctopicpregnancyPhysicalfindingsintubalpregnancyGeneralfindings:

AnemicorpalefacepulseincreasedBPdecreasedT<38degree1/2/20267AbortionandEctopicpregnancyAbdominalexaminationdistentionandtendernesswithorwithoutreboundDecreasedbowelsoundShiftingdullnesspositivemass1/2/20268AbortionandEctopicpregnancyPelvicexaminationSlightlyopencervixwithbleedingCervicalmotiontendernessAdnexaltendernessAdnexalmassTheuterussizemaybenormalorenlarged1/2/20269AbortionandEctopicpregnancyDiagnosticproceduresTypicalcasescanbedeterminedeasyEarlyectopicpregnancyorunrupturetypedifficultyItisnessesarytoneedassistantexamination1/2/202610AbortionandEctopicpregnancy1/2/202611AbortionandEctopicpregnancyLaproscopyItisadirectvisualizationandaccurtemethodtodiagnosisectopicpregnancyEvenlaproscopy,however,carries2-5%misdiagnosisrate,becauseanextremelyearlytubalpregnancygestationmaynotbeidentified1/2/202612AbortionandEctopicpregnancyPothologyofendometriunCurettageoftheuterinecavitycanalsohelpruleoutectopicpregnancyIdentificationofchorionic

villiincurettingmayidentifyanintrauterinepregnancy1/2/202613AbortionandEctopicpregnancyDifferentialdiagnosisAbortionAcutesalpingitisAcuteappendicitisRuptureofcorpusluteumTorsionofovariancyst1/2/202614AbortionandEctopicpregnancyTreatmentofectopicpregnancySurgicaltreatmentSalpingectomyConservativeoperation

Salpinggostomy

Segmantalresectionandtubal

reanatomosis1/2/202615AbortionandEctopicpregnancyNonsurgicaltherapyChinesetraditionalmedicineChemicaltherapy

Drug:MTXIndicationThediameterofthemass<3cm

UnruptureNotsignificantlybleedingHCGlevel<2000U/L1/2/202616AbortionandEctopicpregnancyAbortion1/2/202617AbortionandEctopicpregnancyDefinition

Abortionistheterminationofapregnancybefore28weeksfromthefirstdayofthelastmenstrualperiodandthefetusweight<1000g1/2/202618AbortionandEctopicpregnancyClassificationEarlyabortion<12WLateabortion12-28WSpontaneousabortionArtificialabortion1/2/202619AbortionandEctopicpregnancy1/2/202620AbortionandEctopicpregnancyPathology1.Haemorrhageoccursinthedecidua

basalisleadingtolocalnecrosisandinflammation.1/2/202621AbortionandEctopicpregnancy2.Theovum,partlyorwhollydetached,actsasaforeignbodyandirritatesuterinecontractions.Thecervixbeginstodilate.1/2/202622AbortionandEctopicpregnancy3.Expulsioncomplete,Thedeciduaisshedduringthenextfewdaysinthelochialflow.1/2/202623AbortionandEctopicpregnancyClinicalmanifestationHaemorrhageisusuallythefirstsignandmaybesignificantlyifplacentalseparationisincomplete.Painisusuallyintermittent,‘likeasmalllabrur’.Itceaseswhentheabortioniscomplete.1/2/202624AbortionandEctopicpregnancyThreatenedabortionLowabdominalPaincompanyvaginalbleedingCervixisclosedunruptureofmembraneEmbryosurvive1/2/202625AbortionandEctopicpregnancyInevitableabortionBleedingincreasedPaindevelopmentRuputureofmembraneCevixdilationEmbryotissueincarceratedinthecervix1/2/202626AbortionandEctopicpregnancyCompleteabortionUterinecontractionsarefelt,thecervixdilatesandbloodlosscontinues.Thefetusandplacentaareexpelledcomplete,theuteruscontractsandbleedingstops.Nofurthertreatmentisneeded.1/2/202627AbortionandEctopicpregnancyIncompleteabortionInspiteofuterinecontractionsandcervicaldilatation,onlythefetusandsomemembranesareexpelled.Theplacentaremainspartlyattachedandbleedingcontinues.Thisabortionmustbecompletedbysurgicalmethods.1/2/202628AbortionandEctopicpregnancyMissedabortionIstheretentionofafailedintrauterinepregnancyforaextendedperiod,usuallydefinedasmorethantwomenstrualcyclesRecurrentabortionItisatermusedwhenapatienthashadtwoormoreconsecutivespontaneousabortionsSepticabortion1/2/

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