流产、异位妊娠 课件.ppt

1、Ectopic pregnancyAbortion 2022-4-82Abortion and Ectopic pregnancyEctopic pregnancyDefinitionImplantation outside of the uterine cavity is termed ectopic pregnancyIt is a condition that significantly jeopardizes the mother because catastrophic bleeding may occur when the implanting pregnancy erodes b

2、lood vessels or ruptures of the tubal wall2022-4-83Abortion and Ectopic pregnancyImplant locationsTubal 95% (80% ampullary portion)Ovarian 1%Abdominal 1-2%Cervical 0.15%Cornual 2%2022-4-84Abortion and Ectopic pregnancyEtiologySalpingitis have 6-fold increase the risk of ectopic pregnancyOperation of

3、 tubalIUD(intrauterine device)Dysfunction of tubalOrther: endometriosis2022-4-85Abortion and Ectopic pregnancyOutcomes of ectopic pregnancyTubal abortion 8-12 Weeks ampullary portionRupture of tubal pregnancy 5 weeks isthmic portionTubal abortion with subsequent implantation on an intraperitoneal st

4、ructure for example liver pregnancy2022-4-86Abortion and Ectopic pregnancyClinical manifestation of ectopic pregnancyAmenorrhea 70-80% 6-8 weeksAbdominal 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 peritoneu

5、m by bloodIrregular vaginal bleeding results from the sloughing of the deciduaShock result from amount of blood loss Abdominal mass2022-4-87Abortion and Ectopic pregnancyPhysical findings in tubal pregnancyGeneral findings: Anemic or pale face pulse increased BP decreased T 38 degree2022-4-88Abortio

6、n and Ectopic pregnancyAbdominal examinationdistention and tenderness with or without reboundDecreased bowel soundShifting dullness positivemass2022-4-89Abortion and Ectopic pregnancyPelvic examinationSlightly open cervix with bleedingCervical motion tenderness Adnexal tendernessAdnexal massThe uter

7、us size may be normal or enlarged2022-4-810Abortion and Ectopic pregnancyDiagnostic proceduresTypical cases can be determined easyEarly ectopic pregnancy or unrupture type difficultyIt is nessesary to need assistant examination2022-4-811Abortion and Ectopic pregnancyqHCG test 80-100% positiveUrinary

8、 HCG levelBlood HCG levelIf HCG negative,ectopic pregnancy does not be rule out qType B Utrasound qCuldocentesisAid in the identification of peritoneum bleedingPositive (noncloting blood)ectopic pregnancy may be confirmedNegative ectopic pregnancy does not be depletion 2022-4-812Abortion and Ectopic

9、 pregnancyqLaproscopyIt is a direct visualization and accurte method to diagnosis ectopic pregnancyEven laproscopy,however,carries 2-5% misdiagnosis rate, because an extremely early tubal pregnancy gestation may not be identified2022-4-813Abortion and Ectopic pregnancyqPothology of endometriunCurett

10、age of the uterine cavity can also help rule out ectopic pregnancyIdentification of chorionic villi in curetting may identify an intrauterine pregnancy2022-4-814Abortion and Ectopic pregnancyDifferential diagnosisAbortionAcute salpingitisAcute appendicitisRupture of corpus luteumTorsion of ovarian c

11、yst2022-4-815Abortion and Ectopic pregnancyTreatment of ectopic pregnancyqSurgical treatmentSalpingectomyConservative operation Salpinggostomy Segmantal resection and tubal reanatomosis2022-4-816Abortion and Ectopic pregnancyqNonsurgical therapyChinese traditional medicineChemical therapy Drug:MTX I

12、ndication The diameter of the mass 3cm Unrupture Not significantly bleeding HCG level 2000U/LAbortion2022-4-818Abortion and Ectopic pregnancyDefinition 2022-4-819Abortion and Ectopic pregnancyClassificationnEarly abortion 12WnLate abortion 12-28WnSpontaneous abortionnArtificial abortion2022-4-820Abo

13、rtion and Ectopic pregnancyEtiologyqGenetic factorsqMaternal factorsInfectionsystemic factors heart disease sever anemia endocrineReproductive tract abnormalityqImmunologic factorsqEnviromental factors Toxin Radiation smoking alohol2022-4-821Abortion and Ectopic pregnancyPathology1.Haemorrhage occur

14、s in the decidua basalis leading to local necrosis and inflammation.2022-4-822Abortion and Ectopic pregnancy2. The ovum, partly or wholly detached, acts as a foreign body and irritates uterine contractions. The cervix begins to dilate.2022-4-823Abortion and Ectopic pregnancy3. Expulsion complete, Th

15、e decidua is shed during the next few days in the lochial flow.2022-4-824Abortion and Ectopic pregnancyClinical manifestation2022-4-825Abortion and Ectopic pregnancyThreatened abortionLow abdominal Pain company vaginal bleedingCervix is closedunrupture of membraneEmbryo survive2022-4-826Abortion and

16、 Ectopic pregnancyInevitable abortionBleeding increasedPain developmentRuputure of membraneCevix dilationEmbryo tissue incarcerated in the cervix2022-4-827Abortion and Ectopic pregnancyComplete abortionUterine contractions are felt, the cervix dilates and blood loss continues. The fetus and placenta

17、 are expelled complete, the uterus contracts and bleeding stops. No further treatment is needed.2022-4-828Abortion and Ectopic pregnancyIncomplete abortionIn spite of uterine contractions and cervical dilatation, only the fetus and some membranes are expelled. The placenta remains partly attached an

18、d bleeding continues. This abortion must be completed by surgical methods.2022-4-829Abortion and Ectopic pregnancyMissed abortionIs the retention of a failed intrauterine pregnancy for a extended period, usually defined as more than two menstrual cyclesRecurrent abortionIt is a term used when a pati

19、ent has had two or more consecutive spontaneous abortionsSeptic abortion2022-4-830Abortion and Ectopic pregnancyTreatment of abortionnIncomplete abortionRemove the embryo and placenta as soon as possible Negative pressure suction EmbryulcianMissed abortion Notice blood clot function prevent DICnSept

20、ic abortion Broad-spectrum antibiotics2022-4-831Abortion and Ectopic pregnancyRemoval of placental tissue with ovum forceps.2022-4-832Abortion and Ectopic pregnancy2022-4-833Abortion and Ectopic pregnancyKey words todayn Concept of ectopic pregnancyn Clinical manifestation, diagnosis,differential diagnosis and treatment of ectopic pregnancyn Concept of abortionn Classification of abortionn Clinical manifestation, diagnosis,differential diagnosis and treatment of abortion Thanks for Your Attention