流产、异位妊娠-赵爱民课件.ppt

1、2022-12-62Abortion 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 blood vessels or ruptures

2、of the tubal wall2022-12-63Abortion and Ectopic pregnancyImplant locationsTubal 95%(80%ampullary portion)Ovarian 1%Abdominal 1-2%Cervical 0.15%Cornual 2%2022-12-64Abortion and Ectopic pregnancyEtiologySalpingitis have 6-fold increase the risk of ectopic pregnancyOperation of tubalIUD(intrauterine de

3、vice)Dysfunction of tubalOrther:endometriosis2022-12-65Abortion 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 structure for example liver

4、 pregnancy2022-12-66Abortion 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 peritoneum by bloodIrregular vagina

5、l bleeding results from the sloughing of the deciduaShock result from amount of blood loss Abdominal mass2022-12-67Abortion and Ectopic pregnancyPhysical findings in tubal pregnancyGeneral findings:Anemic or pale face pulse increased BP decreased T 38 degree2022-12-68Abortion and Ectopic pregnancyAb

6、dominal examinationdistention and tenderness with or without reboundDecreased bowel soundShifting dullness positivemass2022-12-69Abortion and Ectopic pregnancyPelvic examinationSlightly open cervix with bleedingCervical motion tenderness Adnexal tendernessAdnexal massThe uterus size may be normal or

7、 enlarged2022-12-610Abortion and Ectopic pregnancyDiagnostic proceduresTypical cases can be determined easyEarly ectopic pregnancy or unrupture type difficultyIt is nessesary to need assistant examination2022-12-611Abortion and Ectopic pregnancyqHCG test 80-100%positiveUrinary HCG levelBlood HCG lev

8、elIf 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 2022-12-612Abortion and Ectopic pregnancyqLaproscopyI

9、t 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 identified2022-12-613Abortion and Ectopic pregnancyqPothology of endometriunCurettage of the uterine cavi

10、ty can also help rule out ectopic pregnancyIdentification of chorionic villi in curetting may identify an intrauterine pregnancy2022-12-614Abortion and Ectopic pregnancyDifferential diagnosisAbortionAcute salpingitisAcute appendicitisRupture of corpus luteumTorsion of ovarian cyst2022-12-615Abortion

11、 and Ectopic pregnancyTreatment of ectopic pregnancyqSurgical treatmentSalpingectomyConservative operation Salpinggostomy Segmantal resection and tubal reanatomosis2022-12-616Abortion and Ectopic pregnancyqNonsurgical therapyChinese traditional medicineChemical therapy Drug:MTX Indication The diamet

12、er of the mass 3cm Unrupture Not significantly bleeding HCG level 2000U/LAbortion2022-12-618Abortion and Ectopic pregnancyDefinition 2022-12-619Abortion and Ectopic pregnancyClassificationnEarly abortion 12WnLate abortion 12-28WnSpontaneous abortionnArtificial abortion2022-12-620Abortion and Ectopic

13、 pregnancyEtiologyqGenetic factorsqMaternal factorsInfectionsystemic factors heart disease sever anemia endocrineReproductive tract abnormalityqImmunologic factorsqEnviromental factors Toxin Radiation smoking alohol2022-12-621Abortion and Ectopic pregnancyPathology1.Haemorrhage occurs in the decidua

14、 basalis leading to local necrosis and inflammation.2022-12-622Abortion and Ectopic pregnancy2.The ovum,partly or wholly detached,acts as a foreign body and irritates uterine contractions.The cervix begins to dilate.2022-12-623Abortion and Ectopic pregnancy3.Expulsion complete,The decidua is shed du

15、ring the next few days in the lochial flow.2022-12-624Abortion and Ectopic pregnancyClinical manifestation2022-12-625Abortion and Ectopic pregnancyThreatened abortionLow abdominal Pain company vaginal bleedingCervix is closedunrupture of membraneEmbryo survive2022-12-626Abortion and Ectopic pregnanc

16、yInevitable abortionBleeding increasedPain developmentRuputure of membraneCevix dilationEmbryo tissue incarcerated in the cervix2022-12-627Abortion and Ectopic pregnancyComplete abortionUterine contractions are felt,the cervix dilates and blood loss continues.The fetus and placenta are expelled comp

17、lete,the uterus contracts and bleeding stops.No further treatment is needed.2022-12-628Abortion and Ectopic pregnancyIncomplete abortionIn spite of uterine contractions and cervical dilatation,only the fetus and some membranes are expelled.The placenta remains partly attached and bleeding continues.

18、This abortion must be completed by surgical methods.2022-12-629Abortion 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 patient has had two or mor

19、e consecutive spontaneous abortionsSeptic abortion2022-12-630Abortion and Ectopic pregnancyTreatment of abortionnIncomplete abortionRemove the embryo and placenta as soon as possible Negative pressure suction EmbryulcianMissed abortion Notice blood clot function prevent DICnSeptic abortion Broad-spe

20、ctrum antibiotics2022-12-631Abortion and Ectopic pregnancyRemoval of placental tissue with ovum forceps.2022-12-632Abortion and Ectopic pregnancy2022-12-633Abortion 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