流产异位妊娠培训课件

1、Abortion1流产异位妊娠10/7/2022Abortion1流产异位妊娠10/3/2022Concept A pregnancy loss before 28 weeks of gestation while fetal weight under 1000 gramsEarly Abortion：pregnancy loss before 12 gestational weeks Late Abortion: pregnancy loss during 1228 gestational weeks Spontaneous AbortionArtificial Abortion2流产异位妊

2、娠10/7/2022Concept A pregnancy loss beforGenetic defectMaternal factors: systematic disease; genital organ anomalies; endocrine anomalies; irritation; bad habitImmune anomaliesEnvironmental factorsEtiology3流产异位妊娠10/7/2022Etiology3流产异位妊娠10/3/2022PathologyBefore 8 weeks: chorionic villi immature Fetal

3、deathbasal decidual bleeding uterine contractionexpulsion of all the products of conception, light bleedingDuring 812 weeks：with firm attachment to the basal deciduaPartial expulsion of the products of conception non-ideal uterine contraction, severe bleedingAfter 12 weeks: placenta fully formed. Ut

4、erine contraction expulsion of all the products of conception，light bleeding4流产异位妊娠10/7/2022PathologyBefore 8 weeks: choriSymptomsAmenorrhea, vaginal bleeding , and abdominal painEarly abortion：vaginal bleeding preceding abdominal painLate abortion：abdominal pain preceding vaginal bleeding5流产异位妊娠10/

5、7/2022SymptomsAmenorrhea, vaginal blTypes of AbortionThreatened AbortionInevitable AbortionIncomplete AbortionComplete AbortionMissed AbortionHabitual AbortionSeptic Abortion6流产异位妊娠10/7/2022Types of AbortionThreatened AbClinical PresentationsThreatened Abortion light vaginal bleeding with mild abdom

6、inal paincervical os closed, fetal membranes unbrokentreatment might work , continue pregnancy Inevitable Abortion bleeding heavier, abdominal pain more severe, or fluid passedcervical os open，pregnancy tissue visibleabortion is inevitable7流产异位妊娠10/7/2022Clinical PresentationsThreatenIncomplete Abor

7、tionheavy vaginal bleedingpregnancy tissue protruding from the cervical osuterus small for the presumed gestational week Complete Abortionvaginal bleeding decreasing, abdominal pain alleviatingcervical os closeduterus normal for the presumed gestational week 8流产异位妊娠10/7/2022Incomplete Abortion8流产异位妊

8、娠10/3Different Stages of Abortionthreatened abortion continue pregnancyinevitable abortion incomplete abortioncomplete abortion9流产异位妊娠10/7/2022Different Stages of AbortiontDiagnosisHistoryPhysical ExaminationLaboratory Assessment:ultrasound pregnancy testhormone level: serum progesterone10流产异位妊娠10/7

9、/2022DiagnosisHistory10流产异位妊娠10/3/2BleedingAbdominal PainTissue ExpulsionCervical OsUterusThreatened AbortionInevitable AbortionIncomplete AbortionComplete AbortionLightMild to heavyLight to heavyLight to noneNone/lightIntensifiedRelievedNoneNoneNonePartialCompleteClosedDilatedDilated or obstructedC

10、losedNormalNormal or slightly smallSmallNormal or slightly large History Pelvic Examination11流产异位妊娠10/7/2022BleedingAbdominal PainTissue EManagementThreatened Abortionbed rest, sedationanti abortion：progesterone，HCG；Vit E；thyroxine supplement monitoring：ultrasound；serum HCG whether to continue pregn

11、ancyInevitable Abortiononce diagnosed，remove the pregnancy tissue as quickly as possible suction curettage 12流产异位妊娠10/7/2022ManagementThreatened Abortion1Incomplete Abortionperform suction curettage promptlyif with heavy bleeding：blood transfusion；preventive antibiotic useComplete Abortionno retaine

12、d products of conception confirmed by ultrasound；no infectionno need for special management13流产异位妊娠10/7/2022Incomplete Abortion13流产异位妊娠10/Missed Abortion Concept: in utero death of the embryo or fetus with retained products of conception Clinical Manifestation:uterine enlargement ceasing or fetal mo

13、vement disappearingcervical os closed, uterus small for the presumed gestational ageno fetal heartbeat ; embryonic demise suggested by ultrasound findings14流产异位妊娠10/7/2022Missed Abortion Concept: in utManagement blood routine examination, coagulation function testcorrecting coagulation defects：hepar

14、in, fibrinogen, etc.sensitizing the uterus： diethylstilbestroltransfusion preparation; emptying the uterus： before 12 weeks: suction curettage after 12 weeks：induction of labor15流产异位妊娠10/7/2022Management blood routine examiHabitual Abortion The occurrence of 3 or more consecutive spontaneous abortio

15、nsThe occurrence of 2 spontaneous abortions is defined as recurrent abortionEarly abortion：chromosomal abnormalities，immunologic factors，luteal-phase insufficiency, hypothyroidismLate abortion：congenital uterine anomalies，cervical incompetence，uterine fibroids, etc.16流产异位妊娠10/7/2022Habitual Abortion

16、 The occurrenManagementobtain information on etiology for prior losses before conceptiongenetic counselingcervical incompetence：cervical cerclage during 1418 weeks of gestationwith unclear causes：progesterone therapy until 10 weeks of gestationactive immunotherapy：intradermic injection of lymphocyte

17、s17流产异位妊娠10/7/2022Managementobtain information oSeptic Abortion Prolonged bleeding during abortion or retained products of conception lead to intrauterine infection, which might progress into pelvic inflammatory disease, peritonitis or even sepsis if not treatedAntibiotic treatment + Prompt evacuati

18、onwithout severe bleeding: management of infection , performance of suction and curettagewith severe bleeding：management of infection while applying forceps, with secondary suction and curettage 18流产异位妊娠10/7/2022Septic Abortion Prolonged blEctopic Pregnancy19流产异位妊娠10/7/2022Ectopic Pregnancy19流产异位妊娠1

19、0/3/Concept Ectopic Pregnancy: implantation of the fertilized ovum in tissue other than the endometriumExtrauterine Pregnancyincluding：tubal pregnancy (95), ovarian pregnancy, cornual pregnancy, cervical pregnancy, abdominal pregnancy, etc.one of the main causes of acute abdomen and death20流产异位妊娠10/

20、7/2022Concept20流产异位妊娠10/3/202221流产异位妊娠10/7/202221流产异位妊娠10/3/2022Etiology and Risk Factorstubal inflammation, pelvic inflammation previous tubal surgery：for infertility, tubal pregnancy, etc.IVFfailure of contraception：current use of IUD or oral contraceptives tubal undergrowth or dysfunctionother fa

21、ctors：endometriosis, hysteromyoma, smoking, etc.22流产异位妊娠10/7/2022Etiology and Risk FactorstubalEndings of tubal pregnancyabortion：812 weeks rupture：1216 weeks secondary abdominal pregnancyChronic ectopic pregnancyPersistent ectopic pregnancy23流产异位妊娠10/7/2022Endings of tubal pregnancyaborPathology of

22、 the Uterusenlargement and softeningamenorrhea vaginal bleeding the Arias-Stella reaction of the endometrium but no chorionic villi24流产异位妊娠10/7/2022Pathology of the UterusenlargeClinical Presentations-SymptomsAmenorrheaAbdominal pain：time, characteristicsVaginal bleedingFaint/shock25流产异位妊娠10/7/2022C

23、linical Presentations-SymptomClinical Presentations-SignsGeneral conditionAbdomen examinationPelvic examination：cervical motion tenderness，sensation of a floating uterus ，adnexal mass, etc.26流产异位妊娠10/7/2022Clinical Presentations-SignsGeLaboratory Assessment HCG: urinary HCG；the rise in the serum -HC

24、G level over 48 hours66serum progesterone：only 1.5%25ng/mlultrasound：the empty uterus sign；adnexal cardiac activity or ultrasonographic lucency ; presence of cul-de-sac fluid27流产异位妊娠10/7/2022Laboratory Assessment HCG: uriculdocentesis：nonclotting bloodlaparoscopy：gold standard，diagnosistreatment ear

25、ly diagnosis missed in 34 of patients use with caution：to avoid anesthetic and surgical risks；medical therapy as an optionUterine curretage：profuse vaginal bleeding; intrauterine pregnancy loss28流产异位妊娠10/7/2022culdocentesis：nonclotting blooDifferential DiagnosisEctopic pregnancyabortionAdnexal infla

26、mmationAppendicitisCorpus luteum ruptureOvary cyst torsion1.Amenorrhea2.Abdominal pain3.Bleeding4.Shock 5.Body temperature6.Pelvic examinatioon7.WBC8.Hb9.HCG10.Ultrasound11.Culdocentesis29流产异位妊娠10/7/2022Differential DiagnosisEctopic Surgical TreatmentRadical operation：hemodynamically unstable ; inte

27、rstitial pregnancy; tubal ruptureConservative operation：with wishes to retain potential for fertility milking or linear salpingostomyMTX30流产异位妊娠10/7/2022Surgical TreatmentRadical operMedical Treatmentprinciple：inhibiting proliferation of trophoblastic tissueindication：no contraindication to chemothe

28、rapy ；no rupture or abortion；mass4cm；serum -HCG 2000U/L；no obvious internal bleeding；no demonstration of cardiac activity or embryonic bud31流产异位妊娠10/7/2022Medical Treatmentprinciple：inhMedical TreatmentProtocol：MTX150 mg，give a second dose on day 7 if necessaryMonitoring therapeutic effectiveness：if

29、 decline in serum hCG level on day 725%； 15% or symptoms worsening or internal bleeding occurring; 2 weeks until negative32流产异位妊娠10/7/2022Medical TreatmentProtocol：MTX1Expectant treatmentPain mild，bleeding light；No evidence of tubal rupture；No intraabdominal bleeding；Serum -HCG 1000U/L，and continue

30、declining;Pregnancy mass3cm or undetected；Follow-up reliable33流产异位妊娠10/7/2022Expectant treatmentPain mild，Nontubal Ectopic Pregnancy34流产异位妊娠10/7/2022Nontubal Ectopic Pregnancy34流Cervical PregnancyConcept：implantation of the developing conceptus in the cervical canalIncidence：1：18000Clinical feature：

31、painless vaginal bleedingDiagnostic criteria：the uterine size is comparable to that of an unpregnant one; the presence of pregnancy tissue related exclusively to the cervical canal；curretage of the endometrial cavity is nonproductive of pregnancy tissueTreatment principle：transfusion preparation; cu

32、rretage or suction curretage ; MTX and/or uterine curretage35流产异位妊娠10/7/2022Cervical PregnancyConcept：implOvarian PregnancyA condition in which an ectopic pregnancy implants within the ovarian cortexDiagnostic criteria：the fallopian tube on the affected side must be intact；the fetal sac must occupy

33、the position of the ovary；ovarian tissue must be located in the sac wall；the ovary and fetal sac must be connected to the uterus by the ovarian ligament36流产异位妊娠10/7/2022Ovarian PregnancyA condition iOvarian PregnancyClinical presentations：amenorrhea, abdominal pain, vaginal bleeding，shock, etc.Differentiated from：ruptured corpus luteum；tubal pregnancyT