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EctopicPregnancy
Normal/AbnormalPregnancyNormalPregnancy:normaldurationnormallocation
AbnormalPregnancy:abnormalduration
abnormallocation
22023/3/26
intrauterinePregnancyNormally,theblastocyst(fertilizedovum)implantsintheendometriumoftheuterinecavity
32023/3/26
EctopicPregnancyEctopicPregnancy:
implantationoftheblastocyst(fertilizedovum)outsidetheuterinecavity
42023/3/26DifferentLocationofEctopicPregnancytubalpregnancy95%
ovarianpregnancy
peritonealpregnancy
broadligamentpregnancy
cervicalpregnancy
cesareanscarpregnancy
52023/3/26
tubalpregnancy6IntersttialEPFimbriaEPAmpullaEPIsthmusEP2023/3/26Incidenceabout1%Inrecentyears,theincidenceisincreasingbecauseof:increasingprevalenceofpelvicinflammationdiseasesgooddetectionforearlydiagnosis……
72023/3/26
EtiologyOvulation,fertilizationandimplantation
8anyreasonthatinfluencestheprocessofovulation,fertilizationandimplantation
2023/3/26
EtiologyTubalFactors
chronicsalpingitis
inflammationdestroytheepithelium,adhesionoccuringin/aroundthetubeFertilizedovumgoestooslowly,don’tarriveuterinecavityintime
OvarianFactors
transmigrationoftheovum
OtherFactors
pelvicendometriosis,myoma,ovariantumors
92023/3/26
Pathology
(1)
Thechangeofthetube
Thetubeislittleandthin,andnodecidualreaction,thetrophoblastinvadesbloodvesselsorpenetratestubalwall
Outcomes:tubalabortionortubalrupture
102023/3/26
Isthmicpregnancy:tubalrupture;5-6weeks
Ampulla/fimbriapregnancy:tubalabortion;8-12weeks
Interstitialpregnancy:tubalrupture;12-16weeks
11
Pathology(1)
Thechangeofthetube
2023/3/26Pathology
(2)
Thechangeofuterus
Enlargeduterus,butsmallthangestationalweekendometriumundergoesdecidualchange:sexhormones(E,P)increase→endometriumbecomesthicker,getsmorebloodsupply,andglandssecretemore.deciduacast:Duetohormoneinsufficiencyandembryodeath,thedeciduamaybepeeledofffromtheuterinewallunbrokenly,lookstriangular
122023/3/26Pathology(2)
Thechangeofuterus
Arias-Stellareaction(A-Sreaction)endometriummicroscopically,theA-Sreactionconsistsofhyperchromatic,hypertrophic,irregularlyshapednuclei,andfoamy,vaculatedcytoplasm
132023/3/26
Clinicalfindings
symptoms
threeprimarysymptomsamenorrheaabdominalpainvaginalbleedingDizzinessandshock
142023/3/26
Clinicalfindings
SignsGeneralcondition
pallor
rapidandfeeblepulse
hypotension:lowbloodpressure
Abdominalexamination
abdominaltenderness
reboundtenderness
guardingShiftingdullness
152023/3/26pelvicexamination
(trans-vaginalexamination,bi-manualexamination)Vaginal
:slightbleedingCervix:motiontendernessUterus:enlargedAdnexal:mass/tenderness16
Clinicalfindings-sighs
2023/3/26
Assistantexaminations
A.Pregnancytest
(urine/bloodHCG)
Virtually100%positivepregnancytest;AnegativepregnancytestexcludesthepossibilityofectopicpregnancyHCGriserapidlyinnormalpregnancy,doublingevery48-72hrsHCGwithinadequateincreasemaysuggestabnormalpregnancy,includingectopicpregnancy172023/3/26
AssistantexaminationsB.UltrasoundThesiteofgestationalsac?serumβ-HCG>2000,anintrauterinesacshouldbevisiblebytransvaginalultrasoundserumβ-HCG>4000,anintrauterinesacshouldbevisiblebytransabdominalultrasoundAdnexalmass?Pelvicfluid?
182023/3/26
AssistantexaminationsC.CuldocentesisThetransvaginalpassageofaneedleintotheposteriorcul-de-sac
Inordetodeterminewhetherfreebloodispresentinperitonealcavitypossiblyindicatearupturedectopicpregnancy
192023/3/26
AssistantexaminationsD.diagnosticD&C(dilationandcurettage)Chorionicvilli---intrauterinepregnancy
Decidua---ectopicpregnancy
202023/3/26DiagnosisNospecialsymptomsforEP.Anypatientsufferingfromamenorrhea,abdominalpain,vaginalbleedingshouldbedoubtedwithEP.A.HistoryB.SignsC.AssistantexaminationpregnancytestUltrasonographyCuldocentesisdiagnosticD&C212023/3/26DifferentialDiagnosisuterineabortion
acuteappendicitis
Pelvicinflammatorydisease
torsionofovariantumor
Ruptureofcorpusluteum
222023/3/26Treatment
Medicaltreatment:Methotrexate(MTX)
Surgicaltreatment(laparotomy/laparoscopy)
232023/3/26MedicaltreatmentMTX(Methotrexate):destroytrophoblastcellsINDICATIONnocontra-indicationofmedicaltreatment(WBC<4×109/L)massdiameter<4cm
β-HCG<2000U/L
noruptureoftubalpregnancy
No/slightabdominalhemorrhage
follow-up:effective/failure242023/3/26Surgicaltreatment
INDICATION
abdominalhemorrhage
Unstablevitalsignorshock
Progressiveectopicpregnancy
Medicaltreatmentfailed
SURGICALPROCEDURESELECTIONRadicalvs.Conservativesurgery
Laparotomyvs.Laparoscopy
252023/3/26Conservative:Salpingostomy
INDICATION:StablevitalsighAmpullapregnancyPatient’sd
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