妇产科学 异位妊娠(英文)

EctopicPregnancy

Normal/AbnormalPregnancyNormalPregnancy：normaldurationnormallocation

AbnormalPregnancy:abnormalduration

abnormallocation

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intrauterinePregnancyNormally,theblastocyst(fertilizedovum)implantsintheendometriumoftheuterinecavity

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EctopicPregnancyEctopicPregnancy：

implantationoftheblastocyst(fertilizedovum)outsidetheuterinecavity

42023/3/26DifferentLocationofEctopicPregnancytubalpregnancy95%

ovarianpregnancy

peritonealpregnancy

broadligamentpregnancy

cervicalpregnancy

cesareanscarpregnancy

52023/3/26

tubalpregnancy6IntersttialEPFimbriaEPAmpullaEPIsthmusEP2023/3/26Incidenceabout1%Inrecentyears,theincidenceisincreasingbecauseof:increasingprevalenceofpelvicinflammationdiseasesgooddetectionforearlydiagnosis……

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EtiologyOvulation,fertilizationandimplantation

8anyreasonthatinfluencestheprocessofovulation,fertilizationandimplantation

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EtiologyTubalFactors

chronicsalpingitis

inflammationdestroytheepithelium,adhesionoccuringin/aroundthetubeFertilizedovumgoestooslowly,don’tarriveuterinecavityintime

OvarianFactors

transmigrationoftheovum

OtherFactors

pelvicendometriosis,myoma,ovariantumors

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Pathology

(1)

Thechangeofthetube

Thetubeislittleandthin,andnodecidualreaction,thetrophoblastinvadesbloodvesselsorpenetratestubalwall

Outcomes：tubalabortionortubalrupture

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Isthmicpregnancy:tubalrupture;5-6weeks

Ampulla/fimbriapregnancy:tubalabortion;8-12weeks

Interstitialpregnancy:tubalrupture;12-16weeks

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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

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Clinicalfindings

symptoms

threeprimarysymptomsamenorrheaabdominalpainvaginalbleedingDizzinessandshock

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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

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Assistantexaminations

A.Pregnancytest

(urine/bloodHCG)

Virtually100%positivepregnancytest；AnegativepregnancytestexcludesthepossibilityofectopicpregnancyHCGriserapidlyinnormalpregnancy,doublingevery48-72hrsHCGwithinadequateincreasemaysuggestabnormalpregnancy,includingectopicpregnancy172023/3/26

AssistantexaminationsB.UltrasoundThesiteofgestationalsac?serumβ-HCG>2000,anintrauterinesacshouldbevisiblebytransvaginalultrasoundserumβ-HCG>4000,anintrauterinesacshouldbevisiblebytransabdominalultrasoundAdnexalmass?Pelvicfluid?

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AssistantexaminationsC.CuldocentesisThetransvaginalpassageofaneedleintotheposteriorcul-de-sac

Inordetodeterminewhetherfreebloodispresentinperitonealcavitypossiblyindicatearupturedectopicpregnancy

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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