流产、异位妊娠-赵爱民课件

Ectopicpregnancy

Abortion

Zhaoaimin

M.D.,Ph.D.,ProfessorDepartmentOfObstetrics&GynecologyRenjiHospitalAffiliatedtoSJTUSchoolofMedicine9/30/20231AbortionandEctopicpregnancyEctopicpregnancy

AbortionEctopicpregnancyDefinitionImplantationoutsideoftheuterinecavityistermedectopicpregnancyItisaconditionthatsignificantlyjeopardizesthemotherbecausecatastrophicbleedingmayoccurwhentheimplantingpregnancyerodesbloodvesselsorrupturesofthetubalwall9/30/20232AbortionandEctopicpregnancyEctopicpregnancy8/7/20232AborImplantlocationsTubal95%(80%ampullaryportion)Ovarian<1%Abdominal1-2%Cervical0.15%Cornual2%9/30/20233AbortionandEctopicpregnancyImplantlocations8/7/20233AborEtiologySalpingitis

have6-foldincreasetheriskofectopicpregnancyOperationoftubalIUD(intrauterinedevice)DysfunctionoftubalOrther:endometriosis9/30/20234AbortionandEctopicpregnancyEtiology8/7/20234AbortionandOutcomesofectopicpregnancyTubalabortion

8-12WeeksampullaryportionRuptureoftubalpregnancy

5weeksisthmicportionTubalabortionwithsubsequentimplantation

onanintraperitonealstructureforexampleliverpregnancy9/30/20235AbortionandEctopicpregnancyOutcomesofectopicpregnancy8ClinicalmanifestationofectopicpregnancyAmenorrhea

70-80%6-8weeksAbdominalandpelvicpain

themostcommonsymptom,whichispresentinnealyallpatients.PainisaresultofdistentedoftubalandirritationofperitoneumbybloodIrregularvaginalbleeding

resultsfromthesloughingofthedeciduaShock

resultfromamountofbloodlossAbdominalmass9/30/20236AbortionandEctopicpregnancyClinicalmanifestationofectoPhysicalfindingsintubalpregnancyGeneralfindings:

AnemicorpalefacepulseincreasedBPdecreasedT<38degree9/30/20237AbortionandEctopicpregnancyPhysicalfindingsintubalpreAbdominalexaminationdistentionandtendernesswithorwithoutreboundDecreasedbowelsoundShiftingdullnesspositivemass9/30/20238AbortionandEctopicpregnancyAbdominalexamination8/7/20238PelvicexaminationSlightlyopencervixwithbleedingCervicalmotiontendernessAdnexaltendernessAdnexalmassTheuterussizemaybenormalorenlarged9/30/20239AbortionandEctopicpregnancyPelvicexamination8/7/20239AboDiagnosticproceduresTypicalcasescanbedeterminedeasyEarlyectopicpregnancyorunrupturetypedifficultyItisnessesarytoneedassistantexamination9/30/202310AbortionandEctopicpregnancyDiagnosticprocedures8/7/20231HCGtest

80-100%positiveUrinaryHCGlevelBloodHCGlevelIfHCGnegative,ectopicpregnancydoesnotberuleoutTypeBUtrasound

CuldocentesisAidintheidentificationofperitoneumbleedingPositive(nonclotingblood)ectopicpregnancymaybeconfirmedNegativeectopicpregnancydoesnotbedepletion

9/30/202311AbortionandEctopicpregnancyHCGtest80-100%positive8/7/LaproscopyItisadirectvisualizationandaccurtemethodtodiagnosisectopicpregnancyEvenlaproscopy,however,carries2-5%misdiagnosisrate,becauseanextremelyearlytubalpregnancygestationmaynotbeidentified9/30/202312AbortionandEctopicpregnancyLaproscopy8/7/202312AbortionaPothologyofendometriunCurettageoftheuterinecavitycanalsohelpruleoutectopicpregnancyIdentificationofchorionicvilliincurettingmayidentifyanintrauterinepregnancy9/30/202313AbortionandEctopicpregnancyPothologyofendometriun8/7/20DifferentialdiagnosisAbortionAcutesalpingitisAcuteappendicitisRuptureofcorpusluteumTorsionofovariancyst9/30/202314AbortionandEctopicpregnancyDifferentialdiagnosis8/7/2023TreatmentofectopicpregnancySurgicaltreatmentSalpingectomyConservativeoperationSalpinggostomySegmantalresectionandtubalreanatomosis9/30/202315AbortionandEctopicpregnancyTreatmentofectopicpregnancyNonsurgicaltherapyChinesetraditionalmedicineChemicaltherapy

Drug:MTXIndicationThediameterofthemass<3cmUnruptureNotsignificantlybleedingHCGlevel<2000U/L9/30/202316AbortionandEctopicpregnancyNonsurgicaltherapy8/7/202316AAbortion9/30/202317AbortionandEctopicpregnancyAbortion8/7/202317AbortionandDefinition

Abortionistheterminationofapregnancybefore28weeksfromthefirstdayofthelastmenstrualperiodandthefetusweight<1000g9/30/202318AbortionandEctopicpregnancyDefinition8/7/202318AbortiClassificationEarlyabortion<12WLateabortion12-28WSpontaneousabortionArtificialabortion9/30/202319AbortionandEctopicpregnancyClassification8/7/202319AbortiEtiologyGeneticfactorsMaternalfactorsInfectionsystemicfactorsheartdiseaseseveranemiaendocrineReproductivetractabnormalityImmunologicfactorsEnviromentalfactors

ToxinRadiationsmokingalohol9/30/202320AbortionandEctopicpregnancyEtiology8/7/202320AbortionandPathology1.Haemorrhageoccursinthedeciduabasalisleadingtolocalnecrosisandinflammation.9/30/202321AbortionandEctopicpregnancyPathology8/7/202321Abortionan2.Theovum,partlyorwhollydetached,actsasaforeignbodyandirritatesuterinecontractions.Thecervixbeginstodilate.9/30/202322AbortionandEctopicpregnancy2.Theovum,partlyorwholly3.Expulsioncomplete,Thedeciduaisshedduringthenextfewdaysinthelochialflow.9/30/202323AbortionandEctopicpregnancy3.Expulsioncomplete,ThedecClinicalmanifestationHaemorrhageisusuallythefirstsignandmaybesignificantlyifplacentalseparationisincomplete.Painisusuallyintermittent,‘likeasmalllabrur’.Itceaseswhentheabortioniscomplete.9/30/202324AbortionandEctopicpregnancyClinicalmanifestationHaemorrhThreatenedabortionLowabdominalPaincompanyvaginalbleedingCervixisclosedunruptureofmembraneEmbryosurvive9/30/202325AbortionandEctopicpregnancyThreatenedabortionLowabdominInevitableabortionBleedingincreasedPaindevelopmentRuputureofmembraneCevixdilationEmbryotissueincarceratedinthecervix9/30/202326AbortionandEctopicpregnancyInevitableabortionBleedinginCompleteabortionUterinecontractionsarefelt,thecervixdilatesandbloodlosscontinues.Thefetusandplacentaareexpelledcomplete,theuteruscontractsandbleedingstops.Nofurthertreatmentisneeded.9/30/202327AbortionandEctopicpregnancyCompleteabortion8/7/202327AboIncompleteabortionInspiteofuterinecontractionsandcervicaldilatation,onlythefetusandsomemembranesareexpelled.Theplacentaremainspartlyattachedandbleedingcontinues.Thisabortionmustbecompletedbysurgicalmethods.9/30/202328AbortionandEctopicpregnancyIncompleteabortion8/7/202328AMissedabortionIstheretentionofafailedintrauterinepregnancyforaextendedperiod,usuallydefinedasmorethantwomenstrualcyclesRecurrentabortionItisatermusedwhenapatienthashadtwoormoreconsecutivespontaneousabortionsSepticabortion9/30/202329AbortionandEctopicpregnancyMissedabortion8/7/202329AbortTreatmentofabortionIncompleteabortionRemovetheembryoandplacentaassoonaspossibleNegativepressuresuctionEmbryulciaMissedabortion

NoticebloodclotfunctionpreventDICSepticabortion

Broad-spectrumantibiotics9/30/202330AbortionandEctopicpregnancyTreatmentofabortion8/7/2023Removalofplacentaltissuewithovumforceps.9/30/202331AbortionandEctopicpregnancyRemovalofplacentaltissuewi9/30/202332Abort