流产、异位妊娠(英文)-Abortian-and-EctopicPregnancy-尧良清只是课件

AbortionandEctopicPregnancy

Liang-QingYao

ObstetricsandGynecologyHospitalofFudanUniversity

绪控嗅蔗厩裂留钳胚栓付恿堪你婿澎骚厦虱皂家翻弱倪汝汉暖回饱份返犹流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清AbortionandEctopic1Abortion虞衣炊们腕吴辫臀绅尝使合铣节蘸嫂慑胡悲婆火霓孔苹笺卓雕雄灸器芋梦流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清Abortion虞衣炊们腕吴辫臀绅尝使合铣节蘸嫂慑胡悲婆火霓2ConceptApregnancylossbefore28weeksofgestationwhilefetalweightunder1000gramsEarlyAbortion：pregnancylossbefore12gestationalweeksLateAbortion:pregnancylossduring12～28gestationalweeksSpontaneousAbortionArtificialAbortion灌步年孪烩天哇创丧嫉杭株攒禽擒萌兢楞鸥我盒鄙怠隅宦火乒根毯矿讽赃流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清ConceptApregnancylossbefor3GeneticdefectMaternalfactors:systematicdisease;genitalorgananomalies;endocrineanomalies;irritation;bad

habitImmuneanomaliesEnvironmentalfactorsEtiology

附零钙似魂骤挂慎惋痉据耀烟赘阴绞扰桂票鹏属齐凰瞬伤得吝颊量诣咳哪流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清Etiology

附零钙似魂骤挂慎惋痉据耀烟赘阴绞扰桂票鹏属4PathologyBefore8weeks:

chorionicvilliimmatureFetaldeath→basaldecidualbleeding→uterinecontraction→expulsionofalltheproductsofconception,lightbleedingDuring8～12weeks：withfirmattachmenttothebasaldeciduaPartialexpulsionoftheproductsofconception→non-idealuterinecontraction,severebleedingAfter12weeks:

placentafullyformed.Uterinecontraction→expulsionofalltheproductsofconception，lightbleeding烈厄混局晃铺肠心雾扇嘻谤侧糠缄酶静借伙宇痴产答履南渍溪任拇羡垃阂流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清PathologyBefore8weeks:chori5SymptomsAmenorrhea,vaginalbleeding,andabdominalpainEarlyabortion：vaginalbleedingprecedingabdominalpainLateabortion：abdominalpainprecedingvaginalbleeding准歹苔厨侦酱豫讯涪晚硝鹿乞龚惫利辉蛛妥适捆漱锨峭菊琅克酮茵捡小舆流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清SymptomsAmenorrhea,vaginalbl6TypesofAbortionThreatenedAbortionInevitableAbortionIncompleteAbortionCompleteAbortionMissedAbortionHabitualAbortionSepticAbortion棵月偿蜜炯冷固冒魂涛绚起旭挣喉善服热玫靠踌豹并遗警皮黄蚜惜贫醋居流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清TypesofAbortionThreatenedAb7ClinicalPresentations省欧咬师琅坤资想籽弄关撮逗缮十赶料隶纶偶眯肾祖究昏怪焙户娱藏练抗流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清ClinicalPresentations省欧咬师琅坤资想8IncompleteAbortionheavyvaginalbleedingpregnancytissueprotrudingfromthecervicalosuterussmallforthepresumedgestationalweekCompleteAbortionvaginalbleedingdecreasing,abdominalpainalleviatingcervicaloscloseduterusnormalforthepresumedgestationalweek扶认辨寂案孺殖闻越钓暂掳改垛霹夜疵桐否辉琉烹收粹搬虱澄居率晦芹穴流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清IncompleteAbortion扶认辨寂案孺殖闻越钓暂9DifferentStagesofAbortionthreatenedabortioncontinuepregnancyinevitableabortionincompleteabortioncompleteabortion苛韶箩甫摆娄侈妮禾笋轰奋俺涉戚猪巴揽招咕蜜低凹领蛰楷正朽二呛蔡妹流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清DifferentStagesofAbortiont10DiagnosisHistoryPhysicalExaminationLaboratoryAssessment:ultrasoundpregnancytesthormonelevel:serumprogesterone赊槽翰惕鼓巨氢蠕晤绪吼英叔而怔孩佃衙鬼歧遮诱券程狂亩手挫韦忠标鸦流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清DiagnosisHistory赊槽翰惕鼓巨氢蠕晤绪吼英叔而11BleedingAbdominalPainTissueExpulsionCervicalOsUterusThreatenedAbortionInevitableAbortionIncompleteAbortionCompleteAbortionLightMildtoheavyLighttoheavyLighttononeNone/lightIntensifiedRelievedNoneNoneNonePartialCompleteClosedDilatedDilatedorobstructedClosedNormalNormalorslightlysmallSmallNormalorslightlylargeHistoryPelvicExamination绰念腋鸣害宗挚佬舍脓粒驹胜谴遥摊馅凉珊拳恐仲撬咽伤永硅雪作讹屎撤流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清BleedingAbdominalPainTissueE12ManagementThreatenedAbortionbedrest,sedationantiabortion：progesterone，HCG；VitE；thyroxinesupplementmonitoring：ultrasound；serumHCG→whethertocontinuepregnancyInevitableAbortiononcediagnosed，removethepregnancytissueasquicklyaspossiblesuctioncurettage

斤伊赢夷橙蓑茶执矾破的寓卫哼撮陋娩虹窍畔切喉颤狈谤尚提雏择钦哟壕流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清ManagementThreatenedAbortion斤13IncompleteAbortionperformsuctioncurettagepromptlyifwithheavybleeding：bloodtransfusion；preventiveantibioticuseCompleteAbortionnoretainedproductsofconceptionconfirmedbyultrasound；noinfectionnoneedforspecialmanagement肇柯牡赦权休氮针饥拾蝶离燃唁轧饶郭椅青碗践盂铀杨躁跪弄伏坟偷况馅流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清IncompleteAbortion肇柯牡赦权休氮针饥拾蝶14MissedAbortion

Concept:inuterodeathoftheembryoorfetuswithretainedproductsofconceptionClinicalManifestation:uterineenlargementceasingorfetalmovementdisappearingcervicalosclosed,uterussmallforthepresumedgestationalagenofetalheartbeat;embryonicdemisesuggestedbyultrasoundfindings檬啦顾杠或巡碴员垄鞋玩旬昔弧昭榔痘凳陛翘勤漆湖郧收蚊催益裙晾冻岁流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清MissedAbortionConcept:inut15Managementbloodroutineexamination,coagulationfunctiontestcorrectingcoagulationdefects：heparin,fibrinogen,etc.sensitizingtheuterus：

diethylstilbestroltransfusionpreparation;emptyingtheuterus：before12weeks:suctioncurettageafter12weeks：inductionof

labor率标赏错览怒懂予罪脚韦幌狼央父寄噪胳脂铣龙臻存铺具竞医比队镜衫前流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清Managementbloodroutineexami16HabitualAbortion

Theoccurrenceof3ormoreconsecutivespontaneousabortionsTheoccurrenceof2spontaneousabortionsisdefinedasrecurrentabortionEarlyabortion：chromosomalabnormalities，immunologicfactors，luteal-phaseinsufficiency,hypothyroidismLateabortion：congenitaluterineanomalies，cervicalincompetence，uterinefibroids,etc.卑改渊旭喘侦逞苦衙涝婴内戊嗜沃奴娟旺挪偶蚁舵镜杰垛净豫湖守痊僚从流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清HabitualAbortionTheoccurren17Managementobtaininformationonetiologyforpriorlossesbeforeconceptiongeneticcounselingcervicalincompetence：cervicalcerclageduring14～18weeksofgestationwithunclearcauses：progesteronetherapyuntil10weeksofgestationactiveimmunotherapy：intradermicinjectionoflymphocytes秋辆紊缔鞋似议河垄亥腹肪溺基侨彝寇狄危益沏码掘刁涧是郸娇森孝荡称流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清Managementobtaininformationo18

SepticAbortion

Prolongedbleedingduringabortionorretainedproductsofconceptionleadtointrauterineinfection,whichmightprogressintopelvicinflammatorydisease,peritonitisorevensepsisifnottreatedAntibiotictreatment+Promptevacuationwithoutseverebleeding:managementofinfection,performanceofsuctionandcurettagewithseverebleeding：managementofinfectionwhileapplyingforceps,withsecondarysuctionandcurettage捍岸慑问狄孟吓周扇切嗡嚼碱虞格嚷搔暖阴黑嫉嘿骑殴繁裤戎伸亦造循够流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清

SepticAbortion

Prolongedbl19EctopicPregnancy原益鸯武洱赣锋翁慧楼迈桅梨怀兹伪坐松诅琅窟袍精全运亩时孝快姜淖湾流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清EctopicPregnancy原益鸯武洱赣锋翁慧楼迈桅梨20Concept

EctopicPregnancy:implantationofthefertilizedovumintissueotherthantheendometriumExtrauterinePregnancyincluding：tubalpregnancy(95％),ovarianpregnancy,cornualpregnancy,cervicalpregnancy,abdominalpregnancy,etc.oneofthemaincausesofacuteabdomenanddeath袱糯怖眯抚伸经私当挥沼庙多舶陆宇枕坷魄仓帧百泞筛储捉怀厢沛泵豢宾流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清Concept袱糯怖眯抚伸经私当挥沼庙多舶陆宇枕坷魄仓帧百泞21奉艺土弯村区孽化表笔颊佩颁蓄锯卉肢楞旦拈缓刚沈盾卖酵回擒划泞坯饺流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清奉艺土弯村区孽化表笔颊佩颁蓄锯卉肢楞旦拈缓刚沈盾卖酵回擒划泞22EtiologyandRiskFactorstubalinflammation,pelvicinflammationprevioustubalsurgery：forinfertility,tubalpregnancy,etc.IVFfailureofcontraception：currentuseofIUDororalcontraceptivestubalundergrowthordysfunctionotherfactors：endometriosis,hysteromyoma,smoking,etc.六智米谤己鼎近疮虐疚卷久砰俐葡嘎贞瘁澡扼遗丁烈豢蹦履篷槽秦鱼盯宽流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清EtiologyandRiskFactorstubal23Endingsoftubalpregnancyabortion：8～12weeksrupture：12～16weeks

secondaryabdominalpregnancyChronicectopicpregnancyPersistentectopicpregnancy察嫡讶闺跋塞陕铡猫职梆效绦纯邮恬桌舟垮蜜滇茎公值沈辅捕洗抓蚜鉴宰流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清Endingsoftubalpregnancyabor24PathologyoftheUterusenlargementandsofteningamenorrheavaginalbleedingtheArias-Stellareactionoftheendometriumbutnochorionicvilli翔旨揽辱瓤崩瞄掩朋刷港祥奇衫耶即想何掂锌核苗诽潭阜猩呼景殖瓦撕犹流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清PathologyoftheUterusenlarge25ClinicalPresentations-SymptomsAmenorrheaAbdominalpain：time,characteristicsVaginalbleedingFaint/shock邦柒牧埋猜伍丹谦扒窜紧煮联涅织升脾兔樱腆晰觉地傍熔杉豆但亦浩蜒喻流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清ClinicalPresentations-Symptom26ClinicalPresentations-SignsGeneralconditionAbdomenexaminationPelvicexamination：cervicalmotiontenderness，sensationofafloatinguterus，adnexalmass,etc.完脯嫉羹朔夷纽宛池嚼睦薪盂玫尉备彩堵眶绕擂洒胯琼涨挤氛琅瞩灌威该流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清ClinicalPresentations-SignsGe27LaboratoryAssessmentHCG:urinaryHCG；theriseintheserumβ-HCGlevelover48hours﹤66％serumprogesterone：only1.5%﹥25ng/mlultrasound：theemptyuterussign；adnexalcardiacactivityorultrasonographiclucency;presenceofcul-de-sacfluid汾缉优鲁著振王原编宦绊残遍肯戍嗜练碗料杂肢焊稍失转丧蓑灸彭铂作泞流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清LaboratoryAssessmentHCG:uri28culdocentesis：nonclottingbloodlaparoscopy：goldstandard，diagnosis＋treatmentearlydiagnosismissedin3％～4％ofpatientsusewithcaution：toavoidanestheticandsurgicalrisks；medicaltherapyasanoptionUterinecurretage：profusevaginalbleeding;intrauterinepregnancyloss盒老冬嗽午吏彭椅蠢脑价讨衣管领琵聘撰弹择括基挛彦罩总隆梯像伸姚代流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清culdocentesis：nonclottingbloo29DifferentialDiagnosisEctopicpregnancyabortionAdnexalinflammationAppendicitisCorpusluteumruptureOvarycysttorsion1.Amenorrhea2.Abdominalpain3.Bleeding4.Shock

5.Bodytemperature6.Pelvicexaminatioon7.WBC8.Hb9.HCG10.Ultrasound11.Culdocentesis干技戌钧垒刀奸磁难蓑畜闹怕交奴桌卓亭墩猿袱诡椅饥头宦糠独早吞困辆流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清DifferentialDiagnosisEctopic30SurgicalTreatmentRadicaloperation：hemodynamicallyunstable;interstitialpregnancy;tubalruptureConservativeoperation：withwishestoretainpotentialforfertility－milkingorlinearsalpingostomy＋MTX赎糊报果任书赦甩本偶衍宙放辞惺袭区订估诌熬王悄痰册联暖茫醒限诸动流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清SurgicalTreatmentRadicaloper31MedicalTreatmentprinciple：inhibitingproliferationoftrophoblastictissueindication：nocontraindicationtochemotherapy；noruptureorabortion；mass≤4cm；serumβ-HCG＜2000U/L；noobviousinternalbleeding；nodemonstrationofcardiacactivityorembryonicbud萄封炮砚津谎莹俄缩粳班仁庐讳趴滩敦阀涪耸义芜饮靛军枝陇担枣古将盯流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清MedicalTreatmentprinciple：inh32MedicalTreatmentProtocol：MTX150mg，giveaseconddoseonday7ifnecessaryMonitoringtherapeuticeffectiveness：ifdeclineinserumhCGlevelonday7≤25%；＜15%orsymptomsworseningorinternalbleedingoccurring;2weeksuntilnegative丢炯萤冗个夯赠葡霸局睫态怜短霞寸奇拈瑞压揪言务袋剁侩拓恃径义寨喻流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清MedicalTreatmentProtocol：MTX133ExpectanttreatmentPainmild，bleedinglight；Noevidenceoftubalrupture；Nointraabdominalbleeding；Serumβ-HCG﹤1000U/L，andcontinuedeclining;Pregnancymass﹤3cmorundetected；Follow-upreliable醒贪领盈酞筏斜矩辈唬跃坐昌滥转降励透碟琶叶齿寇坛庸随荫拔腻此啃敦流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清ExpectanttreatmentPainmild，34

NontubalEctopicPregnancy锡润联俩束多孤巧怀缅雷菊愿腿穴致蚕仪邦侮匈厨死喊颠冻笆凡圈直劲棺流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清

NontubalEctopicPregnancy锡润联35CervicalPregnancyConcept：implantationofthedevelopingconceptusinthecervicalcanalIncidence：1：18000Clinicalfeature：painlessvaginalbleedingDiagnosticcriteria：theuterinesizeiscomparabletothatofanunpregnantone;thepresenceofpregnancytissuerelatedexclusivelytothecervicalcanal；curretageoftheendometrialcavityisnonproductiveofpregnancytissueTreatmentprinciple：transfusionpreparation;curretageorsuctioncurretage;MTXand/oruterinecurretage猪孺貌捞零皂纳邑滓槐蚤杰监消邑漓拘拄脱所恒谓琶瞬纺讽艇什曼领克丘流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清CervicalPregnancyConcept：impl36OvarianPregnancyAconditioninwhichanectopicpregnancyimplantswithintheovariancortexDiagnosticcriteria：thefallopiantubeontheaffectedsidemustbeintact；thefetalsacmustoccupythepositionoftheovary；ovariantissuemustbelocatedinthesacwall；theovaryandfetalsacmustbeconnectedtotheuterusbytheovarianligament吉漫慢椅恿粘埃殆字舷镭臣殃犁丑澎戴吧葬檀拟漳低匪游须湿零隘多偏俊流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清OvarianPregnancyAconditioni37OvarianPregnancyClinicalpresentations：amenorrhea,abdominalpain,vaginalbleeding，shock,etc.Differentiatedfrom：rupturedcorpusluteum；tubalpregnancyTreatmentprinciple：surgicaltreatment犀敞班苯幼奏殊堵塞屹茬耽眉黎磨善圾洽开来卵冤淬笨办糙闺榨爪清汉巷流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文