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EctopicPregnancyDefinitionAnygestationinwhichimplantationoccursatalocationotherthantheuterinecavity.Incidence:approximately1~2%ofconceptionsAccountsfor10%ofpregnancy-relatedmaternaldeathsCategorytubalpregnancy(95%ofectopicpregnancy)ovarianpregnancyabdominalpregnancybroadligamentpregnancycervicalpregnancycesareanscarpregnancypregnancyinrudimentaryhorn(子宫残角妊娠）
TubalpregnancyTubalPregnancySites:ampullaportionmostcommonisthmicportionfimbrialportionInterstitialportionrareEtiologychronicsalpingitisprevioustubalpregnancyortubalsurgeryabnormalitiesorDysfunctionassistedreproductivetechnique(ART)failureofcontraceptionChronicsalpingitisThefertilizedovumgetstrappedalongthetube.infectionoftubalmucousmembrane(输卵管黏膜炎）destroytheciliated纤毛epitheliumgonococcus淋球菌,Chlamydia衣原体peripheraltubalinfection(输卵管周围炎）adhesionsofepitheliumAbortion,deliveryprevioustubalpregnancyorsurgerychanceofarelapseabout10%withprevioustubalpregnancyIncidenceof10~20%withprevioustubalsurgerytuballigation（结扎术）tubalrepair(reconstructivesurgery)
AbnormalitiesorDysfunctionexcessivelengthofthetubelessdevelopmentoftubalmusclelackofcilium纤毛congenitaldiverticula(憩室)dysfunctionduetoendocrinedisorderanxiety,depressionARTFirstIVF-ETin1975endedupwithectopicpregnancy.1~5%inallARTpregnancymigrationoftransferredembryointothetubesqueezedintothetubebythecontractionofuterusmostpatientsofARTcombinedwithabnormaltubalPathologynocompletedeciduanarrowlumenandthinmusclefertilizedovumburrowsintothethintubalmusclefertilizedovumgrowsanddistendsthetubePathologyOutcomesoftubalpregnancyTubalabortionRuptureoftubalpregnancy
Obsoleteectopicpregnancy陈旧性宫外孕SecondaryabdominalpregnancyTubalabortionoccursmostinampullaabout8th-12thweektwocategories:completetubalabortionincompletetubalabortionrecurrentinvasionoftubalwallbytrophoblastrepeatedhemorrhagebloodcollectedinthePouchofDouglasmayformapelvichematoma.TubalabortionRuptureoftubalpregnancymostlyoccursinisthmicpregnancisduetothesmalldiameterofthisportionofthetubeabout6weeksgestationinvasionofmuscleandserousmembrane浆膜usuallyspontaneousprofusehemorrhageinshorttimeshockseverepainRuptureoftubalpregnancyRuptureoftubalpregnancyIfimplantationisintheinterstitialportion,ruptureisoftendelayedatthe12th-16thweek.duetothethickmuscleonthetubewallseverehemorrhagehypovolemicshockObsoleteectopicpregnancyInabortionorruptureoftubalpregnancyrecurrentinternalhemorrhageOrganizationofhematoma血肿机化AdhesionwithtissuesaroundLastingandcalcification钙化lithopedion石胎Secondaryabdominalpregnancyafterabortionorruptureoftubalpregnancyembryoexpelled,mostlydeadembryoaliveoccasionallyimplantsagainatbroadligamentorinabdominalcavity2010湘雅医院2.18kg重的腹腔妊娠宝宝王雅奇PathologyUteruschangesuterusenlargementandsoftendecidualization蜕膜化ofendometriumThedeciduawillshedafterthedeathoftheembryo,andmaybepassedinfragmentsorintactasadeciduacast蜕膜管型NovilliortrophoblasticcellUteruschangelongafterembryodeathproliferativephaseArias-Stella”(A-S)reactionalivevillisecretoryphaseClinicalmanifestationsamenorrheaabdominalpainvaginalbleedingsyncope(晕厥）andshockabdominalmassAmenorrheausuallythehistoryofamenorrheaabout6-8weeksmaybelongerhistoryininterstitialpregnancyIrregularvaginalbleedinginectopicpregnancymaybemistakenbymenstruationAbdominalpainthemostcommonclinicalcomplaining(95%)one-sidelowerabdominaldullpainasthedevelopmentofthefertilizedovumtear-likepainwhenabortionorruptureoccursradiatingpainVaginalbleedingroughly60%~80%ofcasesirregularusuallyspotting,lessthanmenstrualbleedingcontainingdecidualcastorfratmentsSignsGeneralexaminationwhentheinternalbleedingisrapidandsevere:acuteanemia,pallorrapidandfeeblepulselowbloodpressureAbdominalexaminationpressurepain&reboundtendernessadnexalmasssometimesambulantsonant（移动性浊音）positivePelvicexaminationvaginalbleedingcervix:tendernessespeciallyonmovingthecervix
宫颈举痛或摇摆痛themostimportantsignoftubalpregnancyuterus:softandslightlyenlargedadnexa:fullnessoranindefinitetendermass,sizevariesDiagnosishistory&symptomssignspelvicexaminationspecialexaminationSpecialexaminationhCGtestProgesteronetestUltrasonographyCuldocentesis(后穹隆穿刺术)DiagnositiccurettagehCGtestbloodorurinehCGImportantforearlydiagnosisthevalueofbloodhCGusuallylessthanintrauterinenormalpregnancycontinuedetectionofhCGduplicationtime>7days,verysuspiciousProgesteronetestLowprogesteronevaluebetween10~25ng/ml,ectopicpregnancy<5ng/ml,abortionorectopicpregnancy>25ng/ml,littlepossibilityofectopicpregnancyUltrasonographydistinguishnormalpregnancyfromectopicpregnancyemptyuterus,nogestationalsacadnexalmasshCGtestandultrasoundcomplementeachanotherhCG>2000U/L&nogestationalsacinuterusCuldocentesisSimpleandreliableSuspiciousinternalbleedinginsertinganeedlethroughtheposteriorfornixintothepouchofDouglasblooddoesnotcoagulateectopicpregnancycannotbeexludedifnegativeDifferentialDiagnosisthreatenedorincompleteabortionultrasonographyruptureofcorpusluteumacuteappendicitisacutepelvicinflammatorydiseaseovariantorsionhCGnegativeTreatmentMedicaltreatmentSurgicaltreatmentMedicaltreatmentIndications:nocontraindicationofmedicaltreatmentnoruptureoftubalpregnancydiameterofgestationalsac≤４cmBloodhCG<2000U/LnoobviousinternalbleedingContraindictions:UnstablegeneralconditionRuptureortubalpregnancydiameterofgestationalsac>４cmor>3.5cmwithheartbeatMedicaltreatmentMTX(methotrexate)suppresstheproliferationoftrophoblastdamagethevillileadtothedeath,abscissionandabsorptionoftheembryoTreatmentplan0.4mg/(kg.d)i.m.*5days50mg/m21timeMeasurehCGon4thans7thday,repeatwhenhCGdecrease<15%tillhCG<51U/LLocaltreatment:injectionintogestationalsacMedicaltreatmentWithclosemonitorhCG+UltrasonographyAfter14daysoftreatmentthevalueofbloodhCGshouldbenegativefor3testslessornoabdominalpainlessornovaginalbleedingSur
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