Ectopic pregnancyEctopic pregnancyAbortionAbortion Zhao aiminZhao aimin M.D., Ph.D., Professor M.D., Ph.D., Professor
Department Of Obstetrics & GynecologyDepartment Of Obstetrics & Gynecology Renji Hospital Affiliated to SJTU School of Medicine Renji Hospital Affiliated to SJTU School of Medicine
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Ectopic pregnancyDefinitionImplantation outside of the uterine cavity is termed ectopic pregnancyIt is a condition that significantly jeopardizes the mother because catastrophic bleeding may occur when the implanting pregnancy erodes blood vessels or ruptures of the tubal wall
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Implant locationsTubal 95% (80% ampullary portion)
Ovarian <1%
Abdominal 1-2%
Cervical 0.15%
Cornual 2%
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EtiologySalpingitis have 6-fold increase the risk of
ectopic pregnancy
Operation of tubal
IUD(intrauterine device)
Dysfunction of tubal
Orther: endometriosis
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Outcomes of ectopic pregnancyTubal abortion
8-12 Weeks ampullary portion
Rupture of tubal pregnancy
5 weeks isthmic portion
Tubal abortion with subsequent implantation
on an intraperitoneal structure for example liver pregnancy
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Clinical manifestation of ectopic pregnancy
Amenorrhea 70-80% 6-8 weeks
Abdominal and pelvic pain
the most common symptom,which is present in nealy all patients. Pain is a result of distented of tubal and irritation of peritoneum by blood
Irregular vaginal bleeding
results from the sloughing of the decidua
Shock result from amount of blood loss
Abdominal mass
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Physical findings in tubal pregnancyGeneral findings:
Anemic or pale face
pulse increased
BP decreased
T< 38 degree
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Abdominal examinationdistention and tenderness with or without rebound
Decreased bowel sound
Shifting dullness positive
mass
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Pelvic examinationSlightly open cervix with bleeding
Cervical motion tenderness
Adnexal tenderness
Adnexal mass
The uterus size may be normal or enlarged
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Diagnostic proceduresTypical cases can be determined easy
Early ectopic pregnancy or unrupture type difficulty
It is nessesary to need assistant examination
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HCG test 80-100% positive
Urinary HCG level
Blood HCG level
If HCG negative,ectopic pregnancy does not be rule out
Type B Utrasound
CuldocentesisAid in the identification of peritoneum bleeding
Positive (noncloting blood)
ectopic pregnancy may be confirmed
Negative ectopic pregnancy does not be depletion
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LaproscopyIt is a direct visualization and accurte method to diagnosis ectopic pregnancy
Even laproscopy,however,carries 2-5% misdiagnosis rate, because an extremely early tubal pregnancy gestation may not be identified
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Pothology of endometriunCurettage of the uterine cavity can also help rule out ectopic pregnancy
Identification of chorionic villi in curetting may identify an intrauterine pregnancy
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Differential diagnosisAbortion
Acute salpingitis
Acute appendicitis
Rupture of corpus luteum
Torsion of ovarian cyst
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Treatment of ectopic pregnancySurgical treatment
Salpingectomy
Conservative operation
Salpinggostomy
Segmantal resection and tubal reanatomosis
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Nonsurgical therapyChinese traditional medicine
Chemical therapy
Drug:MTX
Indication The diameter of the mass <3cm
Unrupture
Not significantly bleeding
HCG level <2000U/L
Abortion
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Definition
Abortion is the termination of a Abortion is the termination of a pregnancy before 28 weeks from pregnancy before 28 weeks from the first day of the last menstrual the first day of the last menstrual period and the fetus weight <1000gperiod and the fetus weight <1000g
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ClassificationEarly abortion <12W
Late abortion 12-28W
Spontaneous abortion
Artificial abortion
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EtiologyGenetic factors
Maternal factorsInfection
systemic factors heart disease sever anemia endocrine
Reproductive tract abnormality
Immunologic factorsEnviromental factors Toxin Radiation smoking alohol
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Pathology1.Haemorrhage occurs in the decidua basalis leading to local necrosis and inflammation.
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2. The ovum, partly or wholly detached, acts as a foreign body and irritates uterine contractions. The cervix begins to dilate.
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3. Expulsion complete, The decidua is shed during the next few days in the lochial flow.
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Clinical manifestation Haemorrhage is usually the first sigHaemorrhage is usually the first sign and may be significantly if placenn and may be significantly if placental separation is incomplete.tal separation is incomplete. Pain is usually intermittent, ‘like a Pain is usually intermittent, ‘like a small labrur’. It ceases when the asmall labrur’. It ceases when the abortion is complete.bortion is complete.
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Threatened abortion
Low abdominal Pain company vaginal bleeding
Cervix is closed
unrupture of membrane
Embryo survive
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Inevitable abortion
Bleeding increased
Pain development
Ruputure of membrane
Cevix dilation
Embryo tissue incarcerated in the cervix
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Complete abortionUterine contractions are felt, the cervix dilates and blood loss continues.
The fetus and placenta are expelled complete, the uterus contracts and bleeding stops. No further treatment is needed.
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Incomplete abortionIn spite of uterine contractions and cervical dilatation, only the fetus and some membranes are expelled. The placenta remains partly attached and bleeding continues. This abortion must be completed by surgical methods.
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Missed abortionIs the retention of a failed intrauterine pregnancy for a extended period, usually defined as more than two menstrual cycles
Recurrent abortionIt is a term used when a patient has had two or more consecutive spontaneous abortions
Septic abortion
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Treatment of abortion Incomplete abortionRemove the embryo and placenta as soon as possible Negative pressure suction Embryulcia
Missed abortion
Notice blood clot function prevent DIC
Septic abortion
Broad-spectrum antibiotics
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Removal of placental tissue with ovum forceps.
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Key words today Concept of ectopic pregnancy Clinical manifestation, diagnosis,differential diagnosis and treatment of ectopic pregnancy Concept of abortion Classification of abortion Clinical manifestation, diagnosis,differential diagnosis and treatment of abortion
Zhao aiminZhao aimin M.D., Ph.D., ProfessorM.D., Ph.D., Professor Department of Obstetrics & Gynecology Department of Obstetrics & Gynecology
Renji Hospital Affiliated to SJTU School of MedicineRenji Hospital Affiliated to SJTU School of Medicine
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