流产、异位妊娠-赵爱民.ppt

*,*,单击此处编辑母版标题样式,Abortion and Ectopic pregnancy,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,Ectopic,pregnancyAbortion,Zhao,aimin,M.D.,Ph.D.,Professor,Department Of Obstetrics&Gynecology,Renji,Hospital Affiliated to SJTU School of Medicine,Ectopic,pregnancy,Definition,Implantation outside of the uterine cavity is termed,ectopic,pregnancy,It 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,1/7/2026,2,Abortion and Ectopic pregnancy,Implant locations,Tubal,95%(80%,ampullary,portion),Ovarian 1%,Abdominal 1-2%,Cervical 0.15%,Cornual,2%,1/7/2026,3,Abortion and Ectopic pregnancy,Etiology,Salpingitis,have 6-fold increase the risk of,ectopic,pregnancy,Operation of,tubal,IUD(intrauterine device),Dysfunction of,tubal,Orther,:endometriosis,1/7/2026,4,Abortion and Ectopic pregnancy,Outcomes of,ectopic,pregnancy,Tubal,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,1/7/2026,5,Abortion and Ectopic pregnancy,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,1/7/2026,6,Abortion and Ectopic pregnancy,Physical findings in,tubal,pregnancy,General findings:,Anemic or pale face,pulse increased,BP decreased,T 38 degree,1/7/2026,7,Abortion and Ectopic pregnancy,Abdominal examination,distention and tenderness with or without rebound,Decreased bowel sound,Shifting dullness positive,mass,1/7/2026,8,Abortion and Ectopic pregnancy,Pelvic examination,Slightly open cervix with,bleeding,Cervical motion tenderness,Adnexal,tenderness,Adnexal,mass,The uterus size may be normal or enlarged,1/7/2026,9,Abortion and Ectopic pregnancy,Diagnostic procedures,Typical cases can be determined easy,Early,ectopic,pregnancy or,unrupture,type difficulty,It is,nessesary,to need assistant examination,1/7/2026,10,Abortion and Ectopic pregnancy,HCG test,80-100%positive,Urinary HCG level,Blood HCG level,If HCG,negative,ectopic,pregnancy does not be rule out,Type B,Utrasound,Culdocentesis,Aid in the identification of peritoneum bleeding,Positive (,noncloting,blood),ectopic,pregnancy may be confirmed,Negative,ectopic,pregnancy does not be depletion,1/7/2026,11,Abortion and Ectopic pregnancy,Laproscopy,It 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,1/7/2026,12,Abortion and Ectopic pregnancy,Pothology,of,endometriun,Curettage of the uterine cavity can also help rule out,ectopic,pregnancy,Identification of,chorionic,villi,in curetting may identify an intrauterine pregnancy,1/7/2026,13,Abortion and Ectopic pregnancy,Differential diagnosis,Abortion,Acute,salpingitis,Acute appendicitis,Rupture of corpus,luteum,Torsion of ovarian cyst,1/7/2026,14,Abortion and Ectopic pregnancy,Treatment of,ectopic,pregnancy,Surgical treatment,Salpingectomy,Conservative operation,Salpinggostomy,Segmantal,resection and,tubal,reanatomosis,1/7/2026,15,Abortion and Ectopic pregnancy,Nonsurgical,therapy,Chinese traditional medicine,Chemical therapy,Drug:MTX,Indication,The diameter of the mass 3cm,Unrupture,Not significantly bleeding,HCG level 2000U/L,1/7/2026,16,Abortion and Ectopic pregnancy,Abortion,Definition,Abortion is the termination of a pregnancy before 28 weeks from the first day of the last menstrual period and the fetus weight 1000g,1/7/2026,18,Abortion and Ectopic pregnancy,Classification,Early abortion 12W,Late abortion 12-28W,Spontaneous abortion,Artificial abortion,1/7/2026,19,Abortion and Ectopic pregnancy,Etiology,Genetic factors,Maternal factors,Infection,systemic factors heart disease sever anemia endocrine,Reproductive tract abnormality,Immunologic factors,Enviromental,factors,Toxin Radiation smoking,alohol,1/7/2026,20,Abortion and Ectopic pregnancy,Pathology,1.Haemorrhage,occurs in the,decidua,basalis,leading to local necrosis and inflammation,.,1/7/2026,21,Abortion and Ectopic pregnancy,2.The ovum,partly or wholly detached,acts as a foreign body and irritates uterine contractions.The cervix begins to dilate.,1/7/2026,22,Abortion and Ectopic pregnancy,3.Expulsion complete,The,decidua,is shed during the next few days in the,lochial,flow.,1/7/2026,23,Abortion and Ectopic pregnancy,Clinical manifestation,Haemorrhage,is usually the first sign and may be significantly if placental separation is incomplete.,Pain is usually intermittent,like a small,labrur,.It ceases when the abortion is complete.,1/7/2026,24,Abortion and Ectopic pregnancy,Threatened abortion,Low abdominal Pain company vaginal bleeding,Cervix is closed,unrupture,of membrane,Embryo survive,1/7/2026,25,Abortion and Ectopic pregnancy,Inevitable abortion,Bleeding increased,Pain development,Ruputure,of membrane,Cevix,dilation,Embryo tissue incarcerated in the cervix,1/7/2026,26,Abortion and Ectopic pregnancy,Complete abortion,Uterine 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.,1/7/2026,27,Abortion and Ectopic pregnancy,Incomplete abortion,In 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.,1/7/2026,28,Abortion and Ectopic pregnancy,Missed abortion,Is the retention of a failed intrauterine pregnancy for a extended period,usually defined as more than two menstrual cycles,Recurrent abortion,It is a term used when a patient has had two or more consecutive spontaneous abortions,Septic abortion,1/7/2026,29,Abortion and Ectopic pregnancy,Treatment of abortion,Incomplete abortion,Remove 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,1/7/2026,30,Abortion and Ectopic pregnancy,Removal of placental tissue with ovum forceps.,1/7/2026,31,Abortion and Ectopic pregnancy,1/7/2026,32,Abortion and Ectopic pregnancy,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,1/7/2026,33,Abortion and Ectopic pregnancy,Zhao,aimin,M.D.,Ph.D.,Professor,Department of Obstetrics&Gynecology,Renji,Hospital Affiliated to SJTU School of Medicine,Thanks for Your Attention,