妇产科学课件：异位妊娠（英文版）

1、,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Ectopic Pregnancy,Definition,Any gestation in which implantation occurs at a location other than the uterine cavity.,Incidence:approximately 12%of conceptions,Accounts for 10%of pregnancy-related maternal deaths,Category,tubal pregnancy(95%of ectopic pregnancy),ovarian pregnancy,abdominal pregnancy,broad ligament pregnancy,cervical pregnancy,cesarean scar pregnancy,pregnancy in

2、rudimentary horn(子宫残角妊娠）,Tubal pregnancy,Tubal Pregnancy,Sites:,ampulla portion,most common,isthmic portion,fimbrial portion,Interstitial portion,rare,Etiology,chronic salpingitis,previous tubal pregnancy or tubal surgery,abnormalities or Dysfunction,assisted reproductive technique(ART),failure of contraception,Chronic salpingitis,The fertilized ovum gets trapped along the tube.,infection of tubal mucous membrane(,输卵管黏膜炎）,destroy the ciliated,纤毛,epithelium,gonococcus,淋球菌,Chlamydia,衣原体,peripheral

3、 tubal infection(,输卵管周围炎）,adhesions of epithelium,Abortion,delivery,previous tubal pregnancy or surgery,chance of a relapse about 10%with previous tubal pregnancy,Incidence of 1020%with previous tubal surgery,tubal ligation,（结扎术）,tubal repair(reconstructive surgery),Abnormalities or Dysfunction,excessive length of the tube,less development of tubal muscle,lack of cilium,纤毛,congenital diverticula(,憩室,),dysfunction due to endocrine disorder,anxiety,depression,ART,First IVF-ET in 1975 ended up with

4、 ectopic pregnancy.,15%in all ART pregnancy,migration of transferred embryo into the tube,squeezed into the tube by the contraction of uterus,most patients of ART combined with abnormal tubal,Pathology,no complete decidua,narrow lumen and thin muscle,fertilized ovum burrows into the thin tubal muscle,fertilized ovum grows and distends the tube,Pathology,Outcomes of tubal pregnancy,Tubal abortion,Rupture of tubal pregnancy,Obsolete ectopic pregnancy,陈旧性宫外孕,Secondary abdominal pregnancy,Tubal abor

5、tion,occurs most in ampulla about 8th-12th week,two categories:,complete tubal abortion,incomplete tubal abortion,recurrent invasion of tubal wall by trophoblast,repeated hemorrhage,blood collected in the Pouch of Douglas may form a pelvic hematoma.,Tubal abortion,Rupture of tubal pregnancy,mostly occurs in isthmic pregnancis due to the small diameter of this portion of the tube,about 6 weeks gestation,invasion of muscle and serous membrane,浆膜,usually spontaneous,profuse hemorrhage in short time

6、,shock,severe pain,Rupture of tubal pregnancy,Rupture of tubal pregnancy,If implantation is in the interstitial portion,rupture is often delayed at the 12,th,-16,th,week.,due to the thick muscle on the tube wall,severe hemorrhage,hypovolemic shock,Obsolete ectopic pregnancy,In abortion or rupture of tubal pregnancy,recurrent internal hemorrhage,Organization of hematoma血肿机化,Adhesion with tissues around,Lasting and calcification钙化,lithopedion石胎,Secondary abdominal pregnancy,after abortion or ruptu

7、re of tubal pregnancy,embryo expelled,mostly dead,embryo alive occasionally,implants again at broad ligament or in abdominal cavity,2010,湘雅医院,2.18kg,重的腹腔妊娠宝宝王雅奇,Pathology,Uterus changes,uterus enlargement and soften,decidualization,蜕膜化,of endometrium,The decidua will shed after the death of the embryo,and may be passed in fragments or intact as a decidua cast,蜕膜管型,No villi or trophoblastic cell,Uterus change,long after embryo death,proliferative phase,Arias-Stella”(A-S)reaction,alive villi,secre

8、tory phase,Clinical manifestations,amenorrhea,abdominal pain,vaginal bleeding,syncope(,晕厥）,and shock,abdominal mass,Amenorrhea,usually the history of amenorrhea about 6-8 weeks,may be longer history in interstitial pregnancy,Irregular vaginal bleeding in ectopic pregnancy may be mistaken by menstruation,Abdominal pain,the most common clinical complaining(95%),one-side lower abdominal dull pain as the development of the fertilized ovum,tear-like pain when abortion or rupture occurs,radiating pain

9、,Vaginal bleeding,roughly 60%80%of cases,irregular,usually spotting,less than menstrual bleeding,containing decidual cast or fratments,Signs,General examination,when the internal bleeding is rapid and severe:,acute anemia,pallor,rapid and feeble pulse,low blood pressure,Abdominal examination,pressure pain&rebound tenderness,adnexal mass,sometimes ambulant sonant（移动性浊音）positive,Pelvic examination,vaginal bleeding,cervix:tenderness especially on moving the cervix,宫颈举痛或摇摆痛,the most important sign o

10、f tubal pregnancy,uterus:soft and slightly enlarged,adnexa:fullness or an indefinite tender mass,size varies,Diagnosis,history&symptoms,signs,pelvic examination,special examination,Special examination,hCG test,Progesterone test,Ultrasonography,Culdocentesis (,后穹隆穿刺术,),Diagnositic curettage,hCG test,blood or urine hCG,Important for early diagnosis,the value of blood hCG usually less than intrauterine normal pregnancy,continue detection of hCG,duplication time 7 days,very suspicious,Progesterone t

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