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Early Pregnancy Loss and Ectopic Pregnancy
Xin WuObstetric and Gynecology Hos
pital [email protected]
Case 1
• 27, female, menopause 51 days, a small amount of vaginal bleeding 1 day, no obvious abdominal cramping pain
• Menstrual history: 12 3/30 , rule• G3P0 spontaneous abortion in 2008,
2010
• Ultrasonography: uterus 7×5×4cm, gestational sac 17×12×10mm ,embryo 7mm, fetal heart (+)
• Urine HCG ( + )• Routine blood count and urine: nor
mal
pelvic examination
• Vulva: married type• Vagina: smooth, a small
amount of dark red blood • Cervix: closed, blood-stained,
no obvious motion tenderness• Palace: as 6w+ of pregnancy
size, no tenderness• Annex: soft
QUESTIONS• Current diagnosis• Further examination• Treatment• Prognosis
QUESTIONS• Current diagnosis: incompleted abo
rtion ? Threatened abortion?• Further examination: serum HCG ? r
eview ultrasound ? observe vaginal bleeding and abdominal pain
• Treatment: bed rest , progesterone medical therapy
• Prognosis: good
Case 2
• 29, female, menopause 42 days , a small amount of vaginal bleeding 3 days, sudden right lower abdominal pain 1 hour
• Menstrual history: 14 5-7/28 , rule• G2P0 medical abortion 1 time in 20
10
• Transvaginal ultrasonography: Uterus size 6×5×4cm, endometrium 7mm, no obvious gestational sac, a mixed echo area 25×18×7mm at the left side of the right ovary, dark fluid area deep 12mm behind uterus
• Urine HCG ( ± )• Blood count: Hb 98 g/L• Bp 95/65 mmHg
Pelvic examination
• Vulva: marriged type• Vagina: smooth, a small amount of da
rk blood • Cervix: closed, blood-staining, motio
n tender (+)• Palace: normal size, without tendern
ess• Annex: a 3cm mass palpable on the ri
ght side, tenderness(+)
QUESTIONS• Current diagnosis• Further examination• Treatment method
QUESTIONS• Current diagnosis: Ectopic pregnancy?• Further examination: serum HCG and t
ransvaginal ultrasound• Treatment method: medical therapy (
Methotrexate); surgical management (laparoscopy)
Salpingectomy versus Salpingostomy
Case 3
• 32, female, menopause 42 days, a small amount of vaginal bleeding 1 day, no obvious abdominal cramping pain
• Menstrual history: 13 3/30 , menstrual rules
• G3P0 artificial abortion in 2008, right tubal pregnancy in 2011 (laparoscopic salpingostomy)
• Ultrasound: uterus 7×5×4cm , endometrium 10mm , no gestational sac, no adnexal mass
• Urine HCG ( ± )• Routine blood count and urine test:
normal
Pelvic examination
• Vulva: married type• Vagina: smooth, a small amount
of dark red blood • Cervix: closed, blood-stained,
no obvious motion tenderness• Palace: slightly enlarged, no
tenderness• Annex: soft
QUESTIONS• Current diagnosis
• Further examination
QUESTIONS• Current diagnosis: anembryonic ges
tation? completed abortion ? ectopic pregnancy?
• Further examination: ultrasound and serum HCG every 3 days, observe vaginal bleeding and abdominal pain
Points
• Types of abortion
• Differential diagnosis of ectopic pregnancy
• drug treatment and surgical treatment indications of ectopic pregnancy
Intrauterine abortion
• Anembryonic gestation• Inevitable abortion• Incomplete abortion• Complete abortion
Extrauterine pregnancy
• Tubal pregnancy• Interstitial pregnancy• Abdominal pregnancy• Cervical pregnancy• Ligamentous pregnancy• Heterotopic pregnancy• Ovarian pregnancy
Learn it yourself
• Definition and treatment of premature labor and prolonged pregnancy