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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