流产、异位妊娠(英文)课件

Abortion and Ectopic Pregnancy1ppt课件AbortionandEctopicAbortion2ppt课件Abortion2ppt课件Concept A pregnancy loss before 28 A pregnancy loss before 28 weeks of gestation while fetal weeks of gestation while fetal weight under 1000 gramsweight under 1000 grams Early AbortionEarly Abortion：pregnancy loss pregnancy loss before 12before 12 gestational weeks gestational weeks Late Abortion:pregnancy lossLate Abortion:pregnancy loss during 12during 122828 gestational gestational weeks weeks SpontaneousSpontaneous Abortion Abortion ArtificiaArtificial Abortionl Abortion3ppt课件ConceptApregnancylossbeforGenetic defectGenetic defectMaternal factors:Maternal factors:systematic disease;genital organ systematic disease;genital organ anomalies;endocrine anomalies;anomalies;endocrine anomalies;irritation;badirritation;bad habithabitImmune anomaliesImmune anomaliesEnvironmental factorsEnvironmental factorsEtiology4ppt课件Etiology4ppt课件Pathology Before 8 weeks:Before 8 weeks:chorionic villi chorionic villi immatureimmature Fetal deathFetal deathbasal decidual bleedingbasal decidual bleeding uterine contractionuterine contractionexpulsion of all the expulsion of all the products of conception,light bleedingproducts of conception,light bleeding During 8During 81212 weeksweeks：with firm with firm attachment to the basal deciduaattachment to the basal decidua Partial expulsion of the products of Partial expulsion of the products of conceptionconception non-ideal uterine contraction,non-ideal uterine contraction,severe bleedingsevere bleedingAfter 12After 12 weeks:weeks:placenta fully placenta fully formed.formed.Uterine contractionUterine contraction expulsion of all expulsion of all the products of conceptionthe products of conception，light light bleedingbleeding5ppt课件PathologyBefore8weeks:choriSymptomsAmenorrhea,vaginal Amenorrhea,vaginal bleeding,and bleeding,and abdominal painabdominal painEarly abortionEarly abortion：vaginal vaginal bleeding preceding bleeding preceding abdominal painabdominal painLate abortionLate abortion：abdominal pain abdominal pain preceding vaginal preceding vaginal bleedingbleeding6ppt课件SymptomsAmenorrhea,vaginalblTypesofAbortionThreatenedThreatened Abortion AbortionInevitable AbortionInevitable AbortionIncompleteIncomplete Abortion AbortionComplete AbortionComplete AbortionMissed AbortionMissed AbortionHabitual Habitual AbortionAbortionSeptic AbortionSeptic Abortion7ppt课件TypesofAbortionThreatenedAbClinicalPresentations8ppt课件ClinicalPresentations8ppt课件Incomplete AbortionIncomplete Abortionheavy vaginal bleedingheavy vaginal bleedingpregnancy tissue pregnancy tissue protruding from the protruding from the cervical oscervical osuterus small for the uterus small for the presumed gestational week presumed gestational week Complete AbortionComplete Abortionvaginal bleeding vaginal bleeding decreasing,abdominal pain decreasing,abdominal pain alleviatingalleviatingcervical os closedcervical os closeduterus normal for the uterus normal for the presumed gestational week presumed gestational week 9ppt课件IncompleteAbortion9ppt课件DifferentStagesofAbortionthreatened abortion threatened abortion continue continue pregnancypregnancyinevitable abortion incomplete inevitable abortion incomplete abortionabortioncomplete abortioncomplete abortion10ppt课件DifferentStagesofAbortiontDiagnosis HistoryHistory Physical ExaminationPhysical Examination Laboratory Assessment:Laboratory Assessment:ultrasound ultrasound pregnancy testpregnancy test hormone level:serum progesteronehormone level:serum progesterone11ppt课件DiagnosisHistory11ppt课件12ppt课件12ppt课件ManagementThreatened AbortionThreatened Abortion bed rest,bed rest,sedationsedation anti abortionanti abortion：progesteroneprogesterone，HCGHCG；Vit EVit E；monitoringmonitoring：ultrasoundultrasound；serum serum HCG whether to continue HCG whether to continue pregnancypregnancyInevitable AbortionInevitable Abortion once diagnosedonce diagnosed，remove the remove the pregnancy tissue as quickly as pregnancy tissue as quickly as possible possible suction curettagesuction curettage 13ppt课件ManagementThreatenedAbortion1 Incomplete AbortionIncomplete Abortionperform suction curettage perform suction curettage promptlypromptlyif with heavy bleedingif with heavy bleeding：blood blood transfusiontransfusion；preventive antibiotic preventive antibiotic useuse Complete AbortionComplete Abortionno retained products of conception no retained products of conception confirmed by ultrasoundconfirmed by ultrasound；no no infectioninfectionno need for special managementno need for special management14ppt课件IncompleteAbortion14ppt课件Missed AbortionConcept:in utero death of the embryo or Concept:in utero death of the embryo or fetus with retained products of fetus with retained products of conception conception Clinical Manifestation:Clinical Manifestation:uterine enlargement ceasing or fetal uterine enlargement ceasing or fetal movement disappearingmovement disappearingcervical os closed,uterus small for the cervical os closed,uterus small for the presumed gestational agepresumed gestational ageno fetal heartbeat;embryonic demise no fetal heartbeat;embryonic demise suggested by ultrasound findingssuggested by ultrasound findings15ppt课件MissedAbortionConcept:inutManagement blood routine examination,blood routine examination,coagulation function testcoagulation function test correcting coagulation defectscorrecting coagulation defects：heparin,fibrinogen,etc.heparin,fibrinogen,etc.sensitizing the uterussensitizing the uterus transfusion preparation;transfusion preparation;emptying the uterusemptying the uterus：before 12 weeks:suction before 12 weeks:suction curettagecurettage after 12 weeksafter 12 weeks：induction ofinduction of laborlabor16ppt课件ManagementbloodroutineexamiHabitual Abortion The occurrence of 3 or more consecutive The occurrence of 3 or more consecutive spontaneous abortionsspontaneous abortions The occurrence of 2 spontaneous abortions is The occurrence of 2 spontaneous abortions is defined as recurrent abortiondefined as recurrent abortion Early abortionEarly abortion：chromosomal abnormalitieschromosomal abnormalities，immunologic factorsimmunologic factors，luteal-phase insufficiency,luteal-phase insufficiency,hypothyroidismhypothyroidism Late abortionLate abortion：congenital uterine anomaliescongenital uterine anomalies，cervical incompetencecervical incompetence，uterine fibroids,etcuterine fibroids,etc.17ppt课件HabitualAbortionTheoccurrenManagementobtain information on etiology for prior obtain information on etiology for prior losses before conceptionlosses before conceptiongenetic counselinggenetic counselingcervical incompetencecervical incompetence：cervical cervical cerclagecerclage during 14 during 1418 weeks of 18 weeks of gestationgestationwith unclear causeswith unclear causes：progesterone progesterone therapy until 10 weeks of gestationtherapy until 10 weeks of gestationactive immunotherapyactive immunotherapy：intradermic intradermic injection of lymphocytesinjection of lymphocytes18ppt课件ManagementobtaininformationoSeptic Abortion Prolonged bleeding during abortion Prolonged bleeding during abortion or retained products of conception or retained products of conception lead to intrauterine infection,which lead to intrauterine infection,which might progress into pelvic might progress into pelvic inflammatory disease,peritonitis or inflammatory disease,peritonitis or even sepsis if not treatedeven sepsis if not treated Antibiotic treatment+Prompt Antibiotic treatment+Prompt evacuationevacuation without severe bleeding:management without severe bleeding:management of infection,performance of suction of infection,performance of suction and curettageand curettage with severe bleedingwith severe bleeding：management of management of infection while infection while applying forcepsapplying forceps,with,with secondary suction and curettage secondary suction and curettage 19ppt课件SepticAbortionProlongedblEctopicPregnancy20ppt课件EctopicPregnancy20ppt课件Concept Ectopic Pregnancy:implantation of the fertilized Ectopic Pregnancy:implantation of the fertilized ovum in tissue other than the endometriumovum in tissue other than the endometrium Extrauterine PregnancyExtrauterine Pregnancy includingincluding：tubal pregnancy(95tubal pregnancy(95),ovarian),ovarian pregnancy,pregnancy,cornual pregnancy,cervical pregnancy,cornual pregnancy,cervical pregnancy,abdominal pregnancy,etc.abdominal pregnancy,etc.one of the main causes of acute abdomen and one of the main causes of acute abdomen and deathdeath21ppt课件Concept21ppt课件22ppt课件22ppt课件EtiologyandRiskFactorstubal inflammation,pelvic tubal inflammation,pelvic inflammation inflammation previous tubal surgeryprevious tubal surgery：for for infertility,tubal pregnancy,etc.infertility,tubal pregnancy,etc.IVFIVFfailure of contraceptionfailure of contraception：current use of IUD or oral current use of IUD or oral contraceptives contraceptives tubal undergrowth or tubal undergrowth or dysfunctiondysfunctionother factorsother factors：endometriosis,endometriosis,hysteromyoma,smoking,etc.hysteromyoma,smoking,etc.23ppt课件EtiologyandRiskFactorstubalEndingsoftubalpregnancyabortionabortion rupturerupture secondary abdominal secondary abdominal pregnancypregnancyChronic ectopic Chronic ectopic pregnancypregnancyPersistent ectopic Persistent ectopic pregnancypregnancy24ppt课件EndingsoftubalpregnancyaborPathologyoftheUterusenlargement and enlargement and softeningsofteningamenorrheaamenorrhea vaginal bleeding vaginal bleeding the Arias-Stella reaction the Arias-Stella reaction of the endometrium but of the endometrium but no chorionic villino chorionic villi25ppt课件PathologyoftheUterusenlargeClinicalPresentations-Symptoms AmenorrheaAmenorrhea Abdominal painAbdominal pain：time,time,characteristicscharacteristics Vaginal bleedingVaginal bleeding Faint/shockFaint/shock26ppt课件ClinicalPresentations-SymptomClinicalPresentations-Signs General conditionGeneral condition Abdomen examinationAbdomen examination Pelvic examinationPelvic examination：cervical motion cervical motion tendernesstenderness，sensation of a floating uterus sensation of a floating uterus，adnexal mass,etc.adnexal mass,etc.27ppt课件ClinicalPresentations-SignsGeLaboratoryAssessment HCG:urinary HCGHCG:urinary HCG；the rise the rise in the serum in the serum -HCG level-HCG level over 48over 48 hourshours6666 serum progesteroneserum progesterone：only only 1.5%1.5%25ng/ml25ng/ml ultrasoundultrasound：the empty uterus the empty uterus signsign；adnexal cardiac adnexal cardiac activity or ultrasonographic activity or ultrasonographic lucency;lucency;28ppt课件LaboratoryAssessmentHCG:uri culdocentesisculdocentesis：nonclotting nonclotting bloodblood laparoscopylaparoscopy：gold standardgold standard，diagnosisdiagnosistreatmenttreatment early diagnosis missed in 3early diagnosis missed in 34 4 of patients of patients use with cautionuse with caution：to avoid to avoid anesthetic and surgical risksanesthetic and surgical risks；medical therapy as an medical therapy as an optionoption Uterine curretageUterine curretage：profuse profuse vaginal bleeding;intrauterine vaginal bleeding;intrauterine pregnancy losspregnancy loss29ppt课件culdocentesis：nonclottingblooSurgicalTreatmentRadical operationRadical operation：hemodynamically hemodynamically unstable;interstitial unstable;interstitial pregnancy;tubal pregnancy;tubal ruptureruptureConservative Conservative operationoperation：with with wishes to retain wishes to retain potential for fertilitypotential for fertility milking or linear milking or linear salpingostomysalpingostomyMTXMTX30ppt课件SurgicalTreatmentRadicaloperMedicalTreatmentprincipleprinciple：inhibiting proliferation of inhibiting proliferation of trophoblastic tissuetrophoblastic tissueindicationindication：no contraindication to no contraindication to chemotherapy chemotherapy；no rupture or abortionno rupture or abortion；massmass 4cm4cm；serum serum -HCG-HCG 2000U/L2000U/L；no no obvious internal bleedingobvious internal bleeding；no no demonstration of cardiac activity or demonstration of cardiac activity or embryonic budembryonic bud31ppt课件MedicalTreatmentprinciple：inhMedicalTreatmentProtocolProtocol：MTXMTXMonitoring therapeutic effectivenessMonitoring therapeutic effectiveness：if if decline in serum hCG level on day 7decline in serum hCG level on day 7 25%25%；15%or symptoms worsening or 15%or symptoms worsening or internal bleeding occurring;2 weeks internal bleeding occurring;2 weeks until negativeuntil negative32ppt课件MedicalTreatmentProtocol：MTX3ExpectanttreatmentPain mildPain mild，bleeding lightbleeding light；No evidence of tubal ruptureNo evidence of tubal rupture；No intraabdominal bleedingNo intraabdominal bleeding；Serum Serum -HCG-HCG 1000U/L 1000U/L，and continue and continue declining;declining;Pregnancy massPregnancy mass3cm or undetected3cm or undetected；Follow-up reliableFollow-up reliable33ppt课件ExpectanttreatmentPainmild，NontubalEctopicPregnancy34ppt课件NontubalEctopicPregnancy34pCervicalPregnancyConceptConcept：implantation of the developing implantation of the developing conceptus in the cervical canalconceptus in the cervical canalIncidenceIncidence：1 1：1800018000Clinical featureClinical feature：painless vaginal painless vaginal bleedingbleedingDiagnostic criteriaDiagnostic criteria：the uterine size is the uterine size is comparable to that of an unpregnant comparable to that of an unpregnant one;the presence of pregnancy tissue one;the presence of pregnancy tissue related exclusively to the cervical canalrelated exclusively to the cervical canal；curretage of the endometrial cavity is curretage of the endometrial cavity is nonproductive of pregnancy tissuenonproductive of pregnancy tissueTreatment principleTreatment principle：transfusion transfusion preparation;curretage or suction preparation;curretage or suction curretagecurretage ;MTX and/or uterine curretage;MTX and/or uterine curretage35ppt课件CervicalPregnancyConcept：implOvarianPregnancyA condition in which an ectopic pregnancy A condition in which an ectopic pregnancy implants within the ovarian corteximplants within the ovarian cortexDiagnostic criteriaDiagnostic criteria：the fallopian tube on the fallopian tube on the affected side must be intactthe affected side must be intact；the fetal the fetal sac must occupy the position of the ovarysac must occupy the position of the ovary；ovarian tissue must be located in the ovarian tissue must be located in the sac wallsac wall；the ovary and fetal sac must be the ovary and fetal sac must be connected to the uterus by the ovarian connected to the uterus by the ovarian ligamentligament36ppt课件OvarianPregnancyAconditioniOvarianPregnancy C Cl li in ni ic ca al l p pr re es se en nt ta at ti io on ns s：a amme en no or rr rh he ea a,a ab bd do ommi in na al l p pa ai in n,v va ag gi in na al l b bl le ee ed di in ng g，s sh ho oc ck k,e et tc c.D Di if ff fe er re en nt ti ia at te ed d f fr ro omm：r ru up pt tu ur re ed d c co or rp pu us s l lu ut te eu umm；t tu ub ba al l p pr re eg gn na an nc cy y T Tr re ea at tmme en nt t p pr ri in nc ci ip pl le e：s su ur rg gi ic ca al l t tr re ea at tmme en nt t37ppt课件OvarianPregnancyClinicalpresAbdominalPregnancyThe presence of a pregnancy related to a The presence of a pregnancy related to a peritoneal surface other than fallopian tube,peritoneal surface other than fallopian tube,ovary or broad ligamentovary or broad ligament，1 1：15000 15000 ClassificationClassification：primary,secondaryprimary,secondaryClinical presentationsClinical presentations：amenorrhea,abdominal amenorrhea,abdominal pain and vaginal bleedingpain and vaginal bleeding；fetus.fetus.Treatment principleTreatment principle：remove the fetusremove the fetusplacenta managementplacenta managementtransfusion,prevent transfusion,prevent infectioninfection attached to the uterus,fallopian attached to the uterus,fallopian tubetube attached to peritoneum,attached to peritoneum,mesenteriummesenterium（4 weeks;long been dead4 weeks;long been dead）38ppt课件AbdominalPregnancyThepresenc39ppt课件39ppt课件40ppt课件40ppt课件