Ectopic pregnancy Abortion

1
Ectopic pregnancyAbortion
Zhao aimin M.D.,
Ph.D., Professor
Department Of
Obstetrics Gynecology
Renji Hospital Affiliated to SJTU
School of Medicine

2
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
3

• Implant locations
• Tubal 95 (80 ampullary portion)
• Ovarian lt1
• Abdominal 1-2
• Cervical 0.15
• Cornual 2

4
Etiology Salpingitis have 6-fold increase the
risk of ectopic
pregnancy Operation of tubal IUD(intrauterine
device) Dysfunction of tubal Orther
endometriosis
5
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
6
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
7

• Physical findings in tubal pregnancy
• General findings
• Anemic or pale face
• pulse increased
• BP decreased
• Tlt 38 degree

8

• Abdominal examination
• distention and tenderness with or without rebound
• Decreased bowel sound
• Shifting dullness positive
• mass

9

• Pelvic examination
• Slightly open cervix with bleeding
• Cervical motion tenderness
• Adnexal tenderness
• Adnexal mass
• The uterus size may be normal or enlarged

10
Diagnostic procedures Typical cases can be
determined easy Early ectopic pregnancy or
unrupture type difficulty It is nessesary to need
assistant examination
11

• 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

12

• 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

13

• 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

14

• Differential diagnosis
• Abortion
• Acute salpingitis
• Acute appendicitis
• Rupture of corpus luteum
• Torsion of ovarian cyst

15

• Treatment of ectopic pregnancy
• Surgical treatment
• Salpingectomy
• Conservative operation
• Salpinggostomy
• Segmantal resection and tubal reanatomosis

16

• Nonsurgical therapy
• Chinese traditional medicine
• Chemical therapy
• DrugMTX
• Indication
• The diameter of the mass lt3cm
• Unrupture
• Not significantly bleeding
• HCG level lt2000U/L

17
Abortion
18

• Definition
• Abortion is the termination of a pregnancy before
  28 weeks from the first day of the last menstrual
  period and the fetus weight lt1000g

19

• Classification
• Early abortion lt12W
• Late abortion 12-28W
• Spontaneous abortion
• Artificial abortion

20

• Etiology
• Genetic factors
• Maternal factors
• Infection
• systemic factors heart disease sever anemia
  endocrine
• Reproductive tract abnormality
• Immunologic factors
• Enviromental factors Toxin Radiation smoking
  alohol

21
Pathology 1.Haemorrhage occurs in the decidua
basalis leading to local necrosis and
inflammation.
22
2. The ovum, partly or wholly detached, acts as a
foreign body and irritates uterine contractions.
The cervix begins to dilate.
23
3. Expulsion complete, The decidua is shed during
the next few days in the lochial flow.
24
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.

25
Threatened abortion
Low abdominal Pain company vaginal
bleeding Cervix is closed unrupture of
membrane Embryo survive
26
Inevitable abortion
Bleeding increased Pain development Ruputure of
membrane Cevix dilation Embryo tissue
incarcerated in the cervix
27
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.
28
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.
29
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
30

• 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

31
Removal of placental tissue with ovum forceps.
32
(No Transcript)
33

• 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

34
Thanks for Your Attention

Zhao aimin M.D., Ph.D., Professor

Department of Obstetrics Gynecology

Renji Hospital Affiliated to SJTU
School of Medicine