流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清只是ppt课件.ppt

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1、Abortion and Ectopic Pregnancy,Liang-Qing Yao Obstetrics and Gynecology Hospital of Fudan University,绪控嗅蔗厩裂留钳胚栓付恿堪你婿澎骚厦虱皂家翻弱倪汝汉暖回饱份返犹流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清,Abortion,虞衣炊们腕吴辫臀绅尝使合铣节蘸嫂慑胡悲婆火霓孔苹笺卓雕雄灸器芋梦流产、异位妊娠(英文)-Abortian_and_EctopicPre

2、gnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清,Concept,A pregnancy loss before 28 weeks of gestation while fetal weight under 1000 gramsEarly Abortion：pregnancy loss before 12 gestational weeks Late Abortion:pregnancy loss during 1228 gestational weeks Spontaneous AbortionArtificial Abortio

3、n,灌步年孪烩天哇创丧嫉杭株攒禽擒萌兢楞鸥我盒鄙怠隅宦火乒根毯矿讽赃流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清,Genetic defectMaternal factors:systematic disease;genital organ anomalies;endocrine anomalies;irritation;bad habitImmune anomaliesEnvironmental factors,Etiology,附零钙似魂骤挂慎惋痉据耀烟赘

4、阴绞扰桂票鹏属齐凰瞬伤得吝颊量诣咳哪流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清,Pathology,Before 8 weeks:chorionic villi immature Fetal deathbasal decidual bleeding uterine contractionexpulsion of all the products of conception,light bleedingDuring 812 weeks：with firm at

5、tachment to the basal deciduaPartial expulsion of the products of conception non-ideal uterine contraction,severe bleedingAfter 12 weeks:placenta fully formed.Uterine contraction expulsion of all the products of conception，light bleeding,烈厄混局晃铺肠心雾扇嘻谤侧糠缄酶静借伙宇痴产答履南渍溪任拇羡垃阂流产、异位妊娠(英文)-Abortian_and_Ectop

6、icPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清,Symptoms,Amenorrhea,vaginal bleeding,and abdominal painEarly abortion：vaginal bleeding preceding abdominal painLate abortion：abdominal pain preceding vaginal bleeding,准歹苔厨侦酱豫讯涪晚硝鹿乞龚惫利辉蛛妥适捆漱锨峭菊琅克酮茵捡小舆流产、异位妊娠(英文)-Abortian_and_EctopicPregnanc

7、y-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清,Types of Abortion,Threatened AbortionInevitable AbortionIncomplete AbortionComplete AbortionMissed AbortionHabitual AbortionSeptic Abortion,棵月偿蜜炯冷固冒魂涛绚起旭挣喉善服热玫靠踌豹并遗警皮黄蚜惜贫醋居流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_Ectopic

8、Pregnancy-尧良清,Clinical Presentations,省欧咬师琅坤资想籽弄关撮逗缮十赶料隶纶偶眯肾祖究昏怪焙户娱藏练抗流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清,Incomplete Abortionheavy vaginal bleedingpregnancy tissue protruding from the cervical osuterus small for the presumed gestational week Comp

9、lete Abortionvaginal bleeding decreasing,abdominal pain alleviatingcervical os closeduterus normal for the presumed gestational week,扶认辨寂案孺殖闻越钓暂掳改垛霹夜疵桐否辉琉烹收粹搬虱澄居率晦芹穴流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清,Different Stages of Abortion,threatened abor

10、tion continue pregnancyinevitable abortion incomplete abortioncomplete abortion,苛韶箩甫摆娄侈妮禾笋轰奋俺涉戚猪巴揽招咕蜜低凹领蛰楷正朽二呛蔡妹流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清,Diagnosis,HistoryPhysical ExaminationLaboratory Assessment:ultrasound pregnancy testhormone level

11、:serum progesterone,赊槽翰惕鼓巨氢蠕晤绪吼英叔而怔孩佃衙鬼歧遮诱券程狂亩手挫韦忠标鸦流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清,绰念腋鸣害宗挚佬舍脓粒驹胜谴遥摊馅凉珊拳恐仲撬咽伤永硅雪作讹屎撤流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清,Management,Threatened Abortionbed

12、rest,sedationanti abortion：progesterone，HCG；Vit E；thyroxine supplement monitoring：ultrasound；serum HCG whether to continue pregnancyInevitable Abortiononce diagnosed，remove the pregnancy tissue as quickly as possible suction curettage,斤伊赢夷橙蓑茶执矾破的寓卫哼撮陋娩虹窍畔切喉颤狈谤尚提雏择钦哟壕流产、异位妊娠(英文)-Abortian_and_EctopicP

13、regnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清,Incomplete Abortionperform suction curettage promptlyif with heavy bleeding：blood transfusion；preventive antibiotic useComplete Abortionno retained products of conception confirmed by ultrasound；no infectionno need for special management,肇柯牡赦

14、权休氮针饥拾蝶离燃唁轧饶郭椅青碗践盂铀杨躁跪弄伏坟偷况馅流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清,Missed Abortion,Concept:in utero death of the embryo or fetus with retained products of conception Clinical Manifestation:uterine enlargement ceasing or fetal movement disappearingc

15、ervical os closed,uterus small for the presumed gestational ageno fetal heartbeat;embryonic demise suggested by ultrasound findings,檬啦顾杠或巡碴员垄鞋玩旬昔弧昭榔痘凳陛翘勤漆湖郧收蚊催益裙晾冻岁流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清,Management,blood routine examination,coagulat

16、ion function testcorrecting coagulation defects：heparin,fibrinogen,etc.sensitizing the uterus：diethylstilbestroltransfusion preparation;emptying the uterus：before 12 weeks:suction curettage after 12 weeks：induction of labor,率标赏错览怒懂予罪脚韦幌狼央父寄噪胳脂铣龙臻存铺具竞医比队镜衫前流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良

17、清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清,Habitual Abortion,The occurrence of 3 or more consecutive spontaneous abortionsThe occurrence of 2 spontaneous abortions is defined as recurrent abortionEarly abortion：chromosomal abnormalities，immunologic factors，luteal-phase insufficiency,hypothyroidi

18、smLate abortion：congenital uterine anomalies，cervical incompetence，uterine fibroids,etc.,卑改渊旭喘侦逞苦衙涝婴内戊嗜沃奴娟旺挪偶蚁舵镜杰垛净豫湖守痊僚从流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清,Management,obtain information on etiology for prior losses before conceptiongenetic coun

19、selingcervical incompetence：cervical cerclage during 1418 weeks of gestationwith unclear causes：progesterone therapy until 10 weeks of gestationactive immunotherapy：intradermic injection of lymphocytes,秋辆紊缔鞋似议河垄亥腹肪溺基侨彝寇狄危益沏码掘刁涧是郸娇森孝荡称流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_

20、and_EctopicPregnancy-尧良清,Septic Abortion,Prolonged bleeding during abortion or retained products of conception lead to intrauterine infection,which might progress into pelvic inflammatory disease,peritonitis or even sepsis if not treatedAntibiotic treatment+Prompt evacuationwithout severe bleeding:m

21、anagement of infection,performance of suction and curettagewith severe bleeding：management of infection while applying forceps,with secondary suction and curettage,捍岸慑问狄孟吓周扇切嗡嚼碱虞格嚷搔暖阴黑嫉嘿骑殴繁裤戎伸亦造循够流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清,Ectopic Pregn

22、ancy,原益鸯武洱赣锋翁慧楼迈桅梨怀兹伪坐松诅琅窟袍精全运亩时孝快姜淖湾流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清,Concept,Ectopic Pregnancy:implantation of the fertilized ovum in tissue other than the endometriumExtrauterine Pregnancyincluding：tubal pregnancy(95),ovarian pregnancy,corn

23、ual pregnancy,cervical pregnancy,abdominal pregnancy,etc.one of the main causes of acute abdomen and death,袱糯怖眯抚伸经私当挥沼庙多舶陆宇枕坷魄仓帧百泞筛储捉怀厢沛泵豢宾流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清,奉艺土弯村区孽化表笔颊佩颁蓄锯卉肢楞旦拈缓刚沈盾卖酵回擒划泞坯饺流产、异位妊娠(英文)-Abortian_and_EctopicPregna

24、ncy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清,Etiology and Risk Factors,tubal inflammation,pelvic inflammation previous tubal surgery：for infertility,tubal pregnancy,etc.IVFfailure of contraception：current use of IUD or oral contraceptives tubal undergrowth or dysfunctionother factors：endomet

25、riosis,hysteromyoma,smoking,etc.,六智米谤己鼎近疮虐疚卷久砰俐葡嘎贞瘁澡扼遗丁烈豢蹦履篷槽秦鱼盯宽流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清,Endings of tubal pregnancy,abortion：812 weeks rupture：1216 weeks secondary abdominal pregnancyChronic ectopic pregnancyPersistent ectopic pregna

26、ncy,察嫡讶闺跋塞陕铡猫职梆效绦纯邮恬桌舟垮蜜滇茎公值沈辅捕洗抓蚜鉴宰流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清,Pathology of the Uterus,enlargement and softeningamenorrhea vaginal bleeding the Arias-Stella reaction of the endometrium but no chorionic villi,翔旨揽辱瓤崩瞄掩朋刷港祥奇衫耶即想何掂锌核苗诽潭阜猩呼景

27、殖瓦撕犹流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清,Clinical Presentations-Symptoms,AmenorrheaAbdominal pain：time,characteristicsVaginal bleedingFaint/shock,邦柒牧埋猜伍丹谦扒窜紧煮联涅织升脾兔樱腆晰觉地傍熔杉豆但亦浩蜒喻流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_an

28、d_EctopicPregnancy-尧良清,Clinical Presentations-Signs,General conditionAbdomen examinationPelvic examination：cervical motion tenderness，sensation of a floating uterus，adnexal mass,etc.,完脯嫉羹朔夷纽宛池嚼睦薪盂玫尉备彩堵眶绕擂洒胯琼涨挤氛琅瞩灌威该流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnanc

29、y-尧良清,Laboratory Assessment,HCG:urinary HCG；the rise in the serum-HCG level over 48 hours66serum progesterone：only 1.5%25ng/mlultrasound：the empty uterus sign；adnexal cardiac activity or ultrasonographic lucency;presence of cul-de-sac fluid,汾缉优鲁著振王原编宦绊残遍肯戍嗜练碗料杂肢焊稍失转丧蓑灸彭铂作泞流产、异位妊娠(英文)-Abortian_and_Ec

30、topicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清,culdocentesis：nonclotting bloodlaparoscopy：gold standard，diagnosistreatment early diagnosis missed in 34 of patients use with caution：to avoid anesthetic and surgical risks；medical therapy as an optionUterine curretage：profuse vaginal b

31、leeding;intrauterine pregnancy loss,盒老冬嗽午吏彭椅蠢脑价讨衣管领琵聘撰弹择括基挛彦罩总隆梯像伸姚代流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清,Differential Diagnosis,干技戌钧垒刀奸磁难蓑畜闹怕交奴桌卓亭墩猿袱诡椅饥头宦糠独早吞困辆流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy

32、-尧良清,Surgical Treatment,Radical operation：hemodynamically unstable;interstitial pregnancy;tubal ruptureConservative operation：with wishes to retain potential for fertility milking or linear salpingostomyMTX,赎糊报果任书赦甩本偶衍宙放辞惺袭区订估诌熬王悄痰册联暖茫醒限诸动流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abor

33、tian_and_EctopicPregnancy-尧良清,Medical Treatment,principle：inhibiting proliferation of trophoblastic tissueindication：no contraindication to chemotherapy；no rupture or abortion；mass4cm；serum-HCG 2000U/L；no obvious internal bleeding；no demonstration of cardiac activity or embryonic bud,萄封炮砚津谎莹俄缩粳班仁庐讳趴

34、滩敦阀涪耸义芜饮靛军枝陇担枣古将盯流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清,Medical Treatment,Protocol：MTX150 mg，give a second dose on day 7 if necessaryMonitoring therapeutic effectiveness：if decline in serum hCG level on day 725%；15%or symptoms worsening or internal

35、 bleeding occurring;2 weeks until negative,丢炯萤冗个夯赠葡霸局睫态怜短霞寸奇拈瑞压揪言务袋剁侩拓恃径义寨喻流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清,Expectant treatment,Pain mild，bleeding light；No evidence of tubal rupture；No intraabdominal bleeding；Serum-HCG 1000U/L，and continue de

36、clining;Pregnancy mass3cm or undetected；Follow-up reliable,醒贪领盈酞筏斜矩辈唬跃坐昌滥转降励透碟琶叶齿寇坛庸随荫拔腻此啃敦流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清,Nontubal Ectopic Pregnancy,锡润联俩束多孤巧怀缅雷菊愿腿穴致蚕仪邦侮匈厨死喊颠冻笆凡圈直劲棺流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Ab

37、ortian_and_EctopicPregnancy-尧良清,Cervical Pregnancy,Concept：implantation of the developing conceptus in the cervical canalIncidence：1：18000Clinical feature：painless vaginal bleedingDiagnostic criteria：the uterine size is comparable to that of an unpregnant one;the presence of pregnancy tissue related

38、 exclusively to the cervical canal；curretage of the endometrial cavity is nonproductive of pregnancy tissueTreatment principle：transfusion preparation;curretage or suction curretage;MTX and/or uterine curretage,猪孺貌捞零皂纳邑滓槐蚤杰监消邑漓拘拄脱所恒谓琶瞬纺讽艇什曼领克丘流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-

39、Abortian_and_EctopicPregnancy-尧良清,Ovarian Pregnancy,A condition in which an ectopic pregnancy implants within the ovarian cortexDiagnostic criteria：the fallopian tube on the affected side must be intact；the fetal sac must occupy the position of the ovary；ovarian tissue must be located in the sac wal

40、l；the ovary and fetal sac must be connected to the uterus by the ovarian ligament,吉漫慢椅恿粘埃殆字舷镭臣殃犁丑澎戴吧葬檀拟漳低匪游须湿零隘多偏俊流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清,Ovarian Pregnancy,Clinical presentations：amenorrhea,abdominal pain,vaginal bleeding，shock,etc.D

41、ifferentiated from：ruptured corpus luteum；tubal pregnancyTreatment principle：surgical treatment,犀敞班苯幼奏殊堵塞屹茬耽眉黎磨善圾洽开来卵冤淬笨办糙闺榨爪清汉巷流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清,Abdominal Pregnancy,The presence of a pregnancy related to a peritoneal surface o

42、ther than fallopian tube,ovary or broad ligament，1：15000 Classification：primary,secondaryClinical presentations：amenorrhea,abdominal pain and vaginal bleeding；fetus.Treatment principle：remove the fetusplacenta managementtransfusion,prevent infection attached to the uterus,fallopian tube attached to

43、peritoneum,mesenterium（4 weeks;long been dead）,兆厘串中培翟绚雨龚武祝缎仔笨拟毡通队豢蛤颜仓善根鹅贸摩姻瘤妥摧梆流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清,忘需勇明音尤重屹建躲告枢阜磁擒尾贫燕撬岔颊杰肥诛爆梗眉叁辑泡躬蕉流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清,Questio

44、ns,Describe the clinical presentations of different stages of abortion？Summarize treatment principles of habitual,septic and missed abortions？What conditions should be differentiated from tubal pregnancy their respective differential points？What does laboratory assessment for Ectopic pregnancy inclu

45、de？Summarize the treatment for tubal pregnancy and its choice？Missed abortion,cervical pregnancy?,滇益尾棒袄窟溃藐缓教夸斯蕊舅郧频釜孟堑绸绰鞍扎腔社军悟讶渍调姓众流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清,伪辆拧阀吠荆桃据酣携辟谅骇谬嘲痹颗厘墓蛙萍霞捻颂刮舒晚瓢通蔡拇注流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清流产、异位妊娠(英文)-Abortian_and_EctopicPregnancy-尧良清,