流产异位妊娠

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Abortion

1ConceptApregnancylossbefore28weeksofgestationwhilefetalweightunder1000gramsEarlyAbortion：pregnancylossbefore12gestationalweeksLateAbortion:pregnancylossduring12～28gestationalweeksSpontaneousAbortionArtificialAbortion

2GeneticdefectMaternalfactors:systematicdisease;genitalorgananomalies;endocrineanomalies;irritation;badhabitImmuneanomaliesEnvironmentalfactorsEtiology

3PathologyBefore8weeks:chorionicvilliimmatureFetaldeath→basaldecidualbleeding→uterinecontraction→expulsionofalltheproductsofconception,lightbleedingDuring8～12weeks：withfirmattachmenttothebasaldeciduaPartialexpulsionoftheproductsofconception→non-idealuterinecontraction,severebleedingAfter12weeks:placentafullyformed.Uterinecontraction→expulsionofalltheproductsofconception，lightbleeding

4SymptomsAmenorrhea,vaginalbleeding,andabdominalpainEarlyabortion：vaginalbleedingprecedingabdominalpainLateabortion：abdominalpainprecedingvaginalbleeding

5TypesofAbortionThreatenedAbortionInevitableAbortionIncompleteAbortionCompleteAbortionMissedAbortionHabitualAbortionSepticAbortion

6ClinicalPresentationsThreatenedAbortionlightvaginalbleedingwithmildabdominalpaincervicalosclosed,fetalmembranesunbrokentreatmentmightwork,continuepregnancyInevitableAbortionbleedingheavier,abdominalpainmoresevere,orfluidpassedcervicalosopen，pregnancytissuevisibleabortionisinevitable

7IncompleteAbortionheavyvaginalbleedingpregnancytissueprotrudingfromthecervicalosuterussmallforthepresumedgestationalweekCompleteAbortionvaginalbleedingdecreasing,abdominalpainalleviatingcervicaloscloseduterusnormalforthepresumedgestationalweek

8DifferentStagesofAbortionthreatenedabortioncontinuepregnancyinevitableabortionincompleteabortioncompleteabortion

9DiagnosisHistoryPhysicalExaminationLaboratoryAssessment:ultrasoundpregnancytesthormonelevel:serumprogesterone

10BleedingAbdominalPainTissueExpulsionCervicalOsUterusThreatenedAbortionInevitableAbortionIncompleteAbortionCompleteAbortionLightMildtoheavyLighttoheavyLighttononeNone/lightIntensifiedRelievedNoneNoneNonePartialCompleteClosedDilatedDilatedorobstructedClosedNormalNormalorslightlysmallSmallNormalorslightlylargeHistoryPelvicExamination

11ManagementThreatenedAbortionbedrest,sedationantiabortion：progesterone，HCG；VitE；thyroxinesupplementmonitoring：ultrasound；serumHCG→whethertocontinuepregnancyInevitableAbortiononcediagnosed，removethepregnancytissueasquicklyaspossiblesuctioncurettage

12IncompleteAbortionperformsuctioncurettagepromptlyifwithheavybleeding：bloodtransfusion；preventiveantibioticuseCompleteAbortionnoretainedproductsofconceptionconfirmedbyultrasound；noinfectionnoneedforspecialmanagement

13MissedAbortionConcept:inuterodeathoftheembryoorfetuswithretainedproductsofconceptionClinicalManifestation:uterineenlargementceasingorfetalmovementdisappearingcervicalosclosed,uterussmallforthepresumedgestationalagenofetalheartbeat;embryonicdemisesuggestedbyultrasoundfindings

14Managementbloodroutineexamination,coagulationfunctiontestcorrectingcoagulationdefects：heparin,fibrinogen,etc.sensitizingtheuterus：diethylstilbestroltransfusionpreparation;emptyingtheuterus：before12weeks:suctioncurettageafter12weeks：inductionoflabor

15HabitualAbortionTheoccurrenceof3ormoreconsecutivespontaneousabortionsTheoccurrenceof2spontaneousabortionsisdefinedasrecurrentabortionEarlyabortion：chromosomalabnormalities，immunologicfactors，luteal-phaseinsufficiency,hypothyroidismLateabortion：congenitaluterineanomalies，cervicalincompetence，uterinefibroids,etc.

16Managementobtaininformationonetiologyforpriorlossesbeforeconceptiongeneticcounselingcervicalincompetence：cervicalcerclageduring14～18weeksofgestationwithunclearcauses：progesteronetherapyuntil10weeksofgestationactiveimmunotherapy：intradermicinjectionoflymphocytes

17SepticAbortionProlongedbleedingduringabortionorretainedproductsofconceptionleadtointrauterineinfection,whichmightprogressintopelvicinflammatorydisease,peritonitisorevensepsisifnottreatedAntibiotictreatment+Promptevacuationwithoutseverebleeding:managementofinfection,performanceofsuctionandcurettagewithseverebleeding：managementofinfectionwhileapplyingforceps,withsecondarysuctionandcurettage

18EctopicPregnancy

19ConceptEctopicPregnancy:implantationofthefertilizedovumintissueotherthantheendometriumExtrauterinePregnancyincluding：tubalpregnancy(95％),ovarianpregnancy,cornualpregnancy,cervicalpregnancy,abdominalpregnancy,etc.oneofthemaincausesofacuteabdomenanddeath

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21EtiologyandRiskFactorstubalinflammation,pelvicinflammationprevioustubalsurgery：forinfertility,tubalpregnancy,etc.IVFfailureofcontraception：currentuseofIUDororalcontraceptivestubalundergrowthordysfunctionotherfactors：endometriosis,hysteromyoma,smoking,etc.

22Endingsoftubalpregnancyabortion：8～12weeksrupture：12～16weekssecondaryabdominalpregnancyChronicectopicpregnancyPersistentectopicpregnancy

23PathologyoftheUterusenlargementandsofteningamenorrheavaginalbleedingtheArias-Stellareactionoftheendometriumbutnochorionicvilli

24ClinicalPresentations-SymptomsAmenorrheaAbdominalpain：time,characteristicsVaginalbleedingFaint/shock

25ClinicalPresentations-SignsGeneralconditionAbdomenexaminationPelvicexamination：cervicalmotiontenderness，sensationofafloatinguterus，adnexalmass,etc.

26LaboratoryAssessmentHCG:urinaryHCG；theriseintheserumβ-HCGlevelover48hours﹤66％serumprogesterone：only1.5%﹥25ng/mlultrasound：theemptyuterussign；adnexalcardiacactivityorultrasonographiclucency;presenceofcul-de-sacfluid

27culdocentesis：nonclottingbloodlaparoscopy：goldstandard，diagnosis＋treatmentearlydiagnosismissedin3％～4％ofpatientsusewithcaution：toavoidanestheticandsurgicalrisks；medicaltherapyasanoptionUterinecurretage：profusevaginalbleeding;intrauterinepregnancyloss

28DifferentialDiagnosisEctopicpregnancyabortionAdnexalinflammationAppendicitisCorpusluteumruptureOvarycysttorsion1.Amenorrhea2.Abdominalpain3.Bleeding4.Shock5.Bodytemperature6.Pelvicexaminatioon7.WBC8.Hb9.HCG10.Ultrasound11.Culdocentesis

29SurgicalTreatmentRadicaloperation：hemodynamicallyunstable;interstitialpregnancy;tubalruptureConservativeoperation：withwishestoretainpotentialforfertility－milkingorlinearsalpingostomy＋MTX

30MedicalTreatmentprinciple：inhibitingproliferationoftrophoblastictissueindication：nocontraindicationtochemotherapy；noruptureorabortion；mass≤4cm；serumβ-HCG＜2000U/L；noobviousinternalbleeding；nodemonstrationofcardiacactivityorembryonicbud

31MedicalTreatmentProtocol：MTX150mg，giveaseconddoseonday7ifnecessaryMonitoringtherapeuticeffectiveness：ifdeclineinserumhCGlevelonday7≤25%；＜15%orsymptomsworseningorinternalbleedingoccurring;2weeksuntilnegative

32ExpectanttreatmentPainmild，bleedinglight；Noevidenceoftubalrupture；Nointraabdominalbleeding；Serumβ-HCG﹤1000U/L，andcontinuedeclining;Pregnancymass﹤3cmorundetected；Follow-upreliable

33NontubalEctopicPregnancy

34CervicalPregnancyConcept：implantationofthedevelopingconceptusinthecervicalcanalIncidence：1：18000Clinicalfeature：painlessvaginalbleedingDiagnosticcriteria：theuterinesizeiscomparabletothatofanunpregnantone;thepresenceofpregnancytissuerelatedexclusivelytothecervicalcanal；curretageoftheendometrialcavityisnonproductiveofpregnancytissueTreatmentprinciple：transfusionpreparation;curretageorsuctioncurretage;MTXand/oruterinecurretage

35OvarianPregnancyAconditioninwhichanectopicpregnancyimplantswithintheovariancortexDiagnosticcriteria：thefallopiantubeontheaffectedsidemustbeintact；thefetalsacmustoccupythepositionoftheovary；ovariantissuemustbelocatedinthesacwall；theovaryandfetalsacmustbeconnectedtotheuterusbytheovarianligament

36OvarianPregnancyClinicalpresentations：amenorrhea,abdominalpain,vaginalbleeding，shock,etc.Differentiatedfrom：rupturedcorpusluteum；tubalpregnancyTreatmentprinciple：surgicaltreatment

37AbdominalPregnancyThepresenceofapregnancyrelatedtoaperitonealsurfaceotherthanfallopiantube,ovaryorbroadligament，1：15000Classification：primary,secondaryClinicalpresentations：amenorrhea,abdominalpainandvaginalbleeding；fetus.Treatmentprinciple：removethefetus＋placentamanagement＋transfusion,preventinfection－attachedtotheuterus,fallopiantube－attachedtoperitoneum,mesenterium（﹤4weeks;longbeendead）

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39QuestionsDescribetheclinicalpresentationsofdifferentstagesofabortion？Summarizetreatmentprinciplesofhabitual,septicandmissedabortions？Whatconditionsshouldbedifferentiatedfromtubalpregnancytheirrespectivedifferentialpoints？WhatdoeslaboratoryassessmentforEctopicpregnancyinclude？Summarizethetreatmentfortubalpregnancyanditschoice？Missedabortion,cervicalpregnancy?

40Thankyou！