Docstoc

Ectopic pregnancy - PowerPoint

Document Sample
Ectopic pregnancy - PowerPoint Powered By Docstoc
					                      Case
  patient xxx, female, 35 years old
Symptom: amenorrhea for 47 days ; spot vaginal
  bleeding for 3 days; sudden abdominal pain for 2
  hours.
Signs: Bp 12/8Kpa, P 120 times/min, abdominal
  tenderness and rebound tenderness (+); sharp
  pain on motion of the cervix.
   sonography: a 4X5 cm irregular mass, 3 cm-depth
fluid in cul-de- sac
   culdocentesis: 2 ml bloody fluid (did not clot)
   urine HCG (+)
       If you were the doctor,

1. what diagnosis would you
think of first ?

2. How would you treat the
patient ?
                                 ?
                    !

Ectopic pregnancy
    异位妊娠
New words
     Ectopic pregnancy   异位妊娠
     fallopian tube      输卵管
     blastocyst          囊胚
     cervix              宫颈
     amenorrhea          停经
     culdocentesis       后穹隆穿刺
Ⅰ.Definition
   The blastcyst normally implants in the
    endometrial lining of the uterine cavity.
    Implantation anywhere else is an ectopic
    pregnancy.
   It is one in which the fertilized ovum is
    implanted and developed outside of the
    uterine cavity.
 II.Incidence
 more than 1 in every 100 pregnancy
  III . Types of ectopic pregnancy
Tubal            95%
Ovarian     0.5-1%
Cervical
Abdominal
Broad ligament
      Ⅳ.Tubal pregnancy
   It is one of abdominal emergency.
   Interabdominal hemorrhage sever
    hemorrhge shock        died
   1.site
    ※(1)Ampullar 60%
     (2)isthmic 25%
     (3)fimbrial 17%
     (4)Interstitial 2%~4%
Etiology
   (1)pelvic infection
    chronic salpingitis : 30%~50%
    PID(pulvic inflammatory disease)
    (2) previous tubal surgery
    (3)developmental and functional tubal
        abnormality
   (5)Increased use of assisted reproductive
    technique
   (6)Popularity of contraception that prevent
    intrauterine but not extrauterine pregnancy
   (6)endometriosis etc
3.Pathology
    A. tubal pregnancy
   (1)tubal abortion
   common in ampular tubal pregnancy
   (2)tubal rupture: profuse hemorrhage
         common in isthmic TP: 6w
         interstitial TP: 16w
    (3)abdominal pregnancy
B.uterine changes

    Arias-Stella reaction(hyperplasia
     endometrii)
    dicidua cast
    the endometrium undergoes dicidual
     changes indistinguishable from those
     which occur in normal pregnancy
4.Clinical manifestation of
           tubal pregnancy
Symptoms

   (1)amenorrhea
   (2)low abdominal pain
   (3)vaginal bleeding
   (4)shock and collapse
    Signs
   (1)general condition
   (2)abdominal examination
   (3)pelvic examination
       ①the posterior fornix: tendness
       ②pain on motion of cervix
       ③uterus: 6~8w size, soft, float
       ④a soft and elastic mass
   5.Diagnosis
Symptom
Sign
axillary examination
   (1) pregnancy tests:β-HCG>25u
                       quantitive serum β-HCG
   (2) pelvic ultrasound
   (3) culdocentesis: the bloody fluid does not clot
    (4)laproscopy: diagnosis and treatment
   (5)endometrial histology: Arias-Stella reaction
6.Differential diagnosis
   (1)abortion
   (2)salpingitis: HCG, sonography, WBC↑,T↑
   (3)appendicitis :
        tenderness at McBurney’s point, WBC↑
   (4)torsion of an ovarian cyst: B-u, HCG
   (5) ruptured corpus luteum
       B-u
7.Treatment
In   emergency condition
       antishock and operation
       at same time
     Surgical management: laproscopy
                            laprotomy
    Radical: salpingectomy (common)
    conservative: salpingostomy(造口)
                  salpingotomy(切开)
                  salpingoplasty(成形)
                 segmental resection and
                  anastomosis
l a p a r o s c o p e
   medical treatment
       indications:
        ①before rupture or abortion of tubal
    pregnancy, there is less intraabdominal
    bleeding
        ②mass< 4cm
        ③ quantitive serum β-HCG <2000u/L
        ④no contraindication
   Drug: MTX
   Method:
    ①50mg/cm body surface. im
    ②local injection laparoscopy
                      hysteroscopy
                      ultrasound: form cal-de-sac
h y s t e r o s c o p e
Expectant therapy

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:289
posted:8/19/2012
language:English
pages:31