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1、Abortion,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 Abortion,Genetic defectMaternal factors:systematic dis
2、ease;genital organ anomalies;endocrine anomalies;irritation;bad habitImmune anomaliesEnvironmental factors,Etiology,Pathology,Before 8 weeks:chorionic villi immature Fetal deathbasal decidual bleeding uterine contractionexpulsion of all the products of conception,light bleedingDuring 812 weeks：with
3、firm attachment 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,Symptoms,Amenorrhea,vaginal bleeding,and abdominal pain
4、Early abortion：vaginal bleeding preceding abdominal painLate abortion：abdominal pain preceding vaginal bleeding,Types of Abortion,Threatened AbortionInevitable AbortionIncomplete AbortionComplete AbortionMissed AbortionHabitual AbortionSeptic Abortion,Clinical Presentations,Threatened Abortion light
5、 vaginal bleeding with mild abdominal paincervical os closed,fetal membranes unbrokentreatment might work,continue pregnancy Inevitable Abortion bleeding heavier,abdominal pain more severe,or fluid passedcervical os open，pregnancy tissue visibleabortion is inevitable,Habitual Abortionvaginal bleedin
6、g decreasing,abdominal pain alleviatingHabitual AbortionHabitual Abortionrupture：1216 weeksperform suction curettage promptlyComplete AbortionMissed abortion,cervical pregnancy?Incomplete AbortionConcept：implantation of the developing conceptus in the cervical canalPelvic examination：cervical motion
7、 tenderness，sensation of a floating uterus，adnexal mass,etc.A pregnancy loss before 28 weeks of gestation while fetal weight under 1000 gramsVaginal bleedingadnexal cardiac activity or ultrasonographic lucency;presence of cul-de-sac fluidLaboratory AssessmentMissed abortion,cervical pregnancy?Pain m
8、ild，bleeding light；IntensifiedPregnancy mass3cm or undetected；,Incomplete Abortionheavy vaginal bleedingpregnancy tissue protruding from the cervical osuterus small for the presumed gestational week Complete Abortionvaginal bleeding decreasing,abdominal pain alleviatingcervical os closeduterus norma
9、l for the presumed gestational week,Different Stages of Abortion,threatened abortion continue pregnancyinevitable abortion incomplete abortioncomplete abortion,Diagnosis,HistoryPhysical ExaminationLaboratory Assessment:ultrasound pregnancy testhormone level:serum progesterone,Complete AbortionDescri
10、be the clinical presentations of different stages of abortion？No intraabdominal bleeding；Light to noneConcept：implantation of the developing conceptus in the cervical canalultrasound：the empty uterus sign；Before 8 weeks:chorionic villi immatureBefore 8 weeks:chorionic villi immaturevaginal bleeding
11、decreasing,abdominal pain alleviatingBefore 8 weeks:chorionic villi immatureone of the main causes of acute abdomen and deathMissed abortion,cervical pregnancy?abortion：812 weeksprevious tubal surgery：for infertility,tubal pregnancy,etc.Summarize the treatment for tubal pregnancy and its choice？Abdo
12、men examinationThe occurrence of 3 or more consecutive spontaneous abortionsMild to heavyPain mild，bleeding light；culdocentesis：nonclotting bloodmonitoring：ultrasound；Partial expulsion of the products of conception non-ideal uterine contraction,severe bleeding,Management,Threatened Abortionbed rest,
13、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,Incomplete Abortionperform suction curettage promptlyif with heavy ble
14、eding：blood transfusion；preventive antibiotic useComplete Abortionno retained products of conception confirmed by ultrasound；no infectionno need for special management,Missed Abortion,Concept:in utero death of the embryo or fetus with retained products of conception Clinical Manifestation:uterine en
15、largement ceasing or fetal movement disappearingcervical os closed,uterus small for the presumed gestational ageno fetal heartbeat;embryonic demise suggested by ultrasound findings,Management,blood routine examination,coagulation function testcorrecting coagulation defects：heparin,fibrinogen,etc.sen
16、sitizing the uterus：diethylstilbestroltransfusion preparation;emptying the uterus：before 12 weeks:suction curettage after 12 weeks：induction of labor,Habitual Abortion,The occurrence of 3 or more consecutive spontaneous abortionsThe occurrence of 2 spontaneous abortions is defined as recurrent abort
17、ionEarly abortion：chromosomal abnormalities，immunologic factors，luteal-phase insufficiency,hypothyroidismLate abortion：congenital uterine anomalies，cervical incompetence，uterine fibroids,etc.,Management,obtain information on etiology for prior losses before conceptiongenetic counselingcervical incom
18、petence：cervical cerclage during 1418 weeks of gestationwith unclear causes：progesterone therapy until 10 weeks of gestationactive immunotherapy：intradermic injection of lymphocytes,Septic Abortion,Prolonged bleeding during abortion or retained products of conception lead to intrauterine infection,w
19、hich might progress into pelvic inflammatory disease,peritonitis or even sepsis if not treatedAntibiotic treatment+Prompt evacuationwithout severe bleeding:management of infection,performance of suction and curettagewith severe bleeding：management of infection while applying forceps,with secondary s
20、uction and curettage,Ectopic Pregnancy,Concept,Ectopic Pregnancy:implantation of the fertilized ovum in tissue other than the endometriumExtrauterine Pregnancyincluding：tubal pregnancy(95),ovarian pregnancy,cornual pregnancy,cervical pregnancy,abdominal pregnancy,etc.one of the main causes of acute
21、abdomen and death,Concept：implantation of the developing conceptus in the cervical canalLate Abortion:pregnancy loss during 1228 gestational weeksWhat conditions should be differentiated from tubal pregnancy their respective differential points？Treatment principle：transfusion preparation;curretage o
22、r suction curretage;MTX and/or uterine curretageHabitual AbortionPelvic examinatioonabortion：812 weeksComplete AbortionNo intraabdominal bleeding；Septic AbortionSpontaneous Abortioncorrecting coagulation defects：heparin,fibrinogen,etc.Ovarian PregnancyBefore 8 weeks:chorionic villi immatureIncidence
23、：1：18000Inevitable AbortionGenetic defectClinical PresentationsProtocol：MTX150 mg，give a second dose on day 7 if necessaryTypes of AbortionPartial expulsion of the products of conception non-ideal uterine contraction,severe bleedingInevitable Abortion,Etiology and Risk Factors,tubal inflammation,pel
24、vic inflammation previous tubal surgery：for infertility,tubal pregnancy,etc.IVFfailure of contraception：current use of IUD or oral contraceptives tubal undergrowth or dysfunctionother factors：endometriosis,hysteromyoma,smoking,etc.,Endings of tubal pregnancy,abortion：812 weeks rupture：1216 weeks sec
25、ondary abdominal pregnancyChronic ectopic pregnancyPersistent ectopic pregnancy,Pathology of the Uterus,enlargement and softeningamenorrhea vaginal bleeding the Arias-Stella reaction of the endometrium but no chorionic villi,Clinical Presentations-Symptoms,AmenorrheaAbdominal pain：time,characteristi
26、csVaginal bleedingFaint/shock,Clinical Presentations-Signs,General conditionAbdomen examinationPelvic examination：cervical motion tenderness，sensation of a floating uterus，adnexal mass,etc.,Laboratory Assessment,HCG:urinary HCG；the rise in the serum-HCG level over 48 hours66serum progesterone：only 1
27、.5%25ng/mlultrasound：the empty uterus sign；adnexal cardiac activity or ultrasonographic lucency;presence of cul-de-sac fluid,culdocentesis：nonclotting bloodlaparoscopy：gold standard，diagnosistreatment early diagnosis missed in 34 of patients use with caution：to avoid anesthetic and surgical risks；me
28、dical therapy as an optionUterine curretage：profuse vaginal bleeding;intrauterine pregnancy loss,Differential Diagnosis,Surgical Treatment,Radical operation：hemodynamically unstable;interstitial pregnancy;tubal ruptureConservative operation：with wishes to retain potential for fertility milking or li
29、near salpingostomyMTX,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,Medical Treatment,Proto
30、col：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 bleeding occurring;2 weeks until negative,Expectant treatment,Pain mild，bleeding light；No evidence of tubal rupture；No intraabdomi
31、nal bleeding；Serum-HCG 1000U/L，and continue declining;Pregnancy mass3cm or undetected；Follow-up reliable,Threatened AbortionGenetic defectHabitual Abortionpregnancy testInevitable AbortionNo intraabdominal bleeding；Clinical presentations：amenorrhea,abdominal pain and vaginal bleeding；no demonstratio
32、n of cardiac activity or embryonic budHabitual Abortionbefore 12 weeks:suction curettageTissue Expulsionpreventive antibiotic useExtrauterine PregnancyInevitable Abortioncervical os closed,fetal membranes unbrokentubal pregnancyGenetic defectAbdominal pain：time,characteristicsserum HCG whether to co
33、ntinue pregnancyFollow-up reliableFaint/shockabortion：812 weeks,Nontubal Ectopic Pregnancy,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
34、 an unpregnant one;the presence of pregnancy tissue related 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,Ovarian Pregnancy,A condition
35、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 wall；the ovary and fetal sac must be connected to the uterus by the
36、 ovarian ligament,Ovarian Pregnancy,Clinical presentations：amenorrhea,abdominal pain,vaginal bleeding，shock,etc.Differentiated from：ruptured corpus luteum；tubal pregnancyTreatment principle：surgical treatment,Abdominal Pregnancy,The presence of a pregnancy related to a peritoneal surface other than
37、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 peritoneum
38、,mesenterium（4 weeks;long been dead）,Questions,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 labor
39、atory assessment for Ectopic pregnancy include？Summarize the treatment for tubal pregnancy and its choice？Missed abortion,cervical pregnancy?,sensitizing the uterus：diethylstilbestrolpregnancy tissue protruding from the cervical osPelvic examination：cervical motion tenderness，sensation of a floating
40、 uterus，adnexal mass,etc.Differential DiagnosisHabitual AbortionPregnancy mass3cm or undetected；Incidence：1：18000What does laboratory assessment for Ectopic pregnancy include？Late abortion：congenital uterine anomalies，cervical incompetence，uterine fibroids,etc.abortion：812 weeksNo evidence of tubal
41、rupture；Pain mild，bleeding light；curretage of the endometrial cavity is nonproductive of pregnancy tissueExpectant treatmentSpontaneous AbortionLaboratory AssessmentSeptic Abortionculdocentesis：nonclotting bloodpreventive antibiotic useabortion：812 weeksInevitable AbortionGenetic defect,Thank you！,P
42、athology,Before 8 weeks:chorionic villi immature Fetal deathbasal decidual bleeding uterine contractionexpulsion of all the products of conception,light bleedingDuring 812 weeks：with firm attachment to the basal deciduaPartial expulsion of the products of conception non-ideal uterine contraction,sev
43、ere bleedingAfter 12 weeks:placenta fully formed.Uterine contraction expulsion of all the products of conception，light bleeding,Types of Abortion,Threatened AbortionInevitable AbortionIncomplete AbortionComplete AbortionMissed AbortionHabitual AbortionSeptic Abortion,Habitual Abortion,The occurrence
44、 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,hypothyroidismLate abortion：congenital uterine anomalies，cervical incompetence，uterine fibr
45、oids,etc.,Endings of tubal pregnancy,abortion：812 weeks rupture：1216 weeks secondary abdominal pregnancyChronic ectopic pregnancyPersistent ectopic pregnancy,Expectant treatment,Pain mild，bleeding light；No evidence of tubal rupture；No intraabdominal bleeding；Serum-HCG 1000U/L，and continue declining;
46、Pregnancy mass3cm or undetected；Follow-up reliable,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 pregn
47、ancy tissue related 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,Ovarian Pregnancy,A condition in which an ectopic pregnancy implants w
48、ithin 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 wall；the ovary and fetal sac must be connected to the uterus by the ovarian ligament,monitoring：ultrasound；
49、abortion：812 weeksDifferential DiagnosisInevitable AbortionHabitual AbortionEctopic pregnancyHabitual AbortionSeptic AbortionDescribe the clinical presentations of different stages of abortion？Complete AbortionPain mild，bleeding light；Threatened Abortionone of the main causes of acute abdomen and de
50、athFollow-up reliableManagementlaparoscopy：gold standard，diagnosistreatmentFetal deathbasal decidual bleeding uterine contractionexpulsion of all the products of conception,light bleedingSpontaneous AbortionConcept：implantation of the developing conceptus in the cervical canalpregnancy tissue protru
