妇科急腹症1.pptVIP

story Acute abdominal pain wanted to give bowels the abdomen rigidity and tenderness、rebound tenderness. pass water fainted on the spot blood presure was zero Diagnosis? ectopic pregnancy  Ectopic Pregnancy  Definition: Ectopic pregnancy is defined as pregnancy outsied the uterine cavity Most common site of occurrence is the fallopian tube tubal pregnancy 88.5% ovarian pregnancy 4.5% cervical pregnancy 0.7% pregnancy in rudimentary horn 1.5% pregnancy in interstitial 4.8%abdominal pregnancy the UK : 0.25-1% getting more common. In Finland, tripled between 1966 and 1985 in the US , a four-fold rise between 1970 and 1983. In Jamaica, an unusually high rate of ectopic pregnancy (1 in 28 deliveries). etiology: 受精卵着床于子宫体腔以外。或因为输卵管结构异常，或受精卵行走异常。 FACTORS 输卵管结构异常 受精卵行走异常 Pelvic inflammatory disease Advancing age Tubal surgery DES exposure Previous ectopic， repeated IVF and ovulation induction  Previous termination 经宫腔或腹腔向对侧 of pregnancy 输卵管移行 输卵管发育不良或功能异常 smoke IUD Intrauterine device usage 肌瘤，卵巢肿物，EM 输卵管的变化 部位 壶腹部 峡部 间质部 解剖 管腔宽 窄 较窄 肌层 较厚 薄 很厚 停经 8-12周 6周 4个月 表现 流产 破裂 破裂 abdominal pain of ectopic pregnancy tubal rupture: sharp colicky pain tubal abortion:隐痛、胀痛 伴随症状 Straining at stool faintness and shock amenorrhea or menstrual period delayed spotting type bleeding 掉出蜕膜管型 子宫的变化： 子宫稍大 内膜蜕膜反应 胚胎死亡：蜕膜剥离→出血 Arias-Stell反应 sumerize the Symptoms Lower abdominal pain and Abnormal uterine bleeding approximately 1-2 weeks after the missed menstrual period “异位妊娠最容易诊断，异位妊娠最不易诊断” 体检 全身：贫血貌，面色苍白，血压下降，脉搏弱，快。四肢冰冷； 腹部：拒按，腹膜刺激征，全腹压痛、反跳痛重，肌紧张轻(tenderness, rebound tenderness and muscular rigidity)，移动性浊音（＋） 妇科：后穹隆饱满，宫颈着色，举痛，摇摆痛，子宫略大，软，可有飘浮感，一侧附件区触及不规则包块，压痛明显。 辅助检查 Urine preg