流产异位妊娠(英文)-AbortianandEctopicPregnancy-尧良清.pptVIP

* * * * * * * * * * * * * * * * * * * * * * Surgical Treatment Radical operation：hemodynamically unstable ; interstitial pregnancy; tubal rupture Conservative operation：with wishes to retain potential for fertility －milking or linear salpingostomy＋MTX Medical Treatment principle：inhibiting proliferation of trophoblastic tissue indication：no contraindication to chemotherapy ；no rupture or abortion；mass≤4cm；serum β-HCG ＜ 2000U/L；no obvious internal bleeding；no demonstration of cardiac activity or embryonic bud Medical Treatment Protocol：MTX150 mg，give a second dose on day 7 if necessary Monitoring therapeutic effectiveness：if decline in serum hCG level on day 7≤25%； ＜15% or symptoms worsening or internal bleeding occurring; 2 weeks until negative Expectant treatment Pain mild，bleeding light； No evidence of tubal rupture； No intraabdominal bleeding； Serum β-HCG ﹤ 1000U/L，and continue declining; Pregnancy mass﹤3cm or undetected； Follow-up reliable Nontubal Ectopic Pregnancy Cervical Pregnancy Concept：implantation of the developing conceptus in the cervical canal Incidence：1：18000 Clinical feature：painless vaginal bleeding Diagnostic criteria：the uterine size is comparable to that of an unpregnant one; the presence of pregnancy tissue related exclusively to the cervical canal；curretage of the endometrial cavity is nonproductive of pregnancy tissue Treatment principle：transfusion preparation; curretage or suction curretage ; MTX and/or uterine curretage Ovarian Pregnancy A condition in which an ectopic pregnancy implants within the ovarian cortex Diagnostic 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 Ovarian Pregnancy Clinical presentations：amenorrhea, abdominal pain, vaginal bleeding，shock, etc. Differentiated from：ruptured corpus luteum；tubal pregnancy Treat