妇产科宫外孕.pptVIP

异 位 妊 娠 Ectopic Pregnancy (宫 外 孕 extrauterine pregnancy) Introduction Definition Etiology (the most common cause) Pathology (three pathological terminations) Clinical Manifestation (the classic triad) Diagnosis (four ancillary methods) Treatment (the primary treatment) Definition: Pregnancy in any location other than the body of the uterus is considered ectopic. Incidence: 0.5~1% 图1 异位妊娠的发生部位 Tubal Pregnancy 壶腹部(Ampulla) 55~60% 峡部(Isthmus) 20~25% 伞部(Fimbria) 少见 间质部(Interstitial portion) 少见 Chronic salpingitis pelvic inflammatory disease (PID)盆腔炎 sexually transmitted disease(STD)性传播疾病 Prior tubal surgery tubal sterilization or salpingectomy 绝育 输卵管切除术 Current IUD use:intrauterine device 宫内节育器 History of infertility Etiology Pathology 一、Terminations of tubal pregnancy 2 1、输卵管腔 2、输卵管内血肿 3、绒毛侵犯管壁 4、绒毛膜 5、羊膜 图2 输卵管妊娠剖面示意图 图3 输卵管妊娠时孕卵的着床部位 1、着床于粘膜皱襞内常向管腔破裂 2、着床于粘膜皱襞间常穿破管壁 （一）Tubal abortion 图4 输卵管妊娠流产 （二）Rupture of tubal pregnancy 图5 输卵管妊娠破裂 ampullary pregnancy: 8-12W (abortion,rupture) isthmic pregnancy: 6W (rupture) interstitial portoion: 4M(rupture) 图6 间质部妊娠 (三)Secondary abdominal pregnancy 图7 腹腔妊娠 示意图 二、Uterine changes （一）Enlargement and soft: same as IUP(intrauterine pregnancy) 宫内孕 图8 输卵管妊娠子宫剖面示意图 （二）Endometrium 子宫内膜 decidual reactiion 蜕膜变 Arias-Stella reaction A-S反应 proliferative phase 增生期 secretory phase/menstrual period 分泌期或月经期 Clinical Manifestation 一、 Symptoms Amenorrhea 停经 Abdominal pain 腹痛 Vaginal bleeding 阴道出血 Syncope and shock 晕厥与休克 Symptoms Amenorrhea (3/4) mistake uterine bleeding for true menstruation(月经) lack of amenorrhea do not exclude Abdominal pain(90-100%) due to t