妇产科学-Abortian and Ectopic Pregnancy.ppt

Septic Abortion  Prolonged bleeding during abortion or retained products of conception lead to intrauterine infection, which might progress into pelvic inflammatory disease, peritonitis or even sepsis if not treated antibiotic treatment+Prompt evacuation without severe bleeding: management of infection , performance of suction and curettage With severe bleeding：management of infection while applying forceps, with secondary suction and curettage Surgical Treatment Radical operation：hemodynamically unstable ; interstitial pregnancy; tubal rupture Conservative operation：without 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：MTX150mg，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 wit