异位妊娠以输卵管妊娠最常见Fallopiantubepregnancyisacommon.PPT

Normal location of pregnancy Ectopic pregnancy Pregnancy in any location other than the body of the uterus （子宫） is considered ectopic pregnancy . tubal pregnancy  ovarian pregnancy  cervical pregnancy  abdominal pregnancy broad ligament pregnancy 　异位妊娠以输卵管妊娠最常见 Ectopic pregnancies are usually caused by conditions that obstruct or slow the passage of a fertilized ovum (egg) through the fallopian tube to the uterus. Etiology 1、输卵管炎症(Tubal infection) 2、输卵管手术史(Previous tubal surgery) 3、输卵管发育异常（Congenital tubal abnormalities) 4、辅助生殖技术(ART) 5、宫内节育器(IUD) 6、其他（ Pelvic tumors、endometriosis) Pathology of tubal pregnancy 输卵管管腔狭小，管壁薄且缺乏粘膜下组织，其肌层远不如子宫肌壁厚与坚韧，妊娠时不能形成完好的蜕膜，不利于胚胎的生长发育。 着床于粘膜皱襞间 向管壁穿破 破裂 ampullary pregnancy: 8-12W(abortion,rupture) isthmic pregnancy: 6W (rupture) interstitial portion: 4M(rupture) The change of uterus 子宫增大变软，子宫内膜出现蜕膜反应。 Enlargement and soft: same as IUP(intrauterine pregnancy) ①蜕膜变 ② A-S反应：可能为甾体激素过度刺激引起的子宫内膜过度增生和分泌反应。镜下见内膜腺体上皮细胞 增生、增大细胞边界不清，腺细胞排列成团突入腺腔，细胞极性消失，细胞核肥大、深染，胞浆有泡。 ③增生期改变 ④分泌反应 Symptoms of tubal pregnancy Amenorrhea (停经) Vaginal bleeding (阴道流血) Abdominal pain (腹痛) 典型症状为停经后腹痛与阴道流血。 Amenorrhea mistake uterine bleeding for true menstruation lack of amenorrhea do not exclude Abdominal pain-major symptom due to tubal stretching “tearing”pain with nausea and vomiting 肛门坠胀痛 pain in the shoulder Vaginal bleeding (spotting) Syncope and shock(晕厥、休克) acute hemoperitoneum 急性内出血 severe abdominal pain 剧烈腹痛 hemorrhagic shock 失血性休克 Physical signs of tubal pregnancy General conditions : 贫血、休克体征 Abdominal examination : 血腹征、腹部包块 Pelvic examination : 宫颈举痛、后穹隆饱满、子宫漂浮感, 一侧附件包块，有压痛 History Symptoms Physical signs Assisted examinations Assisted examinations 异位