宫外孕课件_3.pptVIP

岳阳市2009年度基层妇、儿科适宜技术推广巡回讲座 Normal location of pregnancy Ectopic pregnancy异位妊娠 Pregnancy in any location other than the body of the uterus （子宫） is considered ectopic pregnancy . tubal pregnancy 输卵管妊娠  ovarian pregnancy 卵巢 妊娠 cervical pregnancy 宫颈妊娠 abdominal pregnancy 腹腔妊娠 broad ligament pregnancy 阔韧带妊娠 　异位妊娠以输卵管妊娠最常见 Ectopic pregnancies （宫外孕）are usually caused by conditions that obstruct（阻塞） or slow（运行缓慢） 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（输卵管妊娠病理） 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（壶腹部妊娠）: 8-12W(abortion流产,rupture破裂) isthmic pregnancy（峡部）: 6W (rupture破裂) interstitial portion（间质部）: 4M(rupture破裂) The change of uterus子宫改变 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停经 mistake uterine bleeding for true menstruation 异常的子宫流血误认为正常月经 lack of amenorrhea do not exclude 无明显停经史 Abdominal pain-major symptom主要症状——腹痛 due to tubal stretching （输卵管痉挛） “tearing”pain with nausea and vomiti（撕裂样疼痛伴恶心、呕吐） 肛门坠胀痛 pain in the shoulder （肩部放射痛） Vaginal bleeding (spotting)阴道流血 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体征 General conditions : 贫血、休克体征 Abdominal examination : 血腹征、腹部包块 Pelvic examinati