(妇产科学课件）6.2 Ectopic.ppt

Ultrasonography Empty uterus 宫腔空虚 Free fluid 游离液体 Adnexal mass 附件包块 Culdocentesis inserting a needle through the posterior fornix(后穹窿) into the cul-de-sac(子宫直肠陷凹) Culdocentesis can aid in the identification of a hemo-peritoneum, which in turn, may indicate a ruptured ectopic pregnancy. Positive : Aspiration of non-clotting blood （indicates intra-peritoneal hemorrhage） Culdocentesis Negative : Aspiration without non-clotting blood or with clear peritoneal fluid indicates no hemorrhage into the abdominal cavity but does not rule out ectopic pregnancy Culdocentesis DC Curettage of the uterine cavity can also help rule out ectopic pregnancy. Identification of chorionic villi(绒毛) identifies an intrauterine location of the pregnancy and rules out ectopic pregnancy. Differential Diagnosis It is important to rule out : uterine abortion 宫内妊娠流产 acute appendicitis 急性阑尾炎 Pelvic inflammatory disease 急性盆腔炎 torsion of ovarian tumor 卵巢肿瘤扭转 Treatment Medical treatment: Methotrexate Surgical treatment (laparotomy /laparoscopy) Medical treatment If the situation is not acute, the conserve therapy with medicine can be used no contra-indication of medical treatment ectopic pregnancy mass diameter3cm β-HCG＜2000U/L no rupture of tubal pregnancy no abdominal hemorrhage Medical treatment MTX (Methotrexate, 甲氨蝶呤) has been successfully used. It is a chemotherapy drug to kill the embryo Toxic to trophoblast cells 0.4mg/kg/d intramuscular ×5 days. Requires compliant patient and follow-up Surgical treatment Indication: abdominal hemorrhage 腹腔内出血 Unstable vital sign or shock 生命体征不平稳 Failure Medical treatment 药物治疗失败 Surgical treatment Radical vs. Conservative surgery 根治性 vs. 保守性 Laparotomy vs. Laparoscopy 剖腹 vs. 腹腔镜 Conservative :Salpingostomy输卵管造口 Small pregnancy leison located in distal fallopian tube preservation of tube 5%risk of recurrence Radical: Salpingectomy输卵管切除 Extraction of the tube Radical: Salpingectomy ectopi