国家级精品课《妇产科学》异位妊娠.ppt

异位妊娠Ectopic Pregnancy 复旦大学附属妇产科医院 隋 龙 Definition and Overview Definition Incidence: one in 100 pregnancies The incresing tendency Induced factors: infertile lower socioeconomic group previous ectopic pregnancy,10-20% salpingitis and tuboplasty Why did it implant outside uterine cavity? Unclear Explanation of Mechanism Etiology Tubal Factors (salpingitis ) Zygote Abnormalities (chromosomal abnormalities ) Ovarian Factors (unextruded ovum ) Exogenous Hormones (progestin-only oral contraceptives ) Other Factors (endometriosis ,IUD) Classification and Specific Incidence Tubal Pregnancy: 99% Abdominal Pregnancy Compound or hysterotrophic pregnancy Cervical Pregnancy Other abnormal pregnancies Tubal pregnancy(99%) Ampullary(55%) Isthmic(25%) Fimbrial(17%) Interstitial(2%) Bilateral Distal with segmental absence of the tube Ovarian Pregnancy(0.5%) Ovarian Tubo-ovarian Abdominal-ovarian(secondary abdominal pregnancy) Abdominal Pregnancy(0.1%) Primary Secondary Abdomino-ovarian Tubo-abdominal Compound or Heterotrophic Combined with intrauterine pregnancy 1 in 17,000～30,000 pregnancies Cervical Pregnancy Very rare Intraligamentous In the vesicovaginal space Following hysterectomy: in a cervical stump, in a uterine tube In a prolapsed uterine tube(fimbrial or abdominal) Other displacement of Pregnancy in Uterus Cornual(角) (One Ex ) Angular(畸形角) Within a uterine diverticulum(憩室) In a uterine sacculation (囊) In a rudimentary horn (始基角) Intramural(肌壁间) Pathology Lackage of resistance to invasion by the trophoblast Minimal defense against the penetrating trophoblast Abdominal pregnancy: 1:15,000 pregnancies Mortality rate: 90% Enlarged uterus: circulation and endometrium changes Endometrial Changes Vaginal Bleeding Bleeding←endometrial involution and slough of decidua Atypical endometrial changes are not diagnostic of ectopic pregnancy The Arias-Stella reaction (hormonal overstimulation) Occasionally, endometrial tissue may be passed as a so-cal