复旦大学上海医学院妇产科学系2009级六年制妇产科学课件 Early Pregnancy Loss and Ectopic Pregnancy.ppt

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2019-05-06 发布于广东
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复旦大学上海医学院妇产科学系2009级六年制妇产科学课件 Early Pregnancy Loss and Ectopic Pregnancy.ppt

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Early Pregnancy Loss and Ectopic Pregnancy Xin Wu Obstetric and Gynecology Hospital sky_xin1980@ Case 1 27, female, menopause 51 days, a small amount of vaginal bleeding 1 day, no obvious abdominal cramping pain Menstrual history: 12 3/30，rule G3P0 spontaneous abortion in 2008, 2010 Ultrasonography: uterus 7×5×4cm，gestational sac 17×12×10mm，embryo 7mm, fetal heart (+) Urine HCG（+） Routine blood count and urine: normal pelvic examination Vulva: married type Vagina: smooth, a small amount of dark red blood Cervix: closed, blood-stained, no obvious motion tenderness Palace: as 6w+ of pregnancy size, no tenderness Annex: soft QUESTIONS Current diagnosis Further examination Treatment Prognosis QUESTIONS Current diagnosis: incompleted abortion？Threatened abortion? Further examination: serum HCG ? review ultrasound ? observe vaginal bleeding and abdominal pain Treatment: bed rest，progesterone medical therapy Prognosis: good Case 2 29, female, menopause 42 days，a small amount of vaginal bleeding 3 days, sudden right lower abdominal pain 1 hour Menstrual history: 14 5-7/28，rule G2P0 medical abortion 1 time in 2010 Transvaginal ultrasonography: Uterus size 6×5×4cm, endometrium 7mm, no obvious gestational sac, a mixed echo area 25×18×7mm at the left side of the right ovary, dark fluid area deep 12mm behind uterus Urine HCG（±） Blood count: Hb 98 g/L Bp 95/65 mmHg Pelvic examination Vulva: marriged type Vagina: smooth, a small amount of dark blood Cervix: closed, blood-staining, motion tender (+) Palace: normal size, without tenderness Annex: a 3cm mass palpable on the right side, tenderness(+) QUESTIONS Current diagnosis Further examination Treatment method QUESTIONS Current diagnosis: Ectopic pregnancy? Further examination: serum HCG and transvaginal ultrasound Treatment method: medical therapy (Methotrexate); surgical management (laparoscopy) Salpingectomy versus Salpingostomy Case 3 32, female, menopause 42 days, a small amount of vaginal bleeding 1 day