流产 异位妊娠医学课件.ppt

* Commonly, uterine contraction Classification Tubal pregnancy (96-98%) ampullary (mid) portion of the fallopian tube (80-90%) isthmic (area closer to uterus) portion of the fallopian tube (5-10%) fimbrial (distal end away from uterus) portion of the fallopian tube (5%) cornual (within the uterine muscle) portion of the fallopian tube (1-2%) Abdominal (1-2%) primary/secondary (tubo-abdominal/abdomino-ovarian) Ovarian (0.5-1%) Cervical (less than 0.5%) Heterotopic (combination of ectopic + intrauterine pregnancy) Uncommon Ectopics Intraligamentous pregnancy (in broad ligament) Angular pregnancy (inside the uterotubal attachment) Pregnancy in a rudimentary horn of uterus Intraural pregnancy (in myometrium) Vaginal pregnancy Multiple tubal pregnancy Tubal Pregnancy Tubal Pregnancy Is a pregnancy that grows in the fallopian tube, not the uterus If the pregnancy continues and the tube ruptures, there may be life-threatening intraabdominal bleeding Even with the modern practice of medicine, the rupture of the tubal ectopic pregnancy is still one of the leading causes of gynecological deaths Etiology Pelvic inflammatory disease (PID) or Salpingitis → 6 -10 times higher risk. Mainly invasion of gonorrhea or chlamydia from the cervix up to the uterus and tubes causes an intense inflammatory response and scar tissue adhesions in the tube and may damage the cilia of the fallopian tube Previous tubal surgery Dysfunction or malformation of the tube Assisted reproductive technology －－In vitro fertilization → 2-5% of pregnancies are conected with IVF History of IUD use Pelvic adhesions, pelvic tumors Endometriosis Outcome of tubal pregnancy 1.Tubal abortion 2.Rupture of tubal pregnancy Most common in tubal pregnancy loaded in interstitial portion 3. Persistent ectopic pregnancy 4. Secondary intraperitoneal pregnancy Symptoms Amenorrhoea Vaginal bleeding Abdominal pain （One-sided pain in abdomen/ Shoulder