Case
patient xxx,female,35 years old
Symptom,amenorrhea for 47 days ; spot vaginal
bleeding for 3 days; sudden abdominal pain for 2
hours,
Signs,Bp 12/8Kpa,P 120 times/min,abdominal
tenderness and rebound tenderness (+); sharp
pain on motion of the cervix,
sonography,a 4X5 cm irregular mass,3 cm-depth
fluid in cul-de- sac
culdocentesis,2 ml bloody fluid (did not clot)
urine HCG (+)
If you were the doctor,
1,what diagnosis would you
think of first?
2,How would you treat the
patient
异位妊娠
!
Ectopic pregnancy
New words
? Ectopic pregnancy 异位妊娠
? fallopian tube 输卵管
? blastocyst 囊胚
? cervix 宫颈
? amenorrhea 停经
? culdocentesis 后穹隆穿刺
Ⅰ,Definition
? The blastcyst normally implants in the
endometrial lining of the uterine cavity,
Implantation anywhere else is an ectopic
pregnancy.
? It is one in which the fertilized ovum is
implanted and developed outside of the
uterine cavity.
II.Incidence
more than 1 in every 100 pregnancy
III, Types of ectopic pregnancy
Tubal 95%
Ovarian 0.5-1%
Cervical
Abdominal
Broad ligament
Ⅳ,Tubal pregnancy
? It is one of abdominal emergency.
? Interabdominal hemorrhage sever
hemorrhge shock died
? 1.site
※ (1)Ampullar 60%
(2)isthmic 25%
(3)fimbrial 17%
(4)Interstitial 2%~4%
Etiology
? (1)pelvic infection
chronic salpingitis, 30%~50%
PID(pulvic inflammatory disease)
? (2) previous tubal surgery
? (3)developmental and functional tubal
abnormality
? (5)Increased use of assisted reproductive
technique
? (6)Popularity of contraception that prevent
intrauterine but not extrauterine pregnancy
? (6)endometriosis etc
3.Pathology
A,tubal pregnancy
? (1)tubal abortion
? common in ampular tubal pregnancy
? (2)tubal rupture,profuse hemorrhage
common in isthmic TP,6w
interstitial TP,16w
(3)abdominal pregnancy
B.uterine changes
? Arias-Stella reaction(hyperplasia
endometrii)
? dicidua cast
? the endometrium undergoes dicidual
changes indistinguishable from those
which occur in normal pregnancy
4.Clinical manifestation of
tubal pregnancy
Symptoms
? (1)amenorrhea
? (2)low abdominal pain
? (3)vaginal bleeding
? (4)shock and collapse
Signs
? (1)general condition
? (2)abdominal examination
? (3)pelvic examination
① the posterior fornix,tendness
② pain on motion of cervix
③ uterus,6~8w size,soft,float
④ a soft and elastic mass
5.Diagnosis
Symptom
Sign
axillary examination
? (1) pregnancy tests:β-HCG>25u
? quantitive serum β-HCG
? (2) pelvic ultrasound
? (3) culdocentesis,the bloody fluid does not clot
(4)laproscopy,diagnosis and treatment
? (5)endometrial histology,Arias-Stella reaction
6.Differential diagnosis
? (1)abortion
? (2)salpingitis,HCG,sonography,WBC↑,T↑
? (3)appendicitis,
tenderness at McBurney’s point,WBC↑
? (4)torsion of an ovarian cyst,B-u,HCG
? (5) ruptured corpus luteum
B-u
7.Treatment
?In emergency condition
? antishock and operation
? at same time
Surgical management,laproscopy
laprotomy
Radical,salpingectomy (common)
conservative,salpingostomy（造口）
salpingotomy（切开）
salpingoplasty（成形）
? segmental resection and
? anastomosis
l a p a r o s c o p e
? medical treatment
indications:
① before rupture or abortion of tubal
pregnancy,there is less intraabdominal
bleeding
② mass< 4cm
③ quantitive serum β-HCG <2000u/L
④ no contraindication
? Drug,MTX
? Method:
① 50mg/cm body surface,im
② local injection laparoscopy
hysteroscopy
ultrasound,form cal-de-sac
h y s t e r o s c o p e
Expectant therapy
patient xxx,female,35 years old
Symptom,amenorrhea for 47 days ; spot vaginal
bleeding for 3 days; sudden abdominal pain for 2
hours,
Signs,Bp 12/8Kpa,P 120 times/min,abdominal
tenderness and rebound tenderness (+); sharp
pain on motion of the cervix,
sonography,a 4X5 cm irregular mass,3 cm-depth
fluid in cul-de- sac
culdocentesis,2 ml bloody fluid (did not clot)
urine HCG (+)
If you were the doctor,
1,what diagnosis would you
think of first?
2,How would you treat the
patient
异位妊娠
!
Ectopic pregnancy
New words
? Ectopic pregnancy 异位妊娠
? fallopian tube 输卵管
? blastocyst 囊胚
? cervix 宫颈
? amenorrhea 停经
? culdocentesis 后穹隆穿刺
Ⅰ,Definition
? The blastcyst normally implants in the
endometrial lining of the uterine cavity,
Implantation anywhere else is an ectopic
pregnancy.
? It is one in which the fertilized ovum is
implanted and developed outside of the
uterine cavity.
II.Incidence
more than 1 in every 100 pregnancy
III, Types of ectopic pregnancy
Tubal 95%
Ovarian 0.5-1%
Cervical
Abdominal
Broad ligament
Ⅳ,Tubal pregnancy
? It is one of abdominal emergency.
? Interabdominal hemorrhage sever
hemorrhge shock died
? 1.site
※ (1)Ampullar 60%
(2)isthmic 25%
(3)fimbrial 17%
(4)Interstitial 2%~4%
Etiology
? (1)pelvic infection
chronic salpingitis, 30%~50%
PID(pulvic inflammatory disease)
? (2) previous tubal surgery
? (3)developmental and functional tubal
abnormality
? (5)Increased use of assisted reproductive
technique
? (6)Popularity of contraception that prevent
intrauterine but not extrauterine pregnancy
? (6)endometriosis etc
3.Pathology
A,tubal pregnancy
? (1)tubal abortion
? common in ampular tubal pregnancy
? (2)tubal rupture,profuse hemorrhage
common in isthmic TP,6w
interstitial TP,16w
(3)abdominal pregnancy
B.uterine changes
? Arias-Stella reaction(hyperplasia
endometrii)
? dicidua cast
? the endometrium undergoes dicidual
changes indistinguishable from those
which occur in normal pregnancy
4.Clinical manifestation of
tubal pregnancy
Symptoms
? (1)amenorrhea
? (2)low abdominal pain
? (3)vaginal bleeding
? (4)shock and collapse
Signs
? (1)general condition
? (2)abdominal examination
? (3)pelvic examination
① the posterior fornix,tendness
② pain on motion of cervix
③ uterus,6~8w size,soft,float
④ a soft and elastic mass
5.Diagnosis
Symptom
Sign
axillary examination
? (1) pregnancy tests:β-HCG>25u
? quantitive serum β-HCG
? (2) pelvic ultrasound
? (3) culdocentesis,the bloody fluid does not clot
(4)laproscopy,diagnosis and treatment
? (5)endometrial histology,Arias-Stella reaction
6.Differential diagnosis
? (1)abortion
? (2)salpingitis,HCG,sonography,WBC↑,T↑
? (3)appendicitis,
tenderness at McBurney’s point,WBC↑
? (4)torsion of an ovarian cyst,B-u,HCG
? (5) ruptured corpus luteum
B-u
7.Treatment
?In emergency condition
? antishock and operation
? at same time
Surgical management,laproscopy
laprotomy
Radical,salpingectomy (common)
conservative,salpingostomy（造口）
salpingotomy（切开）
salpingoplasty（成形）
? segmental resection and
? anastomosis
l a p a r o s c o p e
? medical treatment
indications:
① before rupture or abortion of tubal
pregnancy,there is less intraabdominal
bleeding
② mass< 4cm
③ quantitive serum β-HCG <2000u/L
④ no contraindication
? Drug,MTX
? Method:
① 50mg/cm body surface,im
② local injection laparoscopy
hysteroscopy
ultrasound,form cal-de-sac
h y s t e r o s c o p e
Expectant therapy
