ectopicpregnancy().ppt

异 位 妊 娠ectopic pregnancy 青岛大学医学院附属医院妇科 王宁 Ectopic pregnancy Extrauterine pregnancy A fertilized ovum implants in an area other than the endometrial lining of the uterus 受精卵在子宫腔以外着床称为异位妊娠，习称宫外孕。 95% tubal pregnancy What should be known about EP Incidence 1% A significant cause of maternal morbidity and mortality Leading cause of pregnancy-related deaths in the 1st trimester Accounting for 9% of all pregnancy-related deaths 输卵管妊娠tubal pregnancy Rupture of tubal pregnancy 6 weeks isthmic portion 绒毛侵蚀穿透管壁 内出血 妊娠组织排出 吸收 种植 Pathology 陈旧性宫外孕 继发性腹腔妊娠 Tubal abortion with subsequent implantation on an intraperitoneal structure for example liver pregnancy Pathology Uterus 子宫增大，变软，内膜出现蜕膜反应 （胚胎死亡—滋养细胞活力消失—蜕膜剥脱—阴道流血） A-S反应 腺体高度增生 腺细胞胞浆高度分泌 Irregular vaginal bleeding Shock blood loss Abdominal mass Diagnosis History Physical examination Pelvic examination Conservative operation Salpinggostomy Segmental resection and tubal reanatomosis Treatment--laparoscopy Treatment-- Chinese traditional medicine Chemotherapy Indication The diameter of the mass 3cm no rupture Not significantly bleeding HCG level 2000U/L Treatment—期待疗法 Little pain little bleeding No tubal rupture HCG level 1000U/L The diameter of the mass 3cm or no mass No pelvic bleeding 特殊部位的异位妊娠 卵巢妊娠 宫颈妊娠 腹腔妊娠 宫内外同时妊娠 Abdominal pregnancy 原发 双附件正常，无近期妊娠证据 无子宫腹膜瘘 妊娠只存在于腹腔内 继发 Cervical pregnancy 1:18000 Vaginal bleeding without pain 妇科检查发现宫颈膨大而宫体正常大小 妊娠产物在宫颈管内 分段诊刮宫腔无妊娠产物 宫腔内妊娠与异位妊娠同时存在 性传播性疾病的蔓延 促排卵治疗的应用 辅助生育技术的开展 HP的发病率明显升高 病 例 患者，26岁，已婚，停经45天，突发左下腹痛5小时。 既往月经规律，15天前出现少量阴道流血，淋漓不净。 5小时前，无明显原因突发左下腹剧痛，呈撕裂样，伴头昏，继之腹胀，有下坠感，上厕所时晕倒。 PE: