Pregnancy 异位妊娠课件.ppt

Ectopic Pregnancy异位妊娠 Jun Ma 马军 Dept. of Obstetrics Gynecology The First Hospital of Xi’an Jiaotong Univ intrauterine implantation Animation of intrauterine implantation Animation of ectopic implantation Classification of ectopic pregnancy Overview Leading cause of maternal deaths in the first trimester Constituting 1-2% of all conceptions Subsequent infertility Incidence increasing Mortality decreasing with better detection Which women are at higher risk for tubal pregnancy? High-risk Factors Prior history of PID (pelvic inflammatory disease) High-risk Factors Prior history of PID (pelvic inflammatory disease) Tubal Surgery Previous Ectopic Pregnancy IUD (intrauterine device)??? Other tubal abnormalities Tubal abortion Question How to explain the situation when a woman with ectopic pregnancy claimed that she had expelled an “intra-unterine embryo-like tissue”? Summary What is ectopic pregancy? Which patients are at higher risk for tubal pregnancy? What are the fates of tubal pregnancy? The tubal pregnancy dose not usually proceed beyond 8-10 weeks due to : Lack of decidual reaction in the tube, the thin wall of the tube , the inadequacy of tubal lumen, bleeding in the site of implantation as trophoblast invades Eventually, tubal pregancy will end up in either one of the following four outcomes. 1. Tubal abortion -This occurs more if ovum had been implanted in the ampullary portion of the tube -as shown in this figure, gestational sac is seperated is expelled into the peritoneal cavity through the tubal ostium --if explulsion was complete the bleeding usually ceases but it may continue due to incomplete separation or bleeding from the implantation site. Secondary abdominal pregnancy Most abdomianl pregancies occur after the embryo first implants in the follopian tube, after it is aborted from the fimbrial opening of the tube and it is implanted in the abdomen structure and form a secondary abdominal pregnancy. In most cases , the baby will die to