Normal location of pregnancy

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Normal location of pregnancy
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Ectopic pregnancy

• Pregnancy in any location other
• than the body of the uterus (??)
• is considered ectopic pregnancy .

• ?????????????????,
• ???????(extrauterine pregnancy)?

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• tubal pregnancy ovarian
  pregnancy cervical pregnancy
  abdominal pregnancy
• broad ligament pregnancy

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2
3
4
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1
5
2
3
4
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• ?????????????

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Fallopian tube pregnancy is a common ectopic
pregnancy
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Tubal pregnancy position

• ???(Ampulla) ???
• ??(Isthmus) ??
• ??(Fimbria) ??
• ???(Interstitial portion) ??

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Etiology of tubal pregnancy
Frist part
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• Ectopic pregnancies are usually caused
  by conditions that obstruct or slow the passage
  of a fertilized ovum (egg) through the fallopian
  tube to the uterus.

Key words
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• Etiology
• 1??????(Tubal infection)

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• Etiology
• 1??????(Tubal infection)
• 2???????(Previous tubal surgery)
• 3????????(Congenital tubal abnormalities)
• 4???????(ART)
• 5??????(IUD)
• 6???( Pelvic tumors?endometriosis)

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Pathology of tubal pregnancy

• ???????,???????????,??????????????,????
  ????????,???????????

1????? 2??????? 3??????? 4???? 5???
Second part
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???????? ????? ??
????????????? 1????????? ??????
2????????? ?????
???????? ????? ??
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• ampullary pregnancy 8-12W(abortion,rupture)
• isthmic pregnancy 6W (rupture)
• interstitial portion 4M(rupture)

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The outcome of tubal pregnancy
??????? Secondary abdominal pregnancy
?????? Old Ectopic Pregnancy
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Tubal abortion
Tubal rupture
????????????????????,????????,????????,??????????
??
??????? Secondary abdominal pregnancy
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The change of uterus

• ??????,???????????
• Enlargement and soft
• same as IUP(intrauterine pregnancy)

????????????
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?????????????????

• ????
• ? A-S?????????????????????????????????????????
  ???????????,???????????,??????,????????,?????
• ??????
• ?????

???????, ???????????
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Symptoms of tubal pregnancy

• Amenorrhea (??)
• Vaginal bleeding (????)
• Abdominal pain (??)
• ????????????????

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Amenorrhea

• mistake uterine bleeding for true menstruation
• lack of amenorrhea do not exclude

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Abdominal pain-major symptom

• due to tubal stretching
• tearingpain with nausea and vomiting
• ?????
• pain in the
• shoulder

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Vaginal bleeding (spotting)

• scanty,spotting
• intermittent or continuous

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Syncope and shock(?????)

• acute hemoperitoneum ?????
• severe abdominal pain ????
• hemorrhagic shock ?????

????
?????????
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Physical signs of tubal pregnancy

• General conditions
• ???????
• Abdominal examination
• ????????
• Pelvic examination
• ????????????????,
• ??????,???

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Diagnosis of tubal pregnancy
?????????,????????
?
easy or difficulty
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• History
• Symptoms
• Physical signs
• Assisted examinations

ß-HCG
Ultrasound
Culdocentesis
Laparoscopy
Endometrium
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Assisted examinations
????Pregnancy test,HCG-test
pregnancy?
?ß-hCG????,???????? ?ß-hCG????,???????????????
? ?ß-hCG????????????
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????

• ???????????
• ??????????????????????????????????????(??)?

??????? (A)????????????????(UT)??????(??),?????(UT
O)????
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• ?ß-HCG ???B????????

?ß-HCG gt18KU/L?, ???B????????,?????
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????????
??????? (Culdocentesis)
?????????,????
??????????, ??????, ???????????
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?????( laparoscopy)???
??? ?????????? ??????????????

• ????????????????????????????(????)????????

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????????
Dilatation and curettage

• ??????
• ???????????

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Assisted examinations
major
Endometrium
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????
??
??? ??
????
???????
?????

• ??????

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Treatment of tubal pregnancy
???? Expectant treatment
???? Medical treatment
???? Surgical treatment
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Expectant treatment

• ??
• (1)????
• (2)????
• (3)??????????
• (4)?ß-hCG lt1000U/L,?????
• (5)???????lt3cm????
• (6)??????

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Medical treatment
??????????,?????????? (1)?????????????
(2)???????4cm (3)?ß-hCG lt2000U/L (4)??????
(5)??????
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• 1.Methotrexate(????) has
• become popular in selected cases of
• ectopic pregnancy.
• 2.Traditional Chinese medicine(??)

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????????
?ß-hCG ??
???????7???

????
?? ??

• ??
• ??

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Surgical treatment

• Surgery is the most common management of an
  ectopic pregnancy.

????(Emergency Treatment) ??????????,?????????
??????
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?????
??????????????
?????
???????
??????
?????????????
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????
Laparotomy
laparoscopy
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????
?????????
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????
????
?????????
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????

• Persistent ectopic pregnancy

?????ß-hCG
??3??ß-hCG??lt20
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?????
????
?????? ??????????
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????????????????????????????????
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????????
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