4. Case 1
Mild pale, no jaundice, not dehydrate BP
80/50, PR 120/min, RR 25/min, Temp. 37.0º c
Abdomen: Mild distension, hypoactive
bowel sound, no hepatosplenomegaly, no
palpable mass Moderate tender at suprapubic
area with guarding & rebound tenderness
Shifting dullness negative. Both costovertebral
angle not tender
Physical examination
5. Case 1
Pelvic exam:NIUB : Normal, no urethral discharge
Vagina : Normal mucosa, scanty old blood at posterior
fornix
Cervix : Os closed, old clot blood per os, no lesion,
marked tender
Uterus : Normal size, anteversion, marked tenderness
Adnexa : Marked tender at both sides, Rt > Lt . Mass
can’t be
evaluate due to involuntary guarding
Cul-de-sac : bulging
Physical examination
6. Case 1
Urine pregnancy test: positive
CBC : Hb 7.0 g/dL, Hct 22.2 Vol% MCV 59 fl, MCH
18 pg, MCHC 31.5
g/dl WBC 15,000 cells/mm3 N 85 % L 10 % M 5
%Platelet 393,000
cells/mm3
U/A : Color p.yellow Sp.Gr. 1.015 pH 6.5 Protein,
Suger – ve WBC
3-5 /HF RBC 0-1 /HF
Bacteria 1+
Transvaginal ultrasound:
(gestational sac) 4
complex mass moderate free fluid Cul-
Investigations:
29. Differential Diagnosis
Hb 7.0 g/dL
Hct 22.2 %
MCV 59 fl
MCH 18 pg
WBC 15,000
cells/mm3 N
85 %
CBC
Mild pale
Vagina : scanty old
blood at posterior fornix
Cervix : Os closed, old
clot blood per os
Cul-de-sac : bulging
30. Differential DiagnosisReproductive
system :
- √ Ectopic
pregnancy
- Abortion
- Adnexal
torsion
- Pelvic
inflammatory
disease
- Ovarian cyst
rupture
Abdomen: Moderate tender at
suprapubic area with guarding & rebound
tenderness
Vagina : scanty old blood at posterior
fornix
Cervix : Os closed, old clot blood per
os
Adnexa : Marked tender at both sides,
Rt > Lt Mass can’t be evaluate due to
involuntary guarding
Cul-de-sac : bulgingUrine pregnancy test: positive
Transvaginal ultrasound:
(gestational sac)
4 complex mass
moderate free fluid Cul-de-sac
51. Anatomy of uterus and
adnexa
Saladin KS. Anatomy & Physiology: The Unity of Form and Function. 3rd Edition.
52. Ectopic pregnancy
• Ectopic pregnancy is the result of a flaw in
human reproductive physiology that
allows the conceptus to implant and
mature outside the endometrial
cavity, which ultimately ends in the death
of the fetus
• Without timely diagnosis and
treatment, ectopic pregnancy can become
Sepilian PV. Ectopic pregnancy. Medscape. Updated May 6, 2013. Sited:
53. Ectopic pregnancy
• Ectopic pregnancy refers to the
implantation of a fertilized egg in a
location outside of the uterine cavity
–Fallopian tubes (approximately
97.7%)
–Cervix
–Ovary
–Cornual region of the uterus
–Abdominal cavity
Sepilian PV. Ectopic pregnancy. Medscape. Updated May 6, 2013. Sited:
54. Ectopic pregnancy
http://library.med.utah.edu/WebPat
Ectopic pregnancies occur when the fertilized ovum implants outside of the uterine
fundus. About 1 in 150 pregnancies results in ectopic implantation. Most cannot be
sustained at extrauterine sites. However, a tubal ectopic pregnancy, as
diagrammed here, may proceed for several weeks, but the enlargement can
rupture the tube and lead to acute, life-threatening bleeding, often about 6
weeks after a previous menstrual period.
56. Signs and symptoms
• The classic clinical triad of
ectopic pregnancy is as follows:
–Abdominal pain
–Amenorrhea
–Vaginal bleeding
Sepilian PV. Ectopic pregnancy. Medscape. Updated May 6, 2013. Sited:
57. Signs and symptoms
• The following symptoms have
also been reported:
– Painful fetal movements
(in the case of advanced
abdominal pregnancy)
– Dizziness or weakness
– Fever
– Flulike symptoms
– Vomiting
– Syncope
Sepilian PV. Ectopic pregnancy. Medscape. Updated May 6, 2013. Sited:
58. Signs and symptoms
• The presence of the following signs
suggests a surgical emergency:
– Abdominal rigidity
– Involuntary guarding
– Severe tenderness
– Evidence of hypovolemic shock
(eg, orthostatic blood pressure
changes, tachycardia)
Sepilian PV. Ectopic pregnancy. Medscape. Updated May 6, 2013. Sited:
59. Signs and symptoms
• Findings on pelvic examination may
include the following:
– The uterus may be slightly enlarged
and soft
– Uterine or cervical motion tenderness
may suggest peritoneal inflammation
– An adnexal mass may be palpated
– Uterine contents may be present in
the vagina, due to shedding of
endometrial lining stimulated by an
ectopic pregnancy
Sepilian PV. Ectopic pregnancy. Medscape. Updated May 6, 2013. Sited:
61. Etiology
• An ectopic pregnancy requires the
occurrence of 2 events:
–Fertilization of the ovum
–Abnormal implantation
Sepilian PV. Ectopic pregnancy. Medscape. Updated May 6, 2013. Sited:
62. Etiology
• The following risk factors have been
linked to ectopic pregnancy:
–Tubal damage
–History of previous ectopic
pregnancy
–Smoking
–Altered tubal motility
–History of 2 or more years of
infertility
–History of multiple sexual partnersSepilian PV. Ectopic pregnancy. Medscape. Updated May 6, 2013. Sited:
64. • Tubal damage
• History of previous ectopic
pregnancy
• Smoking
• Altered tubal motility
• History of 2 or more years of
infertility
• History of multiple sexual partners
• Maternal age
22
SI
83. 1. ACOG practice bulletin. Management of recurrent pregnancy loss. Number 24, February 2001.
(Replaces Technical Bulletin Number 212, September 1995). American College of Obstetricians
and Gynecologists. Int J Gynaecol Obstet2002
2. Cnattingius S, Ekbom A, Granath F, Rane A. Caffeine intake and the risk of spontaneous
abortion. Food Chem Toxicol2003
3. Saladin KS. Anatomy & Physiology: The Unity of Form and Function. 3rd Edition. New York:
McGraw-Hill
Companies, Inc.; 2010.
4. Schorge O J, Schaffer I J, Halvorson M L, Hoffman L B, Bradshaw D K, Cunningham G F.
Williams Gynecology.
New York. The McGraw-Hill Companies; 2008.
5. Sepilian PV. Ectopic pregnancy. Medscape. Updated: May 6, 2013.
Sited:http://emedicine.medscape.com/article/2041923
6. Tubal ectopic pregnancy [Internet]. Pathologyoutlines [ 19 . 2556]
http://www.pathologyoutlines.com/topic/placentaspontaneousab.html
7.
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8. 3 :
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10. 1 :
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References
Editor's Notes
Macroscopic examination of the slide shows a rounded collection of material with a variegated appearance. There is an intimate admixture of pink and red tissue.Examination of this material under the microscope shows blood (red) and fibrin (pink) admixed with white blood cells and platelets (1), (2). Scattered through this blood clot are small numbers of immature chorionic villi (1), (2). These villi are rounded structures covered by two layers of cells. The inner cuboidal layer is the cytotrophoblast (2) and the outer syncitial layer is the syncitiotrophoblast (2). No foetal tissue is seen on this slide.การตรวจสอบด้วยตาเปล่าของภาพนิ่งที่แสดงให้เห็นคอลเลกชันที่โค้งมนของวัสดุที่มีลักษณะแตกต่างกัน มีส่วนผสมใกล้ชิดของเนื้อเยื่อสีชมพูและสีแดงเป็นการตรวจสอบของวัสดุนี้ภายใต้กล้องจุลทรรศน์ที่แสดงให้เห็นเลือด (สีแดง) และไฟบริน (สีชมพู) admixed ด้วยเซลล์เม็ดเลือดขาวและเกล็ดเลือด (1), (2) กระจัดกระจายอยู่ทั่วลิ่มเลือดนี้เป็นตัวเลขขนาดเล็กของ chorionic villi การอ่อน (1), (2) villi เหล่านี้เป็นโครงสร้างกลมปกคลุมด้วยสองชั้นของเซลล์ชั้น cuboidal ภายในเป็น cytotrophoblast (2) และชั้น syncitialด้านนอกเป็น syncitiotrophoblast (2) ไม่มีเนื้อเยื่อของทารกในครรภ์มีให้เห็นบนภาพนิ่งนี้
Placentation in the boto, Iniageoffrensis. The glandular endometrium forms trabeculae lined with uterine epithelium. Branched chorionic villi are inserted into the crypts. The spaces between the trophoblast and uterine epithelium are likely shrinkage artefacts. H.E. Scale bar = 1000 μm.
primary villiSyncytiotrophoblasts with a core of cytotrophoblasts. The syncytiotrophoblasts open lacunae and maternal capillaries expand to form sinusoids which anastomose with the trophoblastic lacunaesecondary villiMesoderm invades within the cytoblasts and syncytiotrophoblaststertiarary villivessels formPrimary villiWeek 2 - first stage of chorionic villi development, trophoblastic shell cells (syncitiotrophoblasts and cytotrophoblasts) form finger-like extensions into maternal decidua.Secondary villiWeek 3 - second stage of chorionic villi development, extraembryonic mesoderm grows into villi, covers entire surface of chorionic sac.Basal region will form chorionic plate.Tertiary villiWeek 4 - third stage of chorionic villi development, mesenchyme differentiates into blood vessels and cells, forms arteriocapillary network, fuse with placental vessels, developing in connecting stalk.
These villi are rounded structures covered by two layers of cells. The inner cuboidal layer is the cytotrophoblast (2) and the outer syncitial layer is the syncitiotrophoblast (2). No foetal tissue is seen on this slide.
A positive pregnancy test (presence of human chorionic gonadotropin), ultrasound, and culdocentesis with presence of blood are helpful in making the diagnosis of ectopic pregnancy. Seen here is tubal epithelium at the right, with rupture site and chorionic villi at the lower left.
Diagnosis decidualizedstroma and atrophy due to intrauterine deviceDescription Inactive gland on the right lying in decidualstroma. Dilated blood vessels. Superficial erosion of the endometrium.