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Abortion Ectopic Pregnancy Hyperemesis Gravidarum
- 3. Abortion • Defined as delivery occurring before the 28th completed week of gestation • Fetus weighing less than 1000g • US ( before the 20th completed week of gestation) • Early abortion and late abortion • 15% of clinically evident pregnancies • 80% of abortions prior to 12 weeks’ gestation
- 4. • Abnormal karyotype: 50% • Maternal factors: infection (TORCH) endocrine factors immunologic factors maternal systemic disease anatomic defects trauma • Toxic factors Etiology
- 6. • Hemorrhage into the decidua basalis • Necrosis and inflammation • Uterine contractions and cervical dilatation • Expulsion of most or all of the products of conception Pathology
- 8. Clinical Findings Threatened Abortion Inevitable Abortion Without cervical dilatation Without extrusion of products of conception Cervical dilatation Without extrusion of products of conception
- 9. Clinical Findings Incomplete Abortion Complete Abortion Expulsion of some, but not all, of the products of conception Expulsion of all of the products of conception Bleeding severe
- 10. Clinical Findings Missed Abortion Septic Abortion Embryo or fetus death, products of conception in utero Infection of the uterus Pain
- 12. Laboratory Findings Ultrasonography Pregnancy tests Blood count Gestational sac and viable embryo with heart motion HCG Anemic
- 15. Threatened Abortion Inevitable Incomplete Missed
- 16. Treatment Threatened Abortion Bed rest Forbid sexual life Progesterone
- 18. Treatment Incomplete Abortion Dilatation and curettage Promptly Antibiotics Blood type and cross-match Fluid infusion
- 21. Treatment Habitual Abortion Cause Progesterone Genetic error Anatomic defect Hormonal abnormalities Infection Systemic disease Immunologic factors Cervical cerclage
- 24. Definition A fertilized ovum implants in an area other than the endometrial lining of the uterus.
- 26. Animation of ectopic implantation
- 27. Sites of ectopic pregnancy >95% ectopic pregs in fallopian tubes 70% ampulla 12% isthmic 11.1% fimbrial 3.2% ovarian 2.4% interstitial 1.3% abdominal
- 28. Etiology • Tubal Factors (salpingitis, previous tubal surgery) • Zygote Abnormalities (chromosomal abnormalities) • Ovarian Factors (ovum into contralateral tube) • Exogenous Hormone (oral contraceptives) • Other Factors (endometriosis, IUD)
- 29. Pathology • Lockage of resistance to invasion by the trophoblast • Abdominal pregnancy -1:15000 pregnancies • Enlarged uterus and endometrium changes
- 30. Termination of the pregnancy Abortion Rupture
- 31. Temination of the pregnancy • Tubal:abortion or missed abortion • Interstitial,Angular,Cornual:rupture into the uterine cavity,the broad ligament or the peritoneal cavity. • Cervical:rupture into the cervical canal • Abdominal:rupture into the peritoneal cavity,into the retroperitoneal space • Ovarian:rupture into the peritoneal cavity
- 32. Clinical Findings • Symptoms of early pregnancy (amenorrhea, breast tenderness, and nausea) • Bleeding (usually spotting) • Diffuse lower abdominal pain • Over 15% of ectopic pregnant as surgical emergencies.
- 33. Symptoms Pain • Pelvic or lower abdominal pain (99%) • Generalized pain (44%) • Unilateral lower abdominal pain (33%) • Subdiaphragmatic pain or sharp shoulder pain (22%) Abnormal uterine bleeding (75%) Secondary amenorrhea (68%) Syncope (37%)
- 34. Signs • Abdominal tenderness (80%) • Adnexal tenderness (75%) • Adnexal mass(a unilateral adnexal mass:53%) • Uterine changes (normal size:71%,6-8 weeks’ size:26%, 9-12 weeks’ size:3%) • Fever (only about 2% of patients)
- 35. Laboratory Findings • Pregnancy tests (postive-82.5%) • Hematocrit • White blood cell count • A negative test does not rule out an ectopic gestation
- 36. Special Examinations • Utrasonically scanning • Culdocentesis • Dilatation and curettage • Exploratory laparotomy
- 38. Differential Diagnosis • Appendicitis • Salpingitis • Ruptured corpus luteum cyst • Uterine abortion • Twisted ovarian cyst • Urinary tract disease • Degenerating leiomyomas
- 39. Essentials of Diagnosis • Amenorrhea followed by irregular vaginal bleeding • Adnexal tenderness or mass • Ultrasonographic evidence of adnexal mass and no intrauterine gestation • Positive ß-hCG
- 40. Complications • About I in 1000 ectopic pregnancies result in maternal death • Untreated or mistreated ruptured ectopic tubal pregnancy 8-12% of all materal deaths • The majority of these deaths are preventable Death
- 41. Complications •Chronic salpingitis •Infertility or sterility •Intestinal obstruction may develop after hemoperitoneum and peritonitis Tubal damage
- 42. Treatment • Emergency Treatment Immediate surgery,anti-shock(warm,oxygen) • Surgical treatment laparoscopic techniques • Medical treatmemt-MTX • Supportive treatment antibiotic,iron therapy, a high-protein diet
- 43. Salpingectomy
- 44. Indications for Conservative Drug Therapy • No signs of active intra-abdominal bleeding • Diameter of mass ＜ 3cm • Serum ß-hCG ＜ 2000U/L • No embryonic blood vessle pounding • No contraindication for MTX application • Normal liver and kidney function • Normal RBC count
- 45. Prognosis • Another tubal pregnancy will occur in 10-20% of patients treated • Infertility develops in approximately 50% of patients
- 47. Prolonged and severe nausea/ vomiting associated with dehydration, weight loss, or electrolyte disturbances when pregnancy Definition
- 48. Etiology •Unknown •Hormonal, neurologic, metabolic, toxic, and psychosocial factors (underlying emotional disorder) •Degree of biochemical hyperthyroidismh •The level of beta-HCGlevel o
- 49. • Severe nausea, Waste Away • Ketonuria, Increased urine specific gravity • Elevated hematocrit and BUN level • Hyponatremia,Hypokalemia,Hypochloremia • Metabolic acidosis • Wernicke-Korsakoff • Deficiency of VitaminK Clinical Findings
- 50. – Urine – Blood – Serum Beta-HCG (Molar pregnancy) – Thyroid function – Ultrasound – EKG – Fundus oculi Diagnosis and Differential Diagnosis
- 51. • Indication for hospitalization Intractable emesis, Correction of any electrolyte abnormalities , Hypovolemia • IV hydration • Parental nutrition • Electrolyte supplement Treatment
- 52. • Vitamin supplementation （ B1 ）— — Wernocke’s encephalopathy • NaHCO3 • Oral feedings • Terminal pregnancy Treatment
Editor's Notes
- In this short animation, we can see that the sperm enters the follopian tube and meet with the ovum. However, due to some reasons, the fertilized egg is trapped here before it reached the uterus and develops into a misplaced embryo. This misplaced embryo is somewhat like a time bomb because tissues at these abnormal locations for implantation are vulnerable and thin, they cannot support and accommodate the growing embryo. After several weeks , it may rupture and cause massive intraperitoneal bleeding, resulting in a potentially serious situation.