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Abortion Ectopic Pregnancy Hyperemesis Gravidarum

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Title: Abortion Ectopic Pregnancy Hyperemesis Gravidarum


1
AbortionEctopic PregnancyHyperemesis Gravidarum
Women Hospital , School of Medical,
ZheJiang University Yang
Xiao Fu
2
Abortion
Spontaneous abortion
Induced abortion
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
Etiology
  • Abnormal karyotype 50
  • Maternal factors infection (TORCH)
  • endocrine factors
  • immunologic
    factors
  • maternal systemic
    disease
  • anatomic defects
  • trauma
  • Toxic factors

5
anatomic defects
6
Pathology
  • Hemorrhage into the decidua basalis
  • Necrosis and inflammation
  • Uterine contractions and cervical dilatation
  • Expulsion of most or all of the products of
    conception

7
Clinical Findings
Amenorrhea
Bleeding
Pain
8
Clinical Findings
Threatened Abortion
Without cervical dilatation Without extrusion of
products of conception
Inevitable Abortion
Cervical dilatation Without extrusion of
products of conception
9
Clinical Findings
Bleeding severe
Incomplete Abortion
Expulsion of some, but not all, of the products
of conception
Complete Abortion
Expulsion of all of the products of conception
10
Clinical Findings
Missed Abortion
Embryo or fetus death, products of conception in
utero
Pain
Septic Abortion
Infection of the uterus
11
Clinical Findings
Habitual Abortion
three times abortion
12
Laboratory Findings
Gestational sac and viable embryo with heart
motion
Ultrasonography
Pregnancy tests
HCG
Blood count
Anemic
13
Complication
Life threatening
Severe hemorrhage
Infection Intrauterine synechia Perforation
14
Diagnosis
Medical history
Physical examination
?
Accessory examination
15
Threatened Abortion
Inevitable
Incomplete
Missed
16
Treatment
Threatened Abortion
Bed rest
Forbid sexual life
Progesterone
17
Treatment
pathological examination
Dilatation and curettage
InevitableAbortion
Oxytocin
Ultrasound
Antibiotics
18
Treatment
Dilatation and curettage
Promptly
IncompleteAbortion
Blood type and cross-match
Fluid infusion
Antibiotics
19
Treatment
Products of conception
Examine
Complete Abortion
Ultrasound
Bleeding
20
Treatment
DIC
Estrogen
Missed Abortion
Dilatation and curettage
Second
Oxytocin
21
Treatment
Genetic error Anatomic defect Hormonal
abnormalities Infection Systemic
disease Immunologic factors
Habitual Abortion
Cause
Cervical cerclage
Progesterone
22
Treatment
Antibiotics
Septic Abortion
Dilatation and curettage
Cervical cultures
23
Ectopic pregnancy
24
Definition
  • A fertilized ovum implants in an area other than
    the endometrial lining of the uterus.

25
Animation of intrauterine implantation
26
Animation of ectopic implantation
27
Sites of ectopic pregnancy
  • gt95 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
  • Lackage of resistance to invasion by the
    trophoblast
  • Abdominal pregnancy -115000 pregnancies
  • Enlarged uterus and endometrium changes

30
Termination of the pregnancy
  • Abortion

Rupture
31
Temination of the pregnancy
  • Tubalabortion or missed abortion
  • Interstitial,Angular,Cornualrupture into the
    uterine cavity,the broad ligament or the
    peritoneal cavity.
  • Cervicalrupture into the cervical canal
  • Abdominalrupture into the peritoneal cavity,into
    the retroperitoneal space
  • Ovarianrupture 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)

Secondary amenorrhea (68)
Abnormal uterine bleeding (75)
Syncope (37)
34
Signs
  • Abdominal tenderness (80)
  • Adnexal tenderness (75)
  • Adnexal mass(a unilateral adnexal mass53)
  • Uterine changes (normal size71,6-8 weeks
    size26, 9-12 weeks size3)
  • 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

37
(No Transcript)
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 lt3cm
  • Serum ß-hCG lt2000U/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

46
Hyperemesis Gravidarum


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
Clinical Findings
  • Severe nausea, Waste Away
  • Ketonuria, Increased urine specific gravity
  • Elevated hematocrit and BUN level
  • Hyponatremia,Hypokalemia,Hypochloremia
  • Metabolic acidosis
  • Wernicke-Korsakoff
  • Deficiency of VitaminK

50
Diagnosis and Differential Diagnosis
  • Urine
  • Blood
  • Serum Beta-HCG (Molar pregnancy)
  • Thyroid function
  • Ultrasound
  • EKG
  • Fundus oculi

51
Treatment
  • Indication for hospitalization
  • Intractable emesis, Correction of any
  • electrolyte abnormalities , Hypovolemia
  • IV hydration
  • Parental nutrition
  • Electrolyte supplement

52
Treatment
  • Vitamin supplementation( B1 )Wernockes
    encephalopathy
  • NaHCO3
  • Oral feedings
  • Terminal pregnancy

53
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