Early Pregnancy Loss and Ectopic Pregnancy Xin Wu Obstetric and Gynecology Hospital...
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![Page 1: Early Pregnancy Loss and Ectopic Pregnancy Xin Wu Obstetric and Gynecology Hospital sky_xin1980@aliyun.com.](https://reader036.fdocuments.us/reader036/viewer/2022062301/56649f335503460f94c4f357/html5/thumbnails/1.jpg)
Early Pregnancy Loss and Ectopic Pregnancy
Xin WuObstetric and Gynecology Hos
pital [email protected]
![Page 2: Early Pregnancy Loss and Ectopic Pregnancy Xin Wu Obstetric and Gynecology Hospital sky_xin1980@aliyun.com.](https://reader036.fdocuments.us/reader036/viewer/2022062301/56649f335503460f94c4f357/html5/thumbnails/2.jpg)
Case 1
• 27, female, menopause 51 days, a small amount of vaginal bleeding 1 day, no obvious abdominal cramping pain
• Menstrual history: 12 3/30 , rule• G3P0 spontaneous abortion in 2008,
2010
![Page 3: Early Pregnancy Loss and Ectopic Pregnancy Xin Wu Obstetric and Gynecology Hospital sky_xin1980@aliyun.com.](https://reader036.fdocuments.us/reader036/viewer/2022062301/56649f335503460f94c4f357/html5/thumbnails/3.jpg)
• Ultrasonography: uterus 7×5×4cm, gestational sac 17×12×10mm ,embryo 7mm, fetal heart (+)
• Urine HCG ( + )• Routine blood count and urine: nor
mal
![Page 4: Early Pregnancy Loss and Ectopic Pregnancy Xin Wu Obstetric and Gynecology Hospital sky_xin1980@aliyun.com.](https://reader036.fdocuments.us/reader036/viewer/2022062301/56649f335503460f94c4f357/html5/thumbnails/4.jpg)
pelvic examination
• Vulva: married type• Vagina: smooth, a small
amount of dark red blood • Cervix: closed, blood-stained,
no obvious motion tenderness• Palace: as 6w+ of pregnancy
size, no tenderness• Annex: soft
![Page 5: Early Pregnancy Loss and Ectopic Pregnancy Xin Wu Obstetric and Gynecology Hospital sky_xin1980@aliyun.com.](https://reader036.fdocuments.us/reader036/viewer/2022062301/56649f335503460f94c4f357/html5/thumbnails/5.jpg)
QUESTIONS• Current diagnosis• Further examination• Treatment• Prognosis
![Page 6: Early Pregnancy Loss and Ectopic Pregnancy Xin Wu Obstetric and Gynecology Hospital sky_xin1980@aliyun.com.](https://reader036.fdocuments.us/reader036/viewer/2022062301/56649f335503460f94c4f357/html5/thumbnails/6.jpg)
QUESTIONS• Current diagnosis: incompleted abo
rtion ? Threatened abortion?• Further examination: serum HCG ? r
eview ultrasound ? observe vaginal bleeding and abdominal pain
• Treatment: bed rest , progesterone medical therapy
• Prognosis: good
![Page 7: Early Pregnancy Loss and Ectopic Pregnancy Xin Wu Obstetric and Gynecology Hospital sky_xin1980@aliyun.com.](https://reader036.fdocuments.us/reader036/viewer/2022062301/56649f335503460f94c4f357/html5/thumbnails/7.jpg)
Case 2
• 29, female, menopause 42 days , a small amount of vaginal bleeding 3 days, sudden right lower abdominal pain 1 hour
• Menstrual history: 14 5-7/28 , rule• G2P0 medical abortion 1 time in 20
10
![Page 8: Early Pregnancy Loss and Ectopic Pregnancy Xin Wu Obstetric and Gynecology Hospital sky_xin1980@aliyun.com.](https://reader036.fdocuments.us/reader036/viewer/2022062301/56649f335503460f94c4f357/html5/thumbnails/8.jpg)
• Transvaginal ultrasonography: Uterus size 6×5×4cm, endometrium 7mm, no obvious gestational sac, a mixed echo area 25×18×7mm at the left side of the right ovary, dark fluid area deep 12mm behind uterus
• Urine HCG ( ± )• Blood count: Hb 98 g/L• Bp 95/65 mmHg
![Page 9: Early Pregnancy Loss and Ectopic Pregnancy Xin Wu Obstetric and Gynecology Hospital sky_xin1980@aliyun.com.](https://reader036.fdocuments.us/reader036/viewer/2022062301/56649f335503460f94c4f357/html5/thumbnails/9.jpg)
Pelvic examination
• Vulva: marriged type• Vagina: smooth, a small amount of da
rk blood • Cervix: closed, blood-staining, motio
n tender (+)• Palace: normal size, without tendern
ess• Annex: a 3cm mass palpable on the ri
ght side, tenderness(+)
![Page 10: Early Pregnancy Loss and Ectopic Pregnancy Xin Wu Obstetric and Gynecology Hospital sky_xin1980@aliyun.com.](https://reader036.fdocuments.us/reader036/viewer/2022062301/56649f335503460f94c4f357/html5/thumbnails/10.jpg)
QUESTIONS• Current diagnosis• Further examination• Treatment method
![Page 11: Early Pregnancy Loss and Ectopic Pregnancy Xin Wu Obstetric and Gynecology Hospital sky_xin1980@aliyun.com.](https://reader036.fdocuments.us/reader036/viewer/2022062301/56649f335503460f94c4f357/html5/thumbnails/11.jpg)
QUESTIONS• Current diagnosis: Ectopic pregnancy?• Further examination: serum HCG and t
ransvaginal ultrasound• Treatment method: medical therapy (
Methotrexate); surgical management (laparoscopy)
Salpingectomy versus Salpingostomy
![Page 12: Early Pregnancy Loss and Ectopic Pregnancy Xin Wu Obstetric and Gynecology Hospital sky_xin1980@aliyun.com.](https://reader036.fdocuments.us/reader036/viewer/2022062301/56649f335503460f94c4f357/html5/thumbnails/12.jpg)
![Page 13: Early Pregnancy Loss and Ectopic Pregnancy Xin Wu Obstetric and Gynecology Hospital sky_xin1980@aliyun.com.](https://reader036.fdocuments.us/reader036/viewer/2022062301/56649f335503460f94c4f357/html5/thumbnails/13.jpg)
Case 3
• 32, female, menopause 42 days, a small amount of vaginal bleeding 1 day, no obvious abdominal cramping pain
• Menstrual history: 13 3/30 , menstrual rules
• G3P0 artificial abortion in 2008, right tubal pregnancy in 2011 (laparoscopic salpingostomy)
![Page 14: Early Pregnancy Loss and Ectopic Pregnancy Xin Wu Obstetric and Gynecology Hospital sky_xin1980@aliyun.com.](https://reader036.fdocuments.us/reader036/viewer/2022062301/56649f335503460f94c4f357/html5/thumbnails/14.jpg)
• Ultrasound: uterus 7×5×4cm , endometrium 10mm , no gestational sac, no adnexal mass
• Urine HCG ( ± )• Routine blood count and urine test:
normal
![Page 15: Early Pregnancy Loss and Ectopic Pregnancy Xin Wu Obstetric and Gynecology Hospital sky_xin1980@aliyun.com.](https://reader036.fdocuments.us/reader036/viewer/2022062301/56649f335503460f94c4f357/html5/thumbnails/15.jpg)
Pelvic examination
• Vulva: married type• Vagina: smooth, a small amount
of dark red blood • Cervix: closed, blood-stained,
no obvious motion tenderness• Palace: slightly enlarged, no
tenderness• Annex: soft
![Page 16: Early Pregnancy Loss and Ectopic Pregnancy Xin Wu Obstetric and Gynecology Hospital sky_xin1980@aliyun.com.](https://reader036.fdocuments.us/reader036/viewer/2022062301/56649f335503460f94c4f357/html5/thumbnails/16.jpg)
QUESTIONS• Current diagnosis
• Further examination
![Page 17: Early Pregnancy Loss and Ectopic Pregnancy Xin Wu Obstetric and Gynecology Hospital sky_xin1980@aliyun.com.](https://reader036.fdocuments.us/reader036/viewer/2022062301/56649f335503460f94c4f357/html5/thumbnails/17.jpg)
QUESTIONS• Current diagnosis: anembryonic ges
tation? completed abortion ? ectopic pregnancy?
• Further examination: ultrasound and serum HCG every 3 days, observe vaginal bleeding and abdominal pain
![Page 18: Early Pregnancy Loss and Ectopic Pregnancy Xin Wu Obstetric and Gynecology Hospital sky_xin1980@aliyun.com.](https://reader036.fdocuments.us/reader036/viewer/2022062301/56649f335503460f94c4f357/html5/thumbnails/18.jpg)
Points
• Types of abortion
• Differential diagnosis of ectopic pregnancy
• drug treatment and surgical treatment indications of ectopic pregnancy
![Page 19: Early Pregnancy Loss and Ectopic Pregnancy Xin Wu Obstetric and Gynecology Hospital sky_xin1980@aliyun.com.](https://reader036.fdocuments.us/reader036/viewer/2022062301/56649f335503460f94c4f357/html5/thumbnails/19.jpg)
Intrauterine abortion
• Anembryonic gestation• Inevitable abortion• Incomplete abortion• Complete abortion
![Page 20: Early Pregnancy Loss and Ectopic Pregnancy Xin Wu Obstetric and Gynecology Hospital sky_xin1980@aliyun.com.](https://reader036.fdocuments.us/reader036/viewer/2022062301/56649f335503460f94c4f357/html5/thumbnails/20.jpg)
Extrauterine pregnancy
• Tubal pregnancy• Interstitial pregnancy• Abdominal pregnancy• Cervical pregnancy• Ligamentous pregnancy• Heterotopic pregnancy• Ovarian pregnancy
![Page 21: Early Pregnancy Loss and Ectopic Pregnancy Xin Wu Obstetric and Gynecology Hospital sky_xin1980@aliyun.com.](https://reader036.fdocuments.us/reader036/viewer/2022062301/56649f335503460f94c4f357/html5/thumbnails/21.jpg)
Learn it yourself
• Definition and treatment of premature labor and prolonged pregnancy