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1、Abortion and Ectopic Pregnancy,Liang-Qing Yao Obstetrics and Gynecology Hospital of Fudan University,Abortion,Concept,A pregnancy loss before 28 weeks of gestation while fetal weight under 1000 grams Early Abortion：pregnancy loss before 12 gestational weeks Late Abortion: pregnancy loss during 1228
2、gestational weeks Spontaneous Abortion Artificial Abortion,Genetic defect Maternal factors: systematic disease; genital organ anomalies; endocrine anomalies; irritation; bad habit Immune anomalies Environmental factors,Etiology,Pathology,Before 8 weeks: chorionic villi immature Fetal deathbasal deci
3、dual bleeding uterine contractionexpulsion of all the products of conception, light bleeding During 812 weeks：with firm attachment to the basal decidua Partial expulsion of the products of conception non-ideal uterine contraction, severe bleeding After 12 weeks: placenta fully formed. Uterine contra
4、ction expulsion of all the products of conception，light bleeding,Symptoms,Amenorrhea, vaginal bleeding , and abdominal pain Early abortion：vaginal bleeding preceding abdominal pain Late abortion：abdominal pain preceding vaginal bleeding,Types of Abortion,Threatened Abortion Inevitable Abortion Incom
5、plete Abortion Complete Abortion Missed Abortion Habitual Abortion Septic Abortion,Clinical Presentations,Threatened Abortion light vaginal bleeding with mild abdominal pain cervical os closed, fetal membranes unbroken treatment might work , continue pregnancy Inevitable Abortion bleeding heavier, a
6、bdominal pain more severe, or fluid passed cervical os open，pregnancy tissue visible abortion is inevitable,Incomplete Abortion heavy vaginal bleeding pregnancy tissue protruding from the cervical os uterus small for the presumed gestational week Complete Abortion vaginal bleeding decreasing, abdomi
7、nal pain alleviating cervical os closed uterus normal for the presumed gestational week,Different Stages of Abortion,threatened abortion continue pregnancy inevitable abortion incomplete abortion complete abortion,Diagnosis,History Physical Examination Laboratory Assessment: ultrasound pregnancy tes
8、t hormone level: serum progesterone,Management,Threatened Abortion bed rest, sedation anti abortion：progesterone，HCG；Vit E；thyroxine supplement monitoring：ultrasound；serum HCG whether to continue pregnancy Inevitable Abortion once diagnosed，remove the pregnancy tissue as quickly as possible suction
9、curettage,Incomplete Abortion perform suction curettage promptly if with heavy bleeding：blood transfusion；preventive antibiotic use Complete Abortion no retained products of conception confirmed by ultrasound；no infection no need for special management,Missed Abortion,Concept: in utero death of the
10、embryo or fetus with retained products of conception Clinical Manifestation: uterine enlargement ceasing or fetal movement disappearing cervical os closed, uterus small for the presumed gestational age no fetal heartbeat ; embryonic demise suggested by ultrasound findings,Management,blood routine ex
11、amination, coagulation function test correcting coagulation defects：heparin, fibrinogen, etc. sensitizing the uterus： diethylstilbestrol transfusion preparation; emptying the uterus： before 12 weeks: suction curettage after 12 weeks：induction of labor,Habitual Abortion,The occurrence of 3 or more co
12、nsecutive spontaneous abortions The occurrence of 2 spontaneous abortions is defined as recurrent abortion Early abortion：chromosomal abnormalities，immunologic factors，luteal-phase insufficiency, hypothyroidism Late abortion：congenital uterine anomalies，cervical incompetence，uterine fibroids, etc.,M
13、anagement,obtain information on etiology for prior losses before conception genetic counseling cervical incompetence：cervical cerclage during 1418 weeks of gestation with unclear causes：progesterone therapy until 10 weeks of gestation active immunotherapy：intradermic injection of lymphocytes,Septic
14、Abortion,Prolonged bleeding during abortion or retained products of conception lead to intrauterine infection, which might progress into pelvic inflammatory disease, peritonitis or even sepsis if not treated Antibiotic treatment + Prompt evacuation without severe bleeding: management of infection ,
15、performance of suction and curettage with severe bleeding：management of infection while applying forceps, with secondary suction and curettage,Ectopic Pregnancy,Concept,Ectopic Pregnancy: implantation of the fertilized ovum in tissue other than the endometrium Extrauterine Pregnancy including：tubal
16、pregnancy (95), ovarian pregnancy, cornual pregnancy, cervical pregnancy, abdominal pregnancy, etc. one of the main causes of acute abdomen and death,Etiology and Risk Factors,tubal inflammation, pelvic inflammation previous tubal surgery：for infertility, tubal pregnancy, etc. IVF failure of contraception：current use of IUD or oral contraceptives tubal undergrowth or dysfunction other factors：endometriosis, hysteromyoma, smoking, etc.,Endings of tubal p
