妇产科教学课件：异位妊娠.pptVIP

手术治疗 条件 生命体征不稳定或腹腔内出血 诊断不明确 异位妊娠有进展 随诊不可靠 期待疗法或药物治疗有禁忌证 手术治疗 切除输卵管 必要时结扎对侧输卵管 保守性手术 输卵管开窗术、伞部挤压术、断端吻合术等，手术最好在微创技术下进行 谨防持续性异位妊娠 血β-HCG升高、术后3日下降20%、2周下降10% 腹腔镜手术 MTX注射术、输卵管切除术及保守性手术 其他部位妊娠 卵巢妊娠 腹腔妊娠 宫颈妊娠 子宫残角妊娠 思考题 输卵管妊娠的原因 输卵管妊娠的治疗原则 千 里 之 行 , 始 于 足 下 A journey always starts with the first step 谢谢！！ * We all to be familiar with this picture ,the female pelvic anatomy ,and we can find the Fallopian tube divide into four parts , fimbria ,ampulla ,isthmic Interstitial.and this is uterus , ovarycharacter of the tube is the fimbria like the finger,it can pick up the egg ,and the ampulla have more space to let the ovum stay ,and the space of the isthmic is small ,so if the ectopic pregnancy stay this location ,it will be rupture ,the last one is interstitial ,where the muscular layer is so thick,like uterus and it can support baby to grow bigger ., * 1)tubal abortion Mostly occurs in ampullary pregnancy 8-12 weeks pregnancy 2)tubal rupture: profuse hemorrhage Rupture also can find in ampulla. * 1. Ultrasound Ultrasound is useful in evaluating patients at risk for ectopic pregnancy, namely by documenting the presence or absence of an intrauterine pregnancy (IUP). -hCG titers and ultrasound complement one another in detecting ectopic pregnancy, and have led to earlier detection with a subsequent decrease in adverse outcome. Ultrasound can help distinguish a normal intrauterine pregnancy from a blighted ovum, incomplete abortion, or complete abortion. An intrauterine sac should be visible by transvaginil ultrasound when the 13-hCG is approximately 1000 mIU/mL, and by transabdominal ultrasound approximately 1 week later, when the β-hCG is 1800-3600 mIU/mL. Thus, when an empty uterine cavity is seen with a β-hCG titer above this threshold, the patient is likely to have an ectopic pregnancy. An empty cavity is less of a concern when a β-hCG below the threshold is obtained, as this may be assoc