Ectopic Pregnancy 异位妊娠 马军 Jun Ma 马军 Dept. of Obstetrics & Gynecology The First Hospital of Xi’an Jiaotong Univ

Ectopic:(Ektopos) out of place Definition Ectopic pregnancy: fertilized embryo implanted outside the uterine cavity

intrauterine implantation

Animation of intrauterine implantation

Animation of ectopic implantation

>95% Classification of ectopic pregnancy

Overview Leading cause of maternal deaths in the first trimester Constituting 1-2% of all conceptions Subsequent infertility Incidence increasing Mortality decreasing with better detection

Tubal pregnancy 输卵管妊娠

Incidence of tubal pregnancy by location Interstitial 2-3% isthmic 12% Ampullary 78% Fimbrial 5%

Which women are at higher risk for tubal pregnancy? Which women are at higher risk for tubal pregnancy?

High-risk Factors Prior history of PID (pelvic inflammatory disease)

High-risk Factors Prior history of PID (pelvic inflammatory disease) Tubal Surgery Previous Ectopic Pregnancy IUD (intrauterine device)??? Other tubal abnormalities

Pathology & outcomes

1.Tubal abortion Outcomes

2.Rupture of tubal pregnancy

3. Secondary abdominal pregnancy

4.Tubal mole & pelvic hematoma

Other pathological changes HCG Corpus luteum Endometrium Vaginal bleeding Uterus Intact embryo maintain decidua - slightly enlarged drop regress decidua shedding +/ irregular slightly enlarged or normal size Rupture or abortion

Question How to explain the situation when a woman with ectopic pregnancy claimed that she had expelled an “intra-unterine embryo-like tissue”?

Endometrium Vaginal bleeding Vaginal pass of tissue Pregnancy test ) Histology (Intrauterine villi) Tubal abortion decidua shedding +/ irregular + _ decidua +/ irregular + Intrauterine abortion

Summary   What is ectopic pregancy?   Which patients are at higher risk for tubal pregnancy?   What are the fates of tubal pregnancy?

Thank you.