Abnormal Pregnancy Time Limit and Ectopic Pregnancy Xin Wu Obstetric and Gynecology Hospital sky_xin1980@yahoo.com.cn

Abortion Early abortion Late abortion Spontaneous abortion Artificial abortion

Case 1 27, female, menopause 51 days, a small amount of vaginal bleeding 1 day, no obvious abdominal pain Menstrual history: 12 3/30，menstrual rules G3P0 2008, 2010 spontaneous abortion Miscarriage requirements

Ultrasound: uterus 7×5×4cm，embryo sac 12×8×5，no obvious germ 尿HCG（+） Routine blood and urine: normal

Gynecological examination Vulva: married type Vagina: smooth, a small amount of dark red blood stains Cervix: closed, blood-stained, no obvious lifting pain Palace: front-bit, 6w of pregnancy size, no tenderness Annex: soft

QUESTIONS Current diagnosis Further examination Treatment Prognosis

QUESTIONS Current diagnosis: missed abortion？Threatened abortion? Further examination: review ultrasound and serum HCG 3 days later，coagulation, observe vaginal bleeding and abdominal pain Treatment: bed rest，progesterone miscarriage Prognosis: endocrine factors and immune factors should be checked

Case 2 22, female, menopause 36w，Small amount of vaginal bleeding with paroxysmal abdominal pain 3 hours, half an hour of the vaginal fluid Menstrual history: 12 3/30, menstrual rules G1P0 Check-ups during pregnancy normal

Ultrasound: intrauterine single fetus, BPD 85mm, HC 298mm ,AC 312mm, FL 63mm, AFI 60mm Vagina liquid PH test: blue Routine blood and urine normal, blood pressure and body temperature normal

Abdominal examination Top of Palace at 3cm under xiphoid Regular contractions 20”/5-6’，moderate

Vaginal examination Cervical completely receptivity Cervix can accommodate 2 fingers No obvious amniotic sac Diameters within the pelvic normal

QUESTIONS Current diagnosis Further observation Further treatment

QUESTIONS Current diagnosis: G1P0 36 weeks pregnant，premature birth labor Further observation: CST, contractions,, anomalies Further treatment: review cervical dilation and fetal head down 4 hours later

Case 3 29, female, menopause 42 days，a small amount of vaginal bleeding 3 days, sudden right lower abdominal pain 1 hour Menstrual: 14 5-7/28，rule G2P0 medical abortion 1 time in 2010

Ultrasound: Uterus size 6×5×4cm, endometrial 7mm, no obvious gestational sac, a mixed echo area 25×18×7mm inside the right ovaty Urinary HCG（±） Routine blood Hb 98 g/L Bp 95/65 mmHg

Gynecological Examination Vulva: marriged type Vagina: smooth, a small amount of dark blood Cervix: closed, blood-staining, give pain (+) Palace: median, normal size, without tenderness Annex: a 3cm block on the right side, tenderness(+)

QUESTIONS Current diagnosis Further examination Treatment method

QUESTIONS Current diagnosis: Ectopic pregnancy? Further examination: preoperative examination and blood HCG Treatment method: Laparoscopy

Points Types of abortion Definition of premature labor and prolonged pregnancy Differential diagnosis of ectopic pregnancy, drug treatment and surgical treatment indications