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

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

4. intrauterine implantation

5. Animation of intrauterine implantation

6. Animation of ectopic implantation

7. >95% Classification of ectopic pregnancy

8. 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

9. Tubal pregnancy 输卵管妊娠

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

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

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

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

14. Pathology & outcomes

15. 1.Tubal abortion Outcomes

16. 2.Rupture of tubal pregnancy

17. 3. Secondary abdominal pregnancy

18. 4.Tubal mole & pelvic hematoma

19. 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

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

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

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

23. Thank you.