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Early Pregnancy Loss and Ectopic Pregnancy
Xin Wu Obstetric and Gynecology Hospital
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Case 1 27, female, menopause 51 days, a small amount of vaginal bleeding 1 day, no obvious abdominal cramping pain Menstrual history: 12 3/30,rule G3P0 spontaneous abortion in 2008, 2010
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Ultrasonography: uterus 7×5×4cm,gestational sac 17×12×10mm,embryo 7mm, fetal heart (+)
Urine HCG(+) Routine blood count and urine: normal
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pelvic examination Vulva: married type
Vagina: smooth, a small amount of dark red blood Cervix: closed, blood-stained, no obvious motion tenderness Palace: as 6w+ of pregnancy size, no tenderness Annex: soft
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QUESTIONS Current diagnosis Further examination Treatment Prognosis
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QUESTIONS Current diagnosis: incompleted abortion?Threatened abortion?
Further examination: serum HCG ? review ultrasound ? observe vaginal bleeding and abdominal pain Treatment: bed rest,progesterone medical therapy Prognosis: good
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Case 2 29, female, menopause 42 days,a small amount of vaginal bleeding 3 days, sudden right lower abdominal pain 1 hour Menstrual history: /28,rule G2P0 medical abortion 1 time in 2010
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Transvaginal ultrasonography: Uterus size 6×5×4cm, endometrium 7mm, no obvious gestational sac, a mixed echo area 25×18×7mm at the left side of the right ovary, dark fluid area deep 12mm behind uterus Urine HCG(±) Blood count: Hb 98 g/L Bp 95/65 mmHg
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Pelvic examination Vulva: marriged type
Vagina: smooth, a small amount of dark blood Cervix: closed, blood-staining, motion tender (+) Palace: normal size, without tenderness Annex: a 3cm mass palpable on the right side, tenderness(+)
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QUESTIONS Current diagnosis Further examination Treatment method
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QUESTIONS Current diagnosis: Ectopic pregnancy?
Further examination: serum HCG and transvaginal ultrasound Treatment method: medical therapy (Methotrexate); surgical management (laparoscopy) Salpingectomy versus Salpingostomy
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Case 3 32, female, menopause 42 days, a small amount of vaginal bleeding 1 day, no obvious abdominal cramping pain Menstrual history: 13 3/30,menstrual rules G3P0 artificial abortion in 2008, right tubal pregnancy in 2011 (laparoscopic salpingostomy)
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Ultrasound: uterus 7×5×4cm,endometrium 10mm,no gestational sac, no adnexal mass
Urine HCG(±) Routine blood count and urine test: normal
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Pelvic examination Vulva: married type
Vagina: smooth, a small amount of dark red blood Cervix: closed, blood-stained, no obvious motion tenderness Palace: slightly enlarged, no tenderness Annex: soft
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QUESTIONS Current diagnosis Further examination
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QUESTIONS Current diagnosis: anembryonic gestation? completed abortion?ectopic pregnancy? Further examination: ultrasound and serum HCG every 3 days, observe vaginal bleeding and abdominal pain
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Points Types of abortion Differential diagnosis of ectopic pregnancy
drug treatment and surgical treatment indications of ectopic pregnancy
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Intrauterine abortion
Anembryonic gestation Inevitable abortion Incomplete abortion Complete abortion
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Extrauterine pregnancy
Tubal pregnancy Interstitial pregnancy Abdominal pregnancy Cervical pregnancy Ligamentous pregnancy Heterotopic pregnancy Ovarian pregnancy
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Learn it yourself Definition and treatment of premature labor and prolonged pregnancy
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