Abnormal Pregnancy Time Limit and Ectopic Pregnanc

yXin 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 ob

vious lifting pain• Palace: front-bit, 6w of pregnancy si

ze, no tenderness• Annex: soft

QUESTIONS• Current diagnosis• Further examination• Treatment• Prognosis

QUESTIONS• Current diagnosis: missed abortion ？ Th

reatened 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, bl

ood 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 p

regnant ， premature birth labor• Further observation: CST, contracti

ons,, 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 20

10

• 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 bl

ood • Cervix: closed, blood-staining, give pain (+

)• Palace: median, normal size, without tend

erness• Annex: a 3cm block on the right side, tend

erness(+)

QUESTIONS• Current diagnosis• Further examination• Treatment method

QUESTIONS• Current diagnosis: Ectopic pregnan

cy?• Further examination: preoperative

examination and blood HCG• Treatment method: Laparoscopy

Points

• Types of abortion• Definition of premature labor and p

rolonged pregnancy• Differential diagnosis of ectopic pre

gnancy, drug treatment and surgical treatment indications