Early Pregnancy Loss and Ectopic Pregnancy

Xin WuObstetric and Gynecology Hos

pital sky_xin1980@aliyun.com

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

• Ultrasonography: uterus 7×5×4cm， gestational sac 17×12×10mm ，embryo 7mm, fetal heart (+)

• Urine HCG （ + ）• Routine blood count and urine: nor

mal

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

QUESTIONS• Current diagnosis• Further examination• Treatment• Prognosis

QUESTIONS• Current diagnosis: incompleted abo

rtion ？ Threatened abortion?• Further examination: serum HCG ? r

eview ultrasound ? observe vaginal bleeding and abdominal pain

• Treatment: bed rest ， progesterone medical therapy

• Prognosis: good

Case 2

• 29, female, menopause 42 days ， a small amount of vaginal bleeding 3 days, sudden right lower abdominal pain 1 hour

• Menstrual history: 14 5-7/28 ， rule• G2P0 medical abortion 1 time in 20

10

• 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

Pelvic examination

• Vulva: marriged type• Vagina: smooth, a small amount of da

rk blood • Cervix: closed, blood-staining, motio

n tender (+)• Palace: normal size, without tendern

ess• Annex: a 3cm mass palpable on the ri

ght side, tenderness(+)

QUESTIONS• Current diagnosis• Further examination• Treatment method

QUESTIONS• Current diagnosis: Ectopic pregnancy?• Further examination: serum HCG and t

ransvaginal ultrasound• Treatment method: medical therapy (

Methotrexate); surgical management (laparoscopy)

Salpingectomy versus Salpingostomy

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)

• Ultrasound: uterus 7×5×4cm ， endometrium 10mm ， no gestational sac, no adnexal mass

• Urine HCG （ ± ）• Routine blood count and urine test:

normal

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

QUESTIONS• Current diagnosis

• Further examination

QUESTIONS• Current diagnosis: anembryonic ges

tation? completed abortion ？ ectopic pregnancy?

• Further examination: ultrasound and serum HCG every 3 days, observe vaginal bleeding and abdominal pain

Points

• Types of abortion

• Differential diagnosis of ectopic pregnancy

• drug treatment and surgical treatment indications of ectopic pregnancy

Intrauterine abortion

• Anembryonic gestation• Inevitable abortion• Incomplete abortion• Complete abortion

Extrauterine pregnancy

• Tubal pregnancy• Interstitial pregnancy• Abdominal pregnancy• Cervical pregnancy• Ligamentous pregnancy• Heterotopic pregnancy• Ovarian pregnancy

Learn it yourself

• Definition and treatment of premature labor and prolonged pregnancy