流產(chǎn)異位妊娠AbortionConceptApregnancylossbefore28weeksofgestationwhilefetalweightunder1000gramsEarlyAbortion：pregnancylossbefore12

gestationalweeksLateAbortion:pregnancyloss

during12～28

gestationalweeksSpontaneousAbortionArtificialAbortionGeneticdefectMaternalfactors:systematicdisease;genitalorgananomalies;endocrineanomalies;irritation;bad

habitImmuneanomaliesEnvironmentalfactorsEtiology

PathologyBefore8weeks:

chorionicvilliimmature

Fetaldeath→basaldecidualbleeding→uterinecontraction→expulsionofalltheproductsofconception,lightbleedingDuring8～12

weeks：withfirmattachmenttothebasaldeciduaPartialexpulsionoftheproductsofconception→non-idealuterinecontraction,severebleedingAfter12

weeks:

placentafullyformed.

Uterinecontraction→expulsionofalltheproductsofconception，lightbleedingSymptomsAmenorrhea,vaginalbleeding,andabdominalpainEarlyabortion：vaginalbleedingprecedingabdominalpainLateabortion：abdominalpainprecedingvaginalbleedingTypesofAbortionThreatenedAbortionInevitableAbortionIncompleteAbortionCompleteAbortionMissedAbortionHabitualAbortionSepticAbortionClinicalPresentationsThreatenedAbortionlightvaginalbleedingwithmildabdominalpaincervicalosclosed,fetalmembranesunbrokentreatmentmightwork,continuepregnancyInevitableAbortionbleedingheavier,abdominalpainmoresevere,orfluidpassedcervicalosopen，pregnancytissuevisibleabortionisinevitableIncompleteAbortionheavyvaginalbleedingpregnancytissueprotrudingfromthecervicalosuterussmallforthepresumedgestationalweekCompleteAbortionvaginalbleedingdecreasing,abdominalpainalleviatingcervicaloscloseduterusnormalforthepresumedgestationalweekDifferentStagesofAbortionthreatenedabortion

continuepregnancyinevitableabortionincompleteabortioncompleteabortionDiagnosisBleedingAbdominalPainTissueExpulsionCervicalOsUterusThreatenedAbortionInevitableAbortionIncompleteAbortionCompleteAbortionLightMildtoheavyLighttoheavyLighttononeNone/lightIntensifiedRelievedNoneNoneNonePartialCompleteClosedDilatedDilatedorobstructedClosedNormalNormalorslightlysmallSmallNormalorslightlylargeHistoryPelvicExaminationManagementThreatenedAbortionbedrest,sedationantiabortion：progesterone，HCG；VitE；thyroxinesupplementmonitoring：ultrasound；serumHCG→whethertocontinuepregnancyInevitableAbortiononcediagnosed，removethepregnancytissueasquicklyaspossiblesuctioncurettage

MissedAbortion

Concept:inuterodeathoftheembryoorfetuswithretainedproductsofconceptionClinicalManifestation:uterineenlargementceasingorfetalmovementdisappearingcervicalosclosed,uterussmallforthepresumedgestationalagenofetalheartbeat;embryonicdemisesuggestedbyultrasoundfindingsManagementHabitualAbortion

Theoccurrenceof3ormoreconsecutivespontaneousabortionsTheoccurrenceof2spontaneousabortionsisdefinedasrecurrentabortionEarlyabortion：chromosomalabnormalities，immunologicfactors，luteal-phaseinsufficiency,hypothyroidismLateabortion：congenitaluterineanomalies，cervicalincompetence，uterinefibroids,etc.Management

SepticAbortion

Prolongedbleedingduringabortionorretainedproductsofconceptionleadtointrauterineinfection,whichmightprogressintopelvicinflammatorydisease,peritonitisorevensepsisifnottreatedAntibiotictreatment+Promptevacuationwithoutseverebleeding:managementofinfection,performanceofsuctionandcurettagewithseverebleeding：managementofinfectionwhileapplyingforceps,withsecondarysuctionandcurettageEctopicPregnancyConcept

EctopicPregnancy:implantationofthefertilizedovumintissueotherthantheendometriumExtrauterinePregnancyincluding：tubalpregnancy(95％),ovarianpregnancy,

cornualpregnancy,cervicalpregnancy,abdominalpregnancy,etc.oneofthemaincausesofacuteabdomenanddeathEtiologyandRiskFactorstubalinflammation,pelvicinflammationprevioustubalsurgery：forinfertility,tubalpregnancy,etc.IVFfailureofcontraception：currentuseofIUDororalcontraceptivestubalundergrowthordysfunctionotherfactors：endometriosis,hysteromyoma,smoking,etc.Endingsoftubalpregnancyabortion：8～12

weeks

rupture：12～16weeks

secondaryabdominalpregnancyChronicectopicpregnancyPersistentectopicpregnancyPathologyoftheUterusenlargementandsofteningamenorrhea

vaginalbleedingtheArias-StellareactionoftheendometriumbutnochorionicvilliClinicalPresentations-SymptomsAmenorrheaAbdominalpain：time,characteristicsVaginalbleedingFaint/shockClinicalPresentations-SignsGeneralconditionAbdomenexaminationPelvicexamination：cervicalmotiontenderness，sensationofafloatinguterus，adnexalmass,etc.LaboratoryAssessmentHCG:urinaryHCG；theriseintheserumβ-HCGlevelover48

hours﹤66％serumprogesterone：only1.5%﹥25ng/mlultrasound：theemptyuterussign；adnexalcardiacactivityorultrasonographiclucency;presenceofcul-de-sacfluidculdocentesis：nonclottingbloodlaparoscopy：goldstandard，diagnosis＋treatment

earlydiagnosismissedin3％～4％ofpatientsusewithcaution：toavoidanestheticandsurgicalrisks；medicaltherapyasanoptionUterinecurretage：profusevaginalbleeding;intrauterinepregnancylossDifferentialDiagnosisEctopicpregnancyabortionAdnexalinflammationAppendicitisCorpusluteumruptureOvarycysttorsion1.Amenorrhea2.Abdominalpain3.Bleeding4.Shock

5.Bodytemperature6.Pelvicexaminatioon7.WBC8.Hb9.HCG10.Ultrasound11.CuldocentesisSurgicalTreatmentRadicaloperation：hemodynamicallyunstable;interstitialpregnancy;tubalruptureConservativeoperation：withwishestoretainpotentialforfertility－milkingorlinearsalpingostomy＋MTXMedicalTreatmentMedicalTreatmentProtocol：MTX150mg，giveaseconddoseonday7ifnecessaryMonitoringtherapeuticeffectiveness：ifdeclineinserumhCGlevelonday7≤25%；＜15%orsymptomsworseningorinternalbleedingoccurring;2weeksuntilnegativeExpectanttreatmentPainmild，bleedinglight；Noevidenceoftubalrupture；Nointraabdominalbleeding；Serumβ-HCG﹤1000U/L，andcontinuedeclining;Pregnancymass﹤3cmorundetected；Follow-upreliable

NontubalEctopicPregnancyCervicalPregnancyConcept：implantationofthedevelopingconceptusinthecervicalcanalIncidence：1：18000Clinicalfeature：painlessvaginalbleedingDiagnosticcriteria：theuterinesizeiscomparabletothatofanunpregnantone;thepresenceofpregnancytissuerelatedexclusivelytothecervicalcanal；curretageoftheendometrialcavityisnonproductiveofpregnancytissueTreatmentprinciple：transfusionpreparation;curretageorsuctioncurretage

;MTXand/oruterinecurretageOvarianPregnancyOvarianPregnancyClinicalpresentations：amenorrhea,abdominalpain,vaginalbleeding，shock,etc.Differentiatedfrom：rupturedcorpusluteum；tubalpregnancyTreatmentprinciple：surgicaltreatmentAbdominalPregnancyThepresenceofapregnancyrelatedtoaperitonealsurfaceotherthanfallopiantube,ovary