1. Early Pregnancy Loss and Ectopic Pregnancy
Xin Wu
Obstetric and Gynecology Hospital

2. 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

3. Ultrasonography: uterus 7×5×4cm，gestational sac 17×12×10mm，embryo 7mm, fetal heart (+)
Urine HCG（+）
Routine blood count and urine: normal

4. 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

5. QUESTIONS
Current diagnosis
Further examination
Treatment
Prognosis

6. 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

7. 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

8. 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

9. 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(+)

10. QUESTIONS
Current diagnosis
Further examination
Treatment method

11. QUESTIONS Current diagnosis: Ectopic pregnancy?
Further examination: serum HCG and transvaginal ultrasound
Treatment method: medical therapy (Methotrexate); surgical management (laparoscopy)
Salpingectomy versus Salpingostomy

13. 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)

14. Ultrasound: uterus 7×5×4cm，endometrium 10mm，no gestational sac, no adnexal mass
Urine HCG（±）
Routine blood count and urine test: normal

15. 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

16. QUESTIONS
Current diagnosis
Further examination

17. QUESTIONS
Current diagnosis: anembryonic gestation? completed abortion？ectopic pregnancy?
Further examination: ultrasound and serum HCG every 3 days, observe vaginal bleeding and abdominal pain

18. Points Types of abortion Differential diagnosis of ectopic pregnancy
drug treatment and surgical treatment indications of ectopic pregnancy

19. Intrauterine abortion
Anembryonic gestation
Inevitable abortion
Incomplete abortion
Complete abortion

20. Extrauterine pregnancy
Tubal pregnancy
Interstitial pregnancy
Abdominal pregnancy
Cervical pregnancy
Ligamentous pregnancy
Heterotopic pregnancy
Ovarian pregnancy

21. Learn it yourself
Definition and treatment of premature labor and prolonged pregnancy