ectopic powerpnt 2

8/7/2019 ectopic powerpnt 2

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Case Protocol

Presented by:Clerk Jane Abigail A. Fajardo

Consultant Mentor: Dr. ManabatResident Mentor: Dra. Cerna


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General Data:

I.A.

36 year old

G4P2(2012)

Married Filipino

Catholic

Las Pias City

2nd admission April 2,2009


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Chief Complaint:

Hypogastric pain


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Past Medical History:

No hypertension

No diabetes

No heart disease

No asthma

No known allergy to food and drug

S/P Ex Lap Salpingectomy Left for unruptured

Ectopic Pregnancy - 2001


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Family History:

No hypertension

No diabetes

No heart disease

No asthma


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Personal and Social History:

high school graduate

housewife

non-smoker

non-alcoholic beverage drinker


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Personal and Social History:

Married for 11 years to a 35 year old driver, assignedto different locations

first coitus at 24years old, monogamous

1 sexual partner who claims to be non-promiscuous


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Menstrual History:

y Menarche: 11 years old

y Interval: regular

y Duration: 3-5 days

y Amount: 3 pads/day moderately soaked

y Symptoms: Dysmenorrhea on 2nd day of menses


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Gynecologic History:

No history of any oral contraceptive pills or anyforms of contraception use

No pap smear was done

No dyspareunia

No leucorrhea

No post coital bleeding

No history of sexually transmitted disease


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Obstetric History:

G4P2 (2012)No. of

Pregnancy

Date Outcome Weight Anom/Com

plication

Place

G1 1997 NSD Full Term

Girl

7 lbs None House

G2 2001 Ectopic

Pregnancy,Left

unrupturedS/P Total

Salpingectomy Left

UPHDMC

G3 2004 NSD Full Term

Girl

6.5 lbs None House

G4 Presentpregnancy


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LMP : Jan. 29, 2009

AOG : 9 weeks 1 day

EDC : Nov. 4, 2009


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History of Present Pregnancy:

amenorrheic for 9 weeks and 1 day

No pregnancy test was done

No prenatal check up was done

1 week prior to admission, on and off hypogastricpain, colicky in character, tolerable in intensity,non-radiating

No dysuria, no bleeding, no vomiting


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History of Present Pregnancy:

No medication taken, no consult was done

few hours prior to admission, experienced severehypogastric pain

heavy in character with a pain scale of 6/10 radiatingto lower back

persistence of hypogastric pain

consult at the emergency room and was subsequently

admitted


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Physical Examination:

General Survey : Patient is conscious, coherent,walks with assistance, pale looking and not inrespiratory distress.

Vital Signs:

BP: 90/70mmHg

PR: 115bpm RR: 19cpm T: 36.3C

Ht: 54Wt: 124lbs


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Chest and Lungs: Symmetrical chest expansion, noretractions, clear breath sounds

Heart: Adynamic precordium, tachycardic, regularrhythm, no murmur


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Pelvic Exam:

Gross exam of external genitalia: fair distributionof hair, no lesions, no mass

Speculum exam: cervix pink, smooth, with scantybleeding

Internal exam: cervix closed, soft, uterus slightlyenlarged, there was cervical motion tenderness, withright adnexal tenderness, no mass appreciated, noleft adnexal mass or tenderness


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y Extremities: full equal pulses, no cyanosis, noedema


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Working Impression:

Ectopic Pregnancy, right 9 1/7 wks AOGG4P2(2012)

S/P Ex-lap Salpingectomy, Left for Ectopic

Pregnancy


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Basis:

Amenorrhea (9 1/7 weeks)

History of prior ectopic pregnancy

Hypogastric pain, sudden in onset

Direct and rebound tenderness at right lowerquadrant

Scanty bleeding per os


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Differential Diagnosis:

RULE INRULE IN RULE OUTRULE OUT

1. Threatened Abortion1. Threatened Abortion Vaginal bleedingVaginal bleeding

Lower abdominalLower abdominalcrampingcramping

2. Acute Appendicitis2. Acute Appendicitis Right lower quadrant painRight lower quadrant pain AmenorrheaAmenorrhea

Vaginal bleedingVaginal bleeding

3. Pelvic Inflammatory3. Pelvic Inflammatorydiseasedisease

Direct and reboundDirect and reboundtenderness at the righttenderness at the rightlower quadrantlower quadrant

Vaginal dischargeVaginal discharge

Cervical motionCervical motion

tendernesstendernessAmenorrheaAmenorrhea

Right adnexal tendernessRight adnexal tenderness

Vaginal bleedingVaginal bleeding


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Initial Plan:

Request for some diagnostic tests:

Pregnancy test

Transvaginal ultrasound CBC

Urinalysis


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However,

blood pressure was palpatory 60

tachycardic (130bpm)

no loss of consciousness

Increasing intensity of hypogastric pain


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Admitting Diagnosis:

Hypovolemic shock secondary to

Ruptured Ectopic pregnancy, right

G4P2(2012)

S/P Ex-lap Salpingectomy, Left for EctopicPregnancy


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Plan:

Exploratory Laparatomy, Salpingectomy, right forruptured ectopic pregnancy

Blood Transfusion


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Tubal Pregnancy


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Final Diagnosis:

Tubal Pregnancy, Right ruptured S/P ExploratoryLaparotomy Left for Ectopic Pregnancy

G4P2 (2022)


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Etiology:

The following risk factors have been linked with ectopicpregnancy:

Pelvic inflammatory disease

History of prior ectopic pregnancy History of tubal surgery and conception after tubal

ligation

Use of fertility drugs or assisted reproductivetechnology

Use of an intrauterine device Increasing age

Smoking


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Pathophysiology:

Fallopian tube 98% most common

Ampullary 80%

Isthmic segment of the tube 12%

Fimbria 5%

Cornual and interstitial region of the tube 2%


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Pathophysiology:


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Symptoms:

The early signs are:

y Pain in the lower abdomen, and inflammation

y Pain while urinating

y Pain and discomfort, usually mild

y Vaginal bleeding, usually mild

y Pain while having a bowel movement


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Symptoms:

More severe internal bleeding may cause:

Lowerback, abdominal, or pelvic pain

Shoulder pain

cramping

recent onset of pain


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Diagnosis:

Pregnancy test

Transvaginal ultrasound or pregnancy ultrasound

Quantitative HCG Blood test

Laparoscopy or laparotomy

Culdocentesis


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Treatment:

y Nonsurgical treatment

Methotrexate - can disrupt the growth of the

developing embryo causing the cessation ofpregnancy.


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Treatment:

y Surgical treatment

Laparoscopy or Laparotomy

Salpingostomy

Salpingectomy


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Thank you

and

Good Day !!!

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