Ectopic
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Transcript of Ectopic
Objectives :
what is ectopic pregnancy ? what are different sites, high risk groups of
ectopic pregnancy ? Outcomes of tubal pregnancy clinical features, diagnosis and treatment of
ectopic pregnancy.
Ectopic Pregnancy is Implantation of a fertilized ovum at a site other than the normal uterine cavity.
What is Ectopic Pregnancy ?
Risk factors of ectopic Pregnancy
Major risk factors• Pelvic inflammatory
disease( > 50%).• Previous tubal surgery.• Previous ectopic
pregnancy.• Intrauterine
contraceptive devices.• Termination of
pregnancy.
Minor risk factors.• Tuberculosis
salpingitis.• Cigarette smoking.• Age over 35 years.• Many sexual partners.• Congenital anomalies of
the fallopian tubes.• Ovum transmigration.
Pelvic inflammatory disease.
• Intrauterine contraceptive devices.• puerperal sepsis.• Post abortal sepsis.• Generalized or pelvic peritonitis.• Gonorrhea.• Past appendicitis.
2. Abdominal Pain
Dull ache Unruptured tubal pregnancy.
Sharp Colicky pain Ruptured tubal pregnancy .
3.Vaginal Bleeding
• May persist continuously or intermittent spotting.
• Its mainly uterine in origin and partly by ruptured fallopian tube.
• Due to breakdown of decidua after the pregnancy dies and hormones are withdrawn.
Clinical features: Signs
General physical examination
• patient is sweating, • skin is pale, cold, clammy • low blood pressure• weak pulse.
Clinical features : Signs
Abdominal examination.• Abdomen tenderness.• Abdominal distension.• Cullen’s sign (may be
positive )
Clinical features: Signs
Pelvic examination.
• Bluish discoloration of vulua and vagina.
• On bimanual examination: Tenderness on rocking of cervix, most constant sign of ectopic pregnancy ( chandelier sign).
Clinical Presentation
• Acute ectopic pregnancy.• Chronic ectopic pregnancy. Patient presents with vague history,
intermittent pain and irregular bleeding. The diagnosis can easily be missed if patient is not evaluated thoroughly.
Outcomes of ectopic pregnancy
Usually the tubal pregnancy does not proceed beyond 8-10 weeks of gestation due to
Lack of decidual reaction in the tube. The thin wall of the tube The inadequacy of the tube lumen.
Outcomes of ectopic pregnancy
1.
Tubal abortion
• This occurs more if ovum had been implanted in the ampullary portion of the tube
2-
Tubal rupture• More common if implantation occurs in the narrower portion of the tube which is the isthmus.
3.
Tubal mole and pelvic hematoma.
In tubal mole gestational sac is retained in tube and is surrounded by a blood clot.
Differential diagnosis
• Spontaneous abortion• Ovarian pathology• Corpus luteum haemorrhage.• Acute pelvic inflammatory disease• Appendicitis.• Subserous fibroid.• Retroverted gravid uterus.• Perforated pelvic ulcer• UTI• Ureteric colic.
Diagnosis
• History• General physical examination.• Abdominal and pelvic examination.• Investigations.
Investigation
• Most useful is Ultrasonography Empty uterine cavity, and gestational sac on side of the body of uterus.
• Laparoscopy. Most reliable method of making a diagnosis of ectopic pregnancy.
Investigation
• Culdocentisis . Positive only in the case of ruptured ectopic pregnancy.
•Repeated Blood Hemoglobin in case of atypical features.•Total leukocyte count may be raised.• Abnormal levels of b-hcG.
Surgical treatment
Laparotomy Indicated for1. Ruptured tubal pregnancy2. Patient is hemodynamically
unstable.3. Laparoscopy is
contraindicated4. Pregnancy is in
rudimentary horn of uterus.
LaparoscopyIndicated for1. Unruptured tubal
pregnancy2. Which cannot be treated
by medical methods.
Medical Treatment
Selection criteria Unruptured tubal pregnancy less than 3 cm in
diameter. Absent haemoperitonium Sonographically non viable pregnancy, fetal heart
sound absent. B-hcG less than 2000 IU/L. Minimal symptoms.
Drugs• Methotrexate (50mg with 2ml aqueous sol)• Actinomycin-D• Prostaglandin• Mifepristone• Hyperosmolar glucose.• 20% potassium chloride.