Post on 26-Dec-2015
DEFINITION An ectopic pregnancy is one in which the fertilized ovum is implanted and develops outside the normal uterine cavity.
UTERINE TUBE : 95% AMPULLA 55% ISTHMUS 25% INFUNDIBULUM 18% INTERSTITIAL 2%
ABDOMINAL CAVITY : 3-4% OVARY : 1% CERVIX : 1%
SITES OF IMPLANTATION
History of infertility History of PID Use of intra uterine contraceptive device Previous ectopic pregnancy Tubal factors ART Previous induced abortion Congenital abnormalities of the tube Exposure to diethyl stillbesoestrol in utero Age older than 35 years Progesterone only pills Premature degeneration of zona pellucida
ETIOLOGY AND RISK FACTORS
CLINICAL FEATURES ACUTE ECTOPIC
Associated with tubal rupture and massive intraperitoneal haemorrhage.
Acute onset
Short period of Amenorrhoea (6 – 8 weeks)
Abdominal pain
Vaginal bleeding
Feeling of nausea/ vomiting and fainting attack even to the extent of syncope
Patient lies quiet and conscious, perspires and looks blanched
Pallor is usually severe
Features of shock
Abdomen tense (lower abdomen)
Bladder pain may accompany urination.
Shoulder pain (Ruptured ectopic), is caused by internal bleeding irritating the diaphragm
Most often diagnosed accidently during Laparoscopy or Laparotomy
Short period of amenorrhoea.
Uneasiness on one side of the flank which is continuous and sometimes colicky nature.
A palpable small, well circumscribed tender mass may be felt through one fornix separated from the uterus.
UNRUPTURED
CHRONIC OR OLD ECTOPIC
Associated with pelvic haematocoele.
Onset is insidious.
Amenorrhoea.
Abdominal pain.
Bladder irritation – dysuria, frequency, retention of urine, temperature slightly elevated.
Patient looks ill, pallor.
Cullen sign: An echymotic blueness around the umbilicus indicating haemoperitoneum
Bimanual examination – Boggy and tenderness.
DIAGNOSIS
Clinical history
Physical examination
Blood test : Hb, Hct, WBC
Culdocentesis
Pregnancy test
Quantitative HCG blood test
Transvaginal ultrasound or pregnancy ultrasound
MANAGEMENT OF ECTOPIC PREGNANCY
ACUTE ECTOPIC :
Resuscitation and laprotomy
Anti shock treatment
Morphine 15 mg IM
5% Dextrose drip
Blood transfusion
Vital signs
Laboratory test – Blood type, Rh factor, complete
blood cell count , Beta hCG assay
Methotrexate therapy
CHRONIC ECTOPIC
LAPAROTOMY: Vital signs every 15 minutes
Pre operative laboratory test
Ultrasonography
Blood replacement
Psychological support
PREVENTION
O Avoiding risk factors for pelvic inflammatory disease (PID) such as having many sexual partners, having sex without a condom, and getting STDs
O Early diagnosis and treatment of STDs,
O Early diagnosis and treatment of salpingitis and PID
O Stopping smoking can reduce the risk of ectopic pregnancy