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PREGNANCY
Definition:
Incidence:
Risk Factors:
Any factor that leads, directly or indirectly, to a reduction in
tubal motility increases the risk for tubal pregnancy
Pathology of Ectopic
Pregnancy
TUBAL RUPTURE
Tubal Pregnancy
Symptoms:
Ammenorhea
Abdominal pain
Vaginal bleeding
Signs:
Other Signs:
Tachycardia, Low grade fever
Chadwicks sign (cervix and vaginal cyanosis)
Hegars sign (softened uterine isthmus)
Cervical Motion Tenderness
Enlarged uterus
Tender pelvic or adnexal mass
Cul-de-sac fullness
Signs suggestive of ruptured ectopic pregnancy:
Usually between 6 and 12 weeks gestation
Severe abdominal tenderness with rebound,
guarding
Orthostatic hypotension
Differential Diagnosis
Appendicitis
Threatened Abortion
Ruptured ovarian cyst
PID
Ovarian torsion
Intrauterine pregnancy
Alternative diagnoses:
Dysmenorrhea
Dysfunctional uterine bleed
Mesenteric lymphadenitis
Pregnancy
Normal?
Ectopic
DIAGNOSIS
Laparoscopy
A combination of these
methods may have to be
employed.
Diagnostic modalities
1. Pregnancy test.
a) Urinary B-hCG sensitive, detects 25-50 ml I.U/ml.. Positive
before missing the next period
b) Serum B-hCG Mainly used for quantitative rather than
qualitative purposes
In 85% normal pregnancy B-hCG doubles every 2-3 days
In 85% ectopic pregnancy B-hCG 65% Increase every 2-3 days
3.
4.
Diagnostic modalities
If early pregnancy problems. Urine B-hCG + AScan
Intra-uterine pregnancy .GOOD
No Intra-uterine gestation Seen serum B-hCG + TVS.
with serum B-hCG of 1500-2000 ml I.U/ml Intra uterine gestation should be
seen using TVS otherwise suspect Ectopic pregnancy
3. Diagnostic Laparoscopy.
Diagnostic modalities
Early Pregnancy Assessment Clinic {EPAC}:
With Advance in diagnosis and improvement in patient awareness
ectopic pregnancy is more and more being diagnosed in its early
stages. So, to reduce the incidence of maternal mortality and serious
morbidity this dedicated clinic is a must in regional hospitals.
Patients with early pregnancy problems to report to
MANAGEMENT
Depending on the presentation:
Acute with ruptured ectopic and intra-abdominal bleeding.
ABC,,, + surgical approach.
Early stages, with intact ectopic:
1. Expectant decreasing B-hCG . Tubal abortion
2. Medical Depending on size of ectopic and level of B-hCG..
Use methotrexate.. Not common approach
3. Surgical
SURGICAL TREATMENT OF
ECTOPIC PREGNANCY
The debate goes on
LAPAROTOMY?
VS.
LAPAROSCOPY?
SALPINGECTOMY?
VS
SALPINGOSTOMY / SALPINGOTOMY?
SALPINGECTOMY
VS
SALPINGOSTOMY / SALPINGOTOMY
SALPINGECTOMY
VS
SALPINGOSTOMY / SALPINGOTOMY
SALPINGECTOMY
VS
SALPINGOSTOMY / SALPINGOTOMY
Score
2
SALPINGECTOMY
VS
SALPINGOSTOMY / SALPINGOTOMY
REMEMBER