ECTOPIC PREGNANCY

Presented ByMs. Riya Joy

FEMALE REPRODUCTIVE SYSTEM

DEFINITION An ectopic pregnancy is one in which the fertilized ovum is implanted and develops outside the normal uterine cavity.

INCIDENCE

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

Salphingostomy

CHRONIC ECTOPIC

LAPAROTOMY: Vital signs every 15 minutes

Pre operative laboratory test

Ultrasonography

Blood replacement

Psychological support

Rh negative woman:

Anti –D gamma globulin

PROGNOSIS

COMPLICATIONSO RUPTUREO INTERNAL BLEEDINGO SHOCKO DEATH

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

Thank You