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Ectopic preg
 

Ectopic preg

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about ectopics

about ectopics

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    Ectopic preg Ectopic preg Presentation Transcript

    • STUMP ECTOPIC
    • INTRODUCTION     Stump ectopic is in which pregnancy takes place in the residual part of tube. Incidence of recurrent ectopic after previous one ectopic is approx 15% and this rises to 30% following two ectopics. We present a rare case of recurrent ectopic occurring in the proximal remnant part of left fallopian tube after ipsilateral partial distal salpingectomy. Ref: Obstet Gynae colscand 2002 81:11139-43 Publisher fill text open URI.
    • CASE PRESENTATION      A 29 yrs old infertile Female, with previous H/O Left Salpingectomy for ectopic pregnancy one year back presented with severe pain in abdomen with minimal vaginal bleeding . She was overdue by three days. On investigation her Urine pregnancy test was positive . And Beta HCG done on 04/08/11 was 408 & after 48 hrs 787 so supportive treatment started. Then she came in emergency with severe abdominal pain after one week. O/E- Her vitals were stable and tenderness was there in lower abdomen on left side. On P/V – Cervical excitation test was positive and fullness in left fornix. On trans vaginal sonography there was no intra uterine sac with minimum fluid in uterine cavity with echogenic space occupying lesion about 8.0x5.1 cm visible behind the uterus consistent with left ectopic. Emergency laparoscopy was performed.
    • ON LAPAROSCOPY        Haemoperitoneum about 1 lit lying in pelvis. Uterus was normal. Both ovaries normal. Right tube looked convoluted & unhealthy. Oh it is stump ectopic !!! Bleeding from tubal stump on left side was present The stump was excised and sent for histopathology. Thorough peritoneal wash done.
    • MANAGEMENT      She was an infertility patient who was trying to conceive. Can we say this girl was lucky? In a way Yes. She had ectopic pregnancy on same fallopian tube which was previously affected. She has still more than 65% chances of intrauterine pregnancy if contra lateral tube is healthy. Unfortunately this tube was also unhealthy and convoluted morphologically so it was also removed avoid another ectopic pregnancy, and sent for HPE She was planned for subsequent IVF. The clinical diagnosis of tubal ectopic pregnancy was confirmed histologicaly. She was discharged on 3rd post operative day.
    • DISCUSSION Diagnosis of ectopic needs high degree of suspicion.  Triad of Amenorrhea, Pain and vaginal bleeding present only in 50% patients.  Particular risk factors in our case was previous ectopic pregnancy, prior fallopian tube surgery and history of infertility led to prompt Hospitalization. 
    • LAPAROSCOPY VERSUS LAPAROTOMY     After laparoscopy recurrence is 7%. After Laparotomy recurrence for ectopic is 14%. However there is no statically significant difference in laparoscopy and Laparotomy but laparoscopy is the reference surgical approach because it reduces hospital stay, analgesic requirement, Hospital cost, risk of post surgical adherence & also result in low morbidity & better aesthetic appearance Laparotomy only performed when laparoscopy is Contraindicated. J Gynae colo obstet Bio reporod (Paris) 2003 Nov.
    • SALPINGOSTOMY VERSUS SALPINGECTOMY Recurrence after first ectopic is 10% after salpingectomy and 15% after salpingotomy.  Salpingectomy remains the standard surgical treatment for ectopic.  However the final decisive ability rest with patient and her husband.  (Yao and tuland in 1997)
    •  Concomitant bilateral tubal ectopic pregnancies after bilateral partial salpingectomy for sterilization have also been reported. Br Med J 1977
    • Sangal and Kotwal reported an unusual presentation of a 3rd tubal pregnancy associated with fimbrial end of a previous right partial salpingectomy and left tubal salpingectomy.  The incidence of tubal pregnancy distal to the site of sterilization is five times that in the segment proximal to the site of sterilization.  J. Reprod Med 1987
    •  High rate of ectopic pregnancy following laparoscopic tubal coagulation failure by a tuboperitoneal fistula formation have been reported. Jeffcoate’s Principles of Gynaecology. 5th ed. London:
    •  Ectopic pregnancy in the distal part of the fallopian tube following vaginal hysterectomy (graffagnino,1963; moayer, 1966) or abdominal hysterectomy (ledger & daly, 1963) was shown to be the result of simple trapping of the fertilized ovum in the ligated tube at the time of hysterectomy.
    • CONCLUSION Recurrent ectopic pregnancy following ipsilateral partial salpingectomy is a rare occurrence. At primary care level and emergency department urine pregnancy testing should be performed in any woman of reproductive age with unexplained per vaginal bleeding. At tertiary level, management protocol should be in place to enable expedient diagnosis and therapeutic intervention of ectopic pregnancies, Nevertheless, BHCG trending may not be entirely conclusive in every case and hence the maintenance of a high index of clinical suspicion is a paramount importance.
    • THANK YOU