A summarised presentation on ectopic pregnancy

1. ECTOPIC
PREGNANCY
SIMEON LAISAN AND JOSEPH MANJOLO (MALAWI
COLLEGE OF HEALTH SCIENCES, CCM 2 STUDENTS, LL CAMPUS)

2. CASE PRESANTION
DATE:06/09/22
H S, aged 41 yrs, female, SS:NR, G5 P4,
P/C
 Not having menses for 12 weeks
 Vaginal bleeding since yesterday
HPC
Was well until yesterday, when she started having PV bleeding following 3
months amenorrhoea
OBS HX
Has 4 living children, all delivered through SVD

3. Cont….
O/E
Alert,pink conjuctiva and afebrile to touch
Chest
Clear, symmetrical expansions, S1 + S2+ 0
Abdomen
Soft and flat with mild tenderness on the lower left
Vaginal examination
Cervix closed and blood seen on the os

4. Cont…
VITAL SIGNS
BP:91/55, RR:37b/m, PR:110b/m
DIFFERENTIAL DIAGNOSIS
?Ruptured ectopic pregnancy
?Miscarriage
INVESTIGATIONS
 Pregnancy Test was positive
 Pelvic USS shows a non-gravid uterus, mass in the poch of daglous

5. Cont…
MANAGEMENT
 Iv fluids, N/S( 1l bolus)
 Full blood count
 Blood grouping and cross match
 Ceftriaxone 2g OD for 5 days
 Transfer to gynae ward for exploratory laparotomy
 Counsel about family planning options and risk of future ectopic
pregnancy

6. THEORY

7. OBJECTIVES
 DEFINITION
 AETIOLOGY
 RISK FACTORS
 CLINICAL FEATURES
 DIFFERENTIALS
 INVESTIGATIONS
 MANAGEMENT
 COMPLICATIONS

8. DEFINITION
 Refers to the implantation of a fertilized egg outside the uterine cavity.
 Ectopic pregnancy occurs commonly in fallopian tubes but also other rare
sites such as ovary, abdominal cavity and the cervix
 It is the complication of the first trimester of the pregnancy

10. AETIOLOGY
 The aetiological factors include:
• Anatomical /phsiological tubal obstruction
• Impaired tubular motility and ciliary dysfunction
• Molecular chemotactic factors

11. RISK FACTORS
 Previous surgery
 Infections
 Cigarette smoke
 Previous history of ectopic pregnancy
 Old age
 Treatment for infertility with “In Vitro Fertilization”
 Intra Uterine Contraceptive Devices

12. CLINICAL FEATURES
History of amenorrhoea
PV bleeding(spotting) Lower abdominal pain
TRIAD

13. Other features
 Pelvic tenderness
 Enlarged uterus
 Adnexal mass or tenderness
 Lower back pains

14. DIFFERENTIALS
 Miscarriage
 Ovarian cyst
 Appendicitis
 Urinary Tract Infections
 Salpingitis

15. INVESTIGATIONS
 History of amenorrhoea, per vaginal bleeding or lower abdominal pains
 Speculum examination
 Pregnancy Test
 Transvaginal Ultra Sound Scan
 Culdocentesis
 Urinalysis

16. EMERGENCY MANAGEMENT
 Resuscitation with plasma expanders
 Blood samples
 Prophylactic antibiotics
 Counselling and consent for surgery
 Immediate surgery>salpingectomy

17. other management
 Expectant management-careful monitoring of the condition to see
whether treatment is necessary-methotrexate is used to stop the
pregnancy growing

19. COMPLICATIONS
 Infertility
 Recurrent ectopic pregnancy
 Peritonitis
 Chronic salpingitis
 Intestinal obstruction

20. References
 Malawi Obs and Gynae Protocols and Guidelines, 15 December,2017,
version 3.0, page 15
 Wiley Blackwell, Errol R. Nortwitz, John O. Schorge, Obstretics and
Gynecology at a Glance, 4th Edition, October 2013, ISBN:978-1-118-34173-
5,page 18 of 168
 https://www.mayoclinic.org/diseases-conditions/ectopic –
pregnancy/symptoms-causes/syc-20372088?
 https://www.sciencedirect.com/science/article/abs/pii/S1526952306003382
 https://www.medicalnewstoday.com/articles/164989

21. THANK
YOU!