SlideShare a Scribd company logo
ECTOPIC PREGNANCY
MRS.ELIZEBETH RANI ,
READER,
VHS- MACCON
Introduction
 An ectopic pregnancy, or eccysis , is a
complication of pregnancy in which the embryo
implants outside the uterine cavity.
 In a normal pregnancy, the fertilized egg enters the
uterus and settles into the uterine lining where it has
plenty of room to divide and grow.About 1% of
pregnancies are in an ectopic location with
implantation not occurring inside of the womb, and of
these 98% occur in the Fallopian tubes.
Normal pregnancy
An ectopic
pregnancy is
one in which the
fertilized ovum
is implanted &
develops outside
the normal
uterine cavity.
Factors
 The factors causing this are-
 Chronic inflammatory diseases of the tube.
 Developmental defects of the tube.
 Distortion of the tube.
 Iatrogenic.
 Tubal spasm.
Sites Of Implantation
Angular
Primary Secondary
Intraperitonial Extra-peritoneal
Tubal pregnancy
 The vast majority of ectopic pregnancies implant in the Fallopian
tube. Pregnancies can grow in the fimbrial end (5% of all ectopics),
the ampullary section (80%), the isthmus (12%), and the cornual and
interstitial part of the tube (2%).Mortality of a tubal pregnancy at the
isthmus or within the uterus (interstitial pregnancy) is higher as
there is increased vascularity that may result more likely in sudden
major internal hemorrhage.
 A review published in 2010 supports the hypothesis
that tubal ectopic pregnancy is caused by a combination
of retention of the embryo within the fallopian tube
due to impaired embryo-tubal transport and alterations
in the tubal environment allowing early implantation to
occur.
Causes Of Tubal Pregnancy
High Risk Factors
 Previous ectopic pregnancy
Women who have had one ectopic pregnancy face a 10% chance of having another.
 Abnormal fallopian tubes
Anatomical abnormalities of the fallopian tubes can make implantation in the tubes
much more likely than in women without tubal abnormalities.
 Maternal DES use
The drug DES (or diethylstilbestrol) has been shown to cause congenital abnormalities
of the uterus in girls born to mothers who took the drug during pregnancy.The fallopian
tubes in these girls can also be formed in a way that makes ectopic pregnancy more likely.
Doctors stopped prescribing DES to pregnant women in the early 1970s.
 Endometriosis
The disorder increases the chance of scar tissue and adhesions that interfere with the
ability of the fertilized egg to reach the uterus.
 History ofTubal Surgery
Having had surgical procedures involving the fallopian tubes, such as tubal ligation, can
make an ectopic pregnancy more likely.
 Use of IUD device
Causes Cont..
Moderate Risk Factors
 History of sexually transmitted infections or pelvic inflammatory disease
Sexually transmitted diseases can lead to pelvic inflammatory disease.
 History of infertility
Some medical factors that cause infertility might also make ectopic pregnancy more likely, and
researchers also believe that the drugs commonly used to treat infertility might also increase ectopic
pregnancy risk.
 Multiple sexual partners
The reason why having multiple sexual partners increases risk is most likely due to an increased
chance of acquiring a sexually transmitted infection.
 Exposure to cigarette smoke
The greater the exposure to smoke, the higher the risk for ectopic pregnancy. One study found
that women who smoked 20 or more cigarettes per day were almost four times more likely to have an
ectopic pregnancy than women who never smoked.
Low Risk Factors
 Douching
Some doctors think that douching could potentially cause abnormal bacteria present in the vagina
to ascend higher in the reproductive tract and lead to inflammation of the tubes.
 Past abdominal surgery
In one study, women who had an appendectomy for a ruptured appendix had an increased risk of
miscarriage.
 Age
Risk of an ectopic pregnancy appears to increase for older moms, with moms over 40 having the
highest risk.
Clinical Features
 ACUTE (RECENT)
 UNRUPTURED
 SUB-ACUTE /CHRONIC /OLD
 ACUTE ECTOPIC ( 30 % ) LESS COMMON :
Associated with tubal rupture or tubal abortion
with intraperitonel haemorrhage.
 The four important symptoms -
◦ Amenorrhoea (no periods) of short duration – 6 – 8
weeks
◦ Severe abdominal pain – colicky pains,
Causes of pain :
1. Distention of the tube by blood
2. Colic of the tubal muscless
3. Peritoneal irritation
Pain may be referred to the shoulder due to
diaphragmatic irritation.
◦ Cont……
◦ Vaginal bleeding : slight,sanguinous or dark coloured &
usually continuous.
◦ Feeling of Nausea, vomiting and fainting attacks even
of syncope may be present.
 On examination
◦ Patient is extremely pallor.
◦ features of shock : evidenced by the rapid & feeble
pulse, fall in BP & cold & clammy extremities.
◦ Abdomen Examination :
 Tense, timid & tender and painful to touch.
 Tenderness limited to the lower abdomen
 Cont……
 Bimanual Examination: more intraperitonal
bleeding due to manipulation.
Vaginal mucosa – blanches white
Uterus seems normal in size or slightly
bulky
Extreme tenderness on fornix palpation or
on movement of the cervix ( 75 % ).
No mass is felt through the fornix.
 the uterus floats as in water.
UNRUPTURED TUBAL ECTOPIC
 Symptoms :
◦ Presence of delayed period or spotting with features
suggestive of pregnancy.
◦ Uneasiness on one side of the flank which is continuous
or at times colicky in nature.
 Signs :
CHRONIC OR OLD ECTOPIC

◦ May be of slow onset. Symptoms of-
◦ Ammenorrhoea of short duration.
◦ Abdominal pain may have been an severe initially, from which
patient recovers and has dull aching pain.
◦ Scanty bleeding from vagina.
◦ Other symptoms like frequency of urine, fever etc.
 On examination patient looks sick, varying degree of
paleness is present, features of shock are not there, rise of
temperature, abdomen is painful to touch. On internal
examination a mass is felt.
DIAGNOSIS
 Adominal Examination
 Plvic Examination
 Ultrasound Examination
 Blood Examination
 Culdocentesis
 Laparoscopy
 Dilatation & curettage
 laparotomy
Tubal Pregnancy :
 The tubal pregnancy ends in following way-
 Formation of some thing called a tubal mole
 Tubal abortion through fimbrial end (one end of
the tube).
 Tubal rupture.
Salpingotomy for unruptured ectobic
pregnanccy
Treatment
Medical Surgical
 Early treatment of an ectopic
pregnancy with methotrexate is a
viable alternative to surgical
treatment since at least 1993. If
administered early in the pregnancy,
methotrexate terminates the growth
of the developing embryo; this may
cause an abortion, or the tissue may
then be either resorbed by the
woman's body or pass with a
menstrual period. Contraindications
include liver, kidney, or blood disease,
as well as an ectopic mass > 3.5 cm.
 If hemorrhage has already occurred,
surgical intervention may be necessary.
However, whether to pursue surgical
intervention is an often difficult decision
in a stable patient with minimal
evidence of blood clot on ultrasound.
 Surgeons use laparoscopy or
laparotomy to gain access to the
pelvis and can either incise the affected
Fallopian and remove only the
pregnancy (salpingostomy) or remove
the affected tube with the pregnancy
(salpingectomy).The first successful
surgery for an ectopic pregnancy was
performed by Robert LawsonTait in
1883.
COMPLICATIONS
 The most common complication is rupture with
internal hemorrhage which may lead to
hypovolaemic shock.
 Death from rupture is rare in women who have
access to modern medical facilities.
DEFINITION
 An abdominal pregnancy is a form of an ectopic pregnancy where the
pregnancy is implanted within the peritoneal cavity outside the fallopian tube or
ovary and not located in the broad ligament.
 While rare, abdominal pregnancies have a higher mortality rate than ectopic
pregnancies in general but, on occasion, can lead to a delivery of a viable infant.
Incidence
1% of ectopic pregnancies in the United States are abdominal or about 10 out of
every 100,000 pregnancies.
Nigeria places the frequency in that country at 34 per 100,000 deliveries.
Ectopic pregnancies occur in about 1 out of every 60 pregnancies.
Over 40 percent of ectopic pregnancies occur in women between the ages of 20
and 29.
Anatomy
Implantation site
 Peritoneum outside of the uterus
 The rectouterine pouch (culdesac of douglas)
 Omentum, bowel and its mesentery, mesosalpinx
 Peritoneum of the pelvic wall and the abdominal wall
 The growing placenta may be attached to several organs including
tube and ovary. Rare other sites have been the liver and spleen.
giving rise to a hepatic pregnancy or splenic pregnancy,
respectively.Even an early diaphragmatic pregnancy has been
described in a patient where an embryo began growing on the
underside of the diaphragm.
IMPLANTATION
Primary implantation Secondary implantation
 A primary abdominal
pregnancy refers to a
pregnancy that
implanted directly in
the abdominal cavity
and its organs
 Secondary implantation
which means that it
originated from a tubal
(less common an
ovarian) pregnancy and
re-implanted.
Abdominal pregnancy
Symptoms Signs
1. H/o recurrent attacks of
abdominal pain with vaginal
bleeding in early pregnancy.
2. Minor ailments of normal
uterine pregnancy are often
exaggerated.
1. Abdominal swelling with foetus
is felt superficial,tender,on one
side of midline ; foetus is easily
palpable.
2. Braxton hicks contraction
absent.
3. FHS may be present or absent.
4. Foetus lies above brim in
intraperitoneal pregnancy ,
remains low in pelvis in
intraligamentary pregnancy.
Diagnosis
Sonography
Outside an empty uterus, there is no amniotic fluid between the
placenta and the fetus, no uterine wall surrounding the fetus, fetal parts
are close to the abdominal wall, and the fetus is in abnormal lie.
MRI
Elevated alpha-fetoprotein levels
Treatment
Potential treatments consist of surgery with termination of the
pregnancy (removal of the fetus) via laparoscopy or laparotomy, use of
methotrexate, embolization, and combinations of these.
Complication
1. Placental hemorrhage
2. Fetal death
3. Fetal malformation
4. Infection of gestational sac
Ovarian pregnancy
Introduction
 Ovarian pregnancy refers to an ectopic pregnancy that is
located in the ovary.Typically the egg cellis not released or picked-
up at ovulation, but fertilized within the ovary where the
pregnancy implants. Such a pregnancy usually does not proceed
past the first four weeks of pregnancy.
 An untreated ovarian pregnancy causes potentially fatal intra-
abdominal bleeding and thus may become a medical emergency.
Incidence
 Ovarian pregnancies are rare
 Only about 0.15-3% of ectopics occur in the ovary.
 The incidence has been reported to be about 1:3,000 to 1:7,000
deliveries[
Etiology and pathology
 Etiology of ovarian pregnancy is unknown
 suggested that patients who undergo IVF therapy are at higher risk
for ovarian pregnancy.
 An ovarian pregnancy is usually understood to begin when a
mature egg cell is not expelled or picked up from its follicle and a
sperm enters the follicle and fertilizes the egg, giving rise to an
intra follicular pregnancy . It has also been debated that an egg cell
fertilized outside of the ovary could implant on the ovarian surface,
perhaps aided by a deicidal reaction or endometriosis .Ovarian
pregnancies rarely go longer than 4 weeks; nevertheless, there is
the possibility that the trophoblas finds further support outside the
ovary and thus may affect the tube and other organs .In very rare
occasions the pregnancy may find a sufficient foothold outside the
ovary to continue as an abdominal pregnancy, and an occasional
delivery has been reported.
Diagnosis
 Ultrasonography
 pelvic examination :
A unilateral adnexal mass may be found
Symptoms
Abdominal pain and, to a lesser degree
Vaginal bleeding during pregnancy
Patients may present with hypovolemia or be in circulatory shock because of
internal bleeding.
Spiegel berg's criteria in (1878 ) diagnosis of
ovarian pregnancy :
 The gestational sac is located in the region of the ovary.
 The gestational sac is attached to the uterus by the ovarian ligament.
 Ovarian tissue is histologically proven in the wall of the gestational sac.
 The oviduct on the affected side is intact (This criterion, however, holds not true
for a longer ongoing ovarian pregnancy).
Management
 Traditionally, an explorative laparotomy was
performed
 Once the ovarian pregnancy was identified, an
oophorectomy or salpingo-oophorectomy was
performed, including the removal of the
pregnancy.
 Today, the surgery can often be performed via
laparoscopy
 Ovarian pregnancies have been successfully
treated with methotrexate
Angular pregnancy
Definition
◦ When the implantation occurs in the angle (or )
cornu of the uterus overlying the tubal ostium , it is
called ‘ angular pregnancy’.
Clinical features :
1. Pain on one side of midline
2. Astmmetric enlargement of uterus
3. Abortion occurs through uterine cavity
4. Retained placenta occurs
CORNUAL
PREGNANCY
 An interstitial pregnancy is a uterine but ectopic pregnancy;
the pregnancy is located outside of the uterine cavity in that part
of the Fallopian tube that penetrates the muscular layer of the
uterus . The term cornual pregnancy is sometimes used as a
synonym, but remains ambiguous as it is also applied to indicate
the presence of a pregnancy located within the cavity in one of the
two upper "horns" of a bicornuate uterus. Interstitial pregnancies
have a higher mortality than ectopics in general.
Cornual pregnancy
 Pregnancy occurring on the rudimentary horn of a bicornuate
uterus. Horn does not communicate with uterus.
 Rupture usually occurrs at second trimester of pregnancy.
Diagnosis :
 Usually made on rupture.
Management :
 Rudimentary horn is removed.
 If pedicle is wide , hysterectomy may be needed.
Cervical pregnancy
 Pregnancy implants on cervical mucosa below internal os.
 It may may be due to rapid passage of the fertilized ovum for
fertilization of the ovum after it reaches the cervical canal.
 It is rare & seldom lasts beyond the 20th week.
Signs &symptoms :
1. Painless bleeding soon after the time of implantation.
2. Palpation of the cervical mass with distention & thinning of the
cervical wall.
3. Partial dilatation of the external os & a slightly enlarged uterine
fundus.
Treatment :
Removal of the products of conception by curettage & packing
of the cervical canal ( or ) total abdominal hysterectomy.
REFERENCE
 Bobak, I.M., & Leonard, D. (1995). Text Book Of Maternity & Gynecologic
Care :The Nurse & The Family (4th ed.). Mosby Publication.
 Diane., Fraser., & Margret. (2003). Text Book for Midwives (14th ed.).
Elsevier Publishers.
 Dutta, D.c., & Hiralal Konar. (2013). Text Book of Obstetrics (7th ed.).
Jaypee Brothers Medical Publishers.
 Elizabeth, M (2014). Midwifery for Nurses (2nd ed.). Sathish Kumar Jain
Publishers.
 Jacob, A. (2008). A Comprehensive textbook of Midwifery &
Gynecological Nursing (4th ed.). Newyork: Jaypee Brothers Medical
Publishers.
 Kumari Neelam., Sharma Shivani., & Gupta Preethi. (2010). A Text Book
of Midwifery and Gynecological Nursing.
 Ladewig, L. Maternal & Newborn Nursing (3rd ed.). Cumming Publication.
 Nurse Midwifery Helen Varney (2nd ed.).
 Parulekar, V. S. Textbook for Midwives. (2nd ed.). Mumbai: Vora Medical
Publications.
 Raman, A. V. (2014). Maternity nursing (1st ed.). Wolters kluwer
publishers.
 Richa S. Snapshort In Obstetrical & Gynaecology. Jaypee Brother’s
Medical Publisher.

More Related Content

What's hot

Cord prolapse
Cord prolapseCord prolapse
Cord prolapse
Priyanka Gohil
 
c section powerpoint presentation
c section powerpoint presentationc section powerpoint presentation
c section powerpoint presentation
NURSING WAY
 
Cord Prolapse
Cord ProlapseCord Prolapse
Cord Prolapse
Kattey Kattey
 
The placenta and its abnormalities
The placenta and its abnormalitiesThe placenta and its abnormalities
The placenta and its abnormalities
Idi Amadou
 
Manual removal of placenta
Manual removal of placentaManual removal of placenta
Manual removal of placenta
Krupa Meet Patel
 
Hyperemesis gravidarum and its management
Hyperemesis gravidarum and its managementHyperemesis gravidarum and its management
Hyperemesis gravidarum and its management
sunil kumar daha
 
Breech presentation
Breech presentationBreech presentation
Breech presentation
Ayman Shehata
 
Forceps delivery
Forceps deliveryForceps delivery
Forceps delivery
Krupa Meet Patel
 
Retro-version of uterus
Retro-version of uterusRetro-version of uterus
Retro-version of uterus
Godwin Pangler
 
First stage of labour
First stage of labourFirst stage of labour
First stage of labour
Pooja Yadav
 
Caesarean section
Caesarean sectionCaesarean section
Caesarean section
Jitendra Ingole
 
intra uterine fetal growth restriction
intra uterine fetal growth restrictionintra uterine fetal growth restriction
intra uterine fetal growth restriction
AmreenKhan93
 
Inversion Of Uterus
Inversion Of UterusInversion Of Uterus
Inversion Of Uterus
Abhishek Joshi
 
Second stage of labor
Second stage of laborSecond stage of labor
Second stage of labor
DR MUKESH SAH
 
Abnormal uterine action
Abnormal uterine actionAbnormal uterine action
Abnormal uterine action
Amandeep Jhinjar
 
Umbilical Cord prolapse
Umbilical Cord prolapseUmbilical Cord prolapse
Umbilical Cord prolapse
Deepa Mishra
 
Rupture uterus
Rupture uterusRupture uterus
Rupture uterus
muhammad al hennawy
 
Inversion of the uterus
Inversion of the uterusInversion of the uterus
Inversion of the uterus
Priyanka Gohil
 
Malposition
MalpositionMalposition
Malposition
Prativa Dhakal
 
Precipitate labour
Precipitate labourPrecipitate labour
Precipitate labour
BRITO MARY
 

What's hot (20)

Cord prolapse
Cord prolapseCord prolapse
Cord prolapse
 
c section powerpoint presentation
c section powerpoint presentationc section powerpoint presentation
c section powerpoint presentation
 
Cord Prolapse
Cord ProlapseCord Prolapse
Cord Prolapse
 
The placenta and its abnormalities
The placenta and its abnormalitiesThe placenta and its abnormalities
The placenta and its abnormalities
 
Manual removal of placenta
Manual removal of placentaManual removal of placenta
Manual removal of placenta
 
Hyperemesis gravidarum and its management
Hyperemesis gravidarum and its managementHyperemesis gravidarum and its management
Hyperemesis gravidarum and its management
 
Breech presentation
Breech presentationBreech presentation
Breech presentation
 
Forceps delivery
Forceps deliveryForceps delivery
Forceps delivery
 
Retro-version of uterus
Retro-version of uterusRetro-version of uterus
Retro-version of uterus
 
First stage of labour
First stage of labourFirst stage of labour
First stage of labour
 
Caesarean section
Caesarean sectionCaesarean section
Caesarean section
 
intra uterine fetal growth restriction
intra uterine fetal growth restrictionintra uterine fetal growth restriction
intra uterine fetal growth restriction
 
Inversion Of Uterus
Inversion Of UterusInversion Of Uterus
Inversion Of Uterus
 
Second stage of labor
Second stage of laborSecond stage of labor
Second stage of labor
 
Abnormal uterine action
Abnormal uterine actionAbnormal uterine action
Abnormal uterine action
 
Umbilical Cord prolapse
Umbilical Cord prolapseUmbilical Cord prolapse
Umbilical Cord prolapse
 
Rupture uterus
Rupture uterusRupture uterus
Rupture uterus
 
Inversion of the uterus
Inversion of the uterusInversion of the uterus
Inversion of the uterus
 
Malposition
MalpositionMalposition
Malposition
 
Precipitate labour
Precipitate labourPrecipitate labour
Precipitate labour
 

Similar to EXTRA UTERINE OR ECTOPIC PRENANCY

ectopic pregnancy
ectopic pregnancyectopic pregnancy
ectopic pregnancy
Snehlata Parashar
 
. ECTOPIC GESTATION.ppt. Obstetrics and gyn
. ECTOPIC GESTATION.ppt. Obstetrics and gyn. ECTOPIC GESTATION.ppt. Obstetrics and gyn
. ECTOPIC GESTATION.ppt. Obstetrics and gyn
Lydiahkawira1
 
ECTOPIC PREGNANCY lecture.pptx
ECTOPIC PREGNANCY lecture.pptxECTOPIC PREGNANCY lecture.pptx
ECTOPIC PREGNANCY lecture.pptx
DarshuBoricha
 
15b.Ectopic Pregnancy
15b.Ectopic Pregnancy15b.Ectopic Pregnancy
15b.Ectopic Pregnancy
Deep Deep
 
ectopic pregnancy and pregnancy loss-1.pptx
ectopic pregnancy and pregnancy loss-1.pptxectopic pregnancy and pregnancy loss-1.pptx
ectopic pregnancy and pregnancy loss-1.pptx
Stano3
 
Ectopic pregnancy BY DR SHASHWAT JANI
Ectopic pregnancy BY DR SHASHWAT JANIEctopic pregnancy BY DR SHASHWAT JANI
Ectopic pregnancy BY DR SHASHWAT JANI
DR SHASHWAT JANI
 
abortion ...pptx
abortion ...pptxabortion ...pptx
abortion ...pptx
KaranSingh321255
 
Ectopic pregnancy
Ectopic pregnancyEctopic pregnancy
Ectopic pregnancy
Fahad Zakwan
 
Ectopic pregnancy
Ectopic pregnancyEctopic pregnancy
Ectopic pregnancy
Amielia Emilda
 
USMLE GENERAL EMBRYOLOGY 009 First week of develoment B embryo .pdf
USMLE   GENERAL EMBRYOLOGY  009 First week of develoment B embryo .pdfUSMLE   GENERAL EMBRYOLOGY  009 First week of develoment B embryo .pdf
USMLE GENERAL EMBRYOLOGY 009 First week of develoment B embryo .pdf
AHMED ASHOUR
 
Obstetric hemorrhages of the 1st half of pregnancy.ppt
Obstetric hemorrhages of the 1st half of pregnancy.pptObstetric hemorrhages of the 1st half of pregnancy.ppt
Obstetric hemorrhages of the 1st half of pregnancy.ppt
TARUNKUMAR472866
 
Ectopic Pregnancy
Ectopic PregnancyEctopic Pregnancy
Ectopic Pregnancy
mohammed sediq
 
Ectopic pregnancy.presentation slides pt
Ectopic pregnancy.presentation slides ptEctopic pregnancy.presentation slides pt
Ectopic pregnancy.presentation slides pt
yakemichael
 
Bleeding during pregnancy
Bleeding during pregnancyBleeding during pregnancy
Bleeding during pregnancy
Royal Medical Services
 
Ectopic pregnancy pannel discussion
Ectopic pregnancy pannel discussionEctopic pregnancy pannel discussion
Ectopic pregnancy pannel discussion
Jaya Kore Tulaskar
 
Ectopic Pregnancy - Obstetrical & Gynaecological Nursing
Ectopic Pregnancy - Obstetrical & Gynaecological NursingEctopic Pregnancy - Obstetrical & Gynaecological Nursing
Ectopic Pregnancy - Obstetrical & Gynaecological Nursing
Jaice Mary Joy
 
Ectopic pergnancy
Ectopic pergnancyEctopic pergnancy
Ectopic pergnancy
Pari Pratik
 
Uterovaginal prolapse by Dr zarkaish
Uterovaginal prolapse by Dr zarkaishUterovaginal prolapse by Dr zarkaish
Uterovaginal prolapse by Dr zarkaish
Ayub Medical College
 
Abruptio Placenta (Original)
Abruptio Placenta (Original)Abruptio Placenta (Original)
Abruptio Placenta (Original)
boblhen
 
Hemorhages during pregnancy
Hemorhages during pregnancyHemorhages during pregnancy
Hemorhages during pregnancy
Ruslan Migorianu
 

Similar to EXTRA UTERINE OR ECTOPIC PRENANCY (20)

ectopic pregnancy
ectopic pregnancyectopic pregnancy
ectopic pregnancy
 
. ECTOPIC GESTATION.ppt. Obstetrics and gyn
. ECTOPIC GESTATION.ppt. Obstetrics and gyn. ECTOPIC GESTATION.ppt. Obstetrics and gyn
. ECTOPIC GESTATION.ppt. Obstetrics and gyn
 
ECTOPIC PREGNANCY lecture.pptx
ECTOPIC PREGNANCY lecture.pptxECTOPIC PREGNANCY lecture.pptx
ECTOPIC PREGNANCY lecture.pptx
 
15b.Ectopic Pregnancy
15b.Ectopic Pregnancy15b.Ectopic Pregnancy
15b.Ectopic Pregnancy
 
ectopic pregnancy and pregnancy loss-1.pptx
ectopic pregnancy and pregnancy loss-1.pptxectopic pregnancy and pregnancy loss-1.pptx
ectopic pregnancy and pregnancy loss-1.pptx
 
Ectopic pregnancy BY DR SHASHWAT JANI
Ectopic pregnancy BY DR SHASHWAT JANIEctopic pregnancy BY DR SHASHWAT JANI
Ectopic pregnancy BY DR SHASHWAT JANI
 
abortion ...pptx
abortion ...pptxabortion ...pptx
abortion ...pptx
 
Ectopic pregnancy
Ectopic pregnancyEctopic pregnancy
Ectopic pregnancy
 
Ectopic pregnancy
Ectopic pregnancyEctopic pregnancy
Ectopic pregnancy
 
USMLE GENERAL EMBRYOLOGY 009 First week of develoment B embryo .pdf
USMLE   GENERAL EMBRYOLOGY  009 First week of develoment B embryo .pdfUSMLE   GENERAL EMBRYOLOGY  009 First week of develoment B embryo .pdf
USMLE GENERAL EMBRYOLOGY 009 First week of develoment B embryo .pdf
 
Obstetric hemorrhages of the 1st half of pregnancy.ppt
Obstetric hemorrhages of the 1st half of pregnancy.pptObstetric hemorrhages of the 1st half of pregnancy.ppt
Obstetric hemorrhages of the 1st half of pregnancy.ppt
 
Ectopic Pregnancy
Ectopic PregnancyEctopic Pregnancy
Ectopic Pregnancy
 
Ectopic pregnancy.presentation slides pt
Ectopic pregnancy.presentation slides ptEctopic pregnancy.presentation slides pt
Ectopic pregnancy.presentation slides pt
 
Bleeding during pregnancy
Bleeding during pregnancyBleeding during pregnancy
Bleeding during pregnancy
 
Ectopic pregnancy pannel discussion
Ectopic pregnancy pannel discussionEctopic pregnancy pannel discussion
Ectopic pregnancy pannel discussion
 
Ectopic Pregnancy - Obstetrical & Gynaecological Nursing
Ectopic Pregnancy - Obstetrical & Gynaecological NursingEctopic Pregnancy - Obstetrical & Gynaecological Nursing
Ectopic Pregnancy - Obstetrical & Gynaecological Nursing
 
Ectopic pergnancy
Ectopic pergnancyEctopic pergnancy
Ectopic pergnancy
 
Uterovaginal prolapse by Dr zarkaish
Uterovaginal prolapse by Dr zarkaishUterovaginal prolapse by Dr zarkaish
Uterovaginal prolapse by Dr zarkaish
 
Abruptio Placenta (Original)
Abruptio Placenta (Original)Abruptio Placenta (Original)
Abruptio Placenta (Original)
 
Hemorhages during pregnancy
Hemorhages during pregnancyHemorhages during pregnancy
Hemorhages during pregnancy
 

More from ELIZEBETH RANI V

Hydatid form mole
Hydatid form moleHydatid form mole
Hydatid form mole
ELIZEBETH RANI V
 
Hemorrhage in early pregnancy / ABORTION
Hemorrhage in early pregnancy / ABORTIONHemorrhage in early pregnancy / ABORTION
Hemorrhage in early pregnancy / ABORTION
ELIZEBETH RANI V
 
Communication of research report
Communication of research reportCommunication of research report
Communication of research report
ELIZEBETH RANI V
 
WRITING RESEARCH REFERENCE STYLE
WRITING RESEARCH REFERENCE STYLEWRITING RESEARCH REFERENCE STYLE
WRITING RESEARCH REFERENCE STYLE
ELIZEBETH RANI V
 
Minor disorders of pregnancy
Minor disorders of pregnancyMinor disorders of pregnancy
Minor disorders of pregnancy
ELIZEBETH RANI V
 
Health Education on Antenatal care
 Health Education on Antenatal care Health Education on Antenatal care
Health Education on Antenatal care
ELIZEBETH RANI V
 
Pre conception care
Pre conception carePre conception care
Pre conception care
ELIZEBETH RANI V
 
Midwifery
MidwiferyMidwifery
Midwifery
ELIZEBETH RANI V
 
Activities of daily living
Activities of daily livingActivities of daily living
Activities of daily living
ELIZEBETH RANI V
 

More from ELIZEBETH RANI V (9)

Hydatid form mole
Hydatid form moleHydatid form mole
Hydatid form mole
 
Hemorrhage in early pregnancy / ABORTION
Hemorrhage in early pregnancy / ABORTIONHemorrhage in early pregnancy / ABORTION
Hemorrhage in early pregnancy / ABORTION
 
Communication of research report
Communication of research reportCommunication of research report
Communication of research report
 
WRITING RESEARCH REFERENCE STYLE
WRITING RESEARCH REFERENCE STYLEWRITING RESEARCH REFERENCE STYLE
WRITING RESEARCH REFERENCE STYLE
 
Minor disorders of pregnancy
Minor disorders of pregnancyMinor disorders of pregnancy
Minor disorders of pregnancy
 
Health Education on Antenatal care
 Health Education on Antenatal care Health Education on Antenatal care
Health Education on Antenatal care
 
Pre conception care
Pre conception carePre conception care
Pre conception care
 
Midwifery
MidwiferyMidwifery
Midwifery
 
Activities of daily living
Activities of daily livingActivities of daily living
Activities of daily living
 

Recently uploaded

Histololgy of Female Reproductive System.pptx
Histololgy of Female Reproductive System.pptxHistololgy of Female Reproductive System.pptx
Histololgy of Female Reproductive System.pptx
AyeshaZaid1
 
share - Lions, tigers, AI and health misinformation, oh my!.pptx
share - Lions, tigers, AI and health misinformation, oh my!.pptxshare - Lions, tigers, AI and health misinformation, oh my!.pptx
share - Lions, tigers, AI and health misinformation, oh my!.pptx
Tina Purnat
 
Adhd Medication Shortage Uk - trinexpharmacy.com
Adhd Medication Shortage Uk - trinexpharmacy.comAdhd Medication Shortage Uk - trinexpharmacy.com
Adhd Medication Shortage Uk - trinexpharmacy.com
reignlana06
 
K CỔ TỬ CUNG.pdf tự ghi chép, chữ hơi xấu
K CỔ TỬ CUNG.pdf tự ghi chép, chữ hơi xấuK CỔ TỬ CUNG.pdf tự ghi chép, chữ hơi xấu
K CỔ TỬ CUNG.pdf tự ghi chép, chữ hơi xấu
HongBiThi1
 
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPromoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
PsychoTech Services
 
CLEAR ALIGNER THERAPY IN ORTHODONTICS .pptx
CLEAR ALIGNER THERAPY IN ORTHODONTICS .pptxCLEAR ALIGNER THERAPY IN ORTHODONTICS .pptx
CLEAR ALIGNER THERAPY IN ORTHODONTICS .pptx
Government Dental College & Hospital Srinagar
 
June 2024 Oncology Cartoons By Dr Kanhu Charan Patro
June 2024 Oncology Cartoons By Dr Kanhu Charan PatroJune 2024 Oncology Cartoons By Dr Kanhu Charan Patro
June 2024 Oncology Cartoons By Dr Kanhu Charan Patro
Kanhu Charan
 
Pharmacology of 5-hydroxytryptamine and Antagonist
Pharmacology of 5-hydroxytryptamine and AntagonistPharmacology of 5-hydroxytryptamine and Antagonist
Pharmacology of 5-hydroxytryptamine and Antagonist
Dr. Nikhilkumar Sakle
 
Demystifying Fallopian Tube Blockage- Grading the Differences and Implication...
Demystifying Fallopian Tube Blockage- Grading the Differences and Implication...Demystifying Fallopian Tube Blockage- Grading the Differences and Implication...
Demystifying Fallopian Tube Blockage- Grading the Differences and Implication...
FFragrant
 
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptxEar and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
Dr. Rabia Inam Gandapore
 
DECLARATION OF HELSINKI - History and principles
DECLARATION OF HELSINKI - History and principlesDECLARATION OF HELSINKI - History and principles
DECLARATION OF HELSINKI - History and principles
anaghabharat01
 
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptxVestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
Dr. Rabia Inam Gandapore
 
CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1
CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1
CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1
rishi2789
 
Ketone bodies and metabolism-biochemistry
Ketone bodies and metabolism-biochemistryKetone bodies and metabolism-biochemistry
Ketone bodies and metabolism-biochemistry
Dhayanithi C
 
Tests for analysis of different pharmaceutical.pptx
Tests for analysis of different pharmaceutical.pptxTests for analysis of different pharmaceutical.pptx
Tests for analysis of different pharmaceutical.pptx
taiba qazi
 
Does Over-Masturbation Contribute to Chronic Prostatitis.pptx
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxDoes Over-Masturbation Contribute to Chronic Prostatitis.pptx
Does Over-Masturbation Contribute to Chronic Prostatitis.pptx
walterHu5
 
CHEMOTHERAPY_RDP_CHAPTER 4_ANTI VIRAL DRUGS.pdf
CHEMOTHERAPY_RDP_CHAPTER 4_ANTI VIRAL DRUGS.pdfCHEMOTHERAPY_RDP_CHAPTER 4_ANTI VIRAL DRUGS.pdf
CHEMOTHERAPY_RDP_CHAPTER 4_ANTI VIRAL DRUGS.pdf
rishi2789
 
How to choose the best dermatologists in Indore.
How to choose the best dermatologists in Indore.How to choose the best dermatologists in Indore.
How to choose the best dermatologists in Indore.
Gokuldas Hospital
 
Travel Clinic Cardiff: Health Advice for International Travelers
Travel Clinic Cardiff: Health Advice for International TravelersTravel Clinic Cardiff: Health Advice for International Travelers
Travel Clinic Cardiff: Health Advice for International Travelers
NX Healthcare
 
Artificial Intelligence Symposium (THAIS)
Artificial Intelligence Symposium (THAIS)Artificial Intelligence Symposium (THAIS)
Artificial Intelligence Symposium (THAIS)
Josep Vidal-Alaball
 

Recently uploaded (20)

Histololgy of Female Reproductive System.pptx
Histololgy of Female Reproductive System.pptxHistololgy of Female Reproductive System.pptx
Histololgy of Female Reproductive System.pptx
 
share - Lions, tigers, AI and health misinformation, oh my!.pptx
share - Lions, tigers, AI and health misinformation, oh my!.pptxshare - Lions, tigers, AI and health misinformation, oh my!.pptx
share - Lions, tigers, AI and health misinformation, oh my!.pptx
 
Adhd Medication Shortage Uk - trinexpharmacy.com
Adhd Medication Shortage Uk - trinexpharmacy.comAdhd Medication Shortage Uk - trinexpharmacy.com
Adhd Medication Shortage Uk - trinexpharmacy.com
 
K CỔ TỬ CUNG.pdf tự ghi chép, chữ hơi xấu
K CỔ TỬ CUNG.pdf tự ghi chép, chữ hơi xấuK CỔ TỬ CUNG.pdf tự ghi chép, chữ hơi xấu
K CỔ TỬ CUNG.pdf tự ghi chép, chữ hơi xấu
 
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPromoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
 
CLEAR ALIGNER THERAPY IN ORTHODONTICS .pptx
CLEAR ALIGNER THERAPY IN ORTHODONTICS .pptxCLEAR ALIGNER THERAPY IN ORTHODONTICS .pptx
CLEAR ALIGNER THERAPY IN ORTHODONTICS .pptx
 
June 2024 Oncology Cartoons By Dr Kanhu Charan Patro
June 2024 Oncology Cartoons By Dr Kanhu Charan PatroJune 2024 Oncology Cartoons By Dr Kanhu Charan Patro
June 2024 Oncology Cartoons By Dr Kanhu Charan Patro
 
Pharmacology of 5-hydroxytryptamine and Antagonist
Pharmacology of 5-hydroxytryptamine and AntagonistPharmacology of 5-hydroxytryptamine and Antagonist
Pharmacology of 5-hydroxytryptamine and Antagonist
 
Demystifying Fallopian Tube Blockage- Grading the Differences and Implication...
Demystifying Fallopian Tube Blockage- Grading the Differences and Implication...Demystifying Fallopian Tube Blockage- Grading the Differences and Implication...
Demystifying Fallopian Tube Blockage- Grading the Differences and Implication...
 
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptxEar and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
 
DECLARATION OF HELSINKI - History and principles
DECLARATION OF HELSINKI - History and principlesDECLARATION OF HELSINKI - History and principles
DECLARATION OF HELSINKI - History and principles
 
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptxVestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
 
CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1
CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1
CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1
 
Ketone bodies and metabolism-biochemistry
Ketone bodies and metabolism-biochemistryKetone bodies and metabolism-biochemistry
Ketone bodies and metabolism-biochemistry
 
Tests for analysis of different pharmaceutical.pptx
Tests for analysis of different pharmaceutical.pptxTests for analysis of different pharmaceutical.pptx
Tests for analysis of different pharmaceutical.pptx
 
Does Over-Masturbation Contribute to Chronic Prostatitis.pptx
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxDoes Over-Masturbation Contribute to Chronic Prostatitis.pptx
Does Over-Masturbation Contribute to Chronic Prostatitis.pptx
 
CHEMOTHERAPY_RDP_CHAPTER 4_ANTI VIRAL DRUGS.pdf
CHEMOTHERAPY_RDP_CHAPTER 4_ANTI VIRAL DRUGS.pdfCHEMOTHERAPY_RDP_CHAPTER 4_ANTI VIRAL DRUGS.pdf
CHEMOTHERAPY_RDP_CHAPTER 4_ANTI VIRAL DRUGS.pdf
 
How to choose the best dermatologists in Indore.
How to choose the best dermatologists in Indore.How to choose the best dermatologists in Indore.
How to choose the best dermatologists in Indore.
 
Travel Clinic Cardiff: Health Advice for International Travelers
Travel Clinic Cardiff: Health Advice for International TravelersTravel Clinic Cardiff: Health Advice for International Travelers
Travel Clinic Cardiff: Health Advice for International Travelers
 
Artificial Intelligence Symposium (THAIS)
Artificial Intelligence Symposium (THAIS)Artificial Intelligence Symposium (THAIS)
Artificial Intelligence Symposium (THAIS)
 

EXTRA UTERINE OR ECTOPIC PRENANCY

  • 1. ECTOPIC PREGNANCY MRS.ELIZEBETH RANI , READER, VHS- MACCON
  • 2. Introduction  An ectopic pregnancy, or eccysis , is a complication of pregnancy in which the embryo implants outside the uterine cavity.  In a normal pregnancy, the fertilized egg enters the uterus and settles into the uterine lining where it has plenty of room to divide and grow.About 1% of pregnancies are in an ectopic location with implantation not occurring inside of the womb, and of these 98% occur in the Fallopian tubes.
  • 4. An ectopic pregnancy is one in which the fertilized ovum is implanted & develops outside the normal uterine cavity.
  • 5. Factors  The factors causing this are-  Chronic inflammatory diseases of the tube.  Developmental defects of the tube.  Distortion of the tube.  Iatrogenic.  Tubal spasm.
  • 6. Sites Of Implantation Angular Primary Secondary Intraperitonial Extra-peritoneal
  • 7. Tubal pregnancy  The vast majority of ectopic pregnancies implant in the Fallopian tube. Pregnancies can grow in the fimbrial end (5% of all ectopics), the ampullary section (80%), the isthmus (12%), and the cornual and interstitial part of the tube (2%).Mortality of a tubal pregnancy at the isthmus or within the uterus (interstitial pregnancy) is higher as there is increased vascularity that may result more likely in sudden major internal hemorrhage.  A review published in 2010 supports the hypothesis that tubal ectopic pregnancy is caused by a combination of retention of the embryo within the fallopian tube due to impaired embryo-tubal transport and alterations in the tubal environment allowing early implantation to occur.
  • 8. Causes Of Tubal Pregnancy High Risk Factors  Previous ectopic pregnancy Women who have had one ectopic pregnancy face a 10% chance of having another.  Abnormal fallopian tubes Anatomical abnormalities of the fallopian tubes can make implantation in the tubes much more likely than in women without tubal abnormalities.  Maternal DES use The drug DES (or diethylstilbestrol) has been shown to cause congenital abnormalities of the uterus in girls born to mothers who took the drug during pregnancy.The fallopian tubes in these girls can also be formed in a way that makes ectopic pregnancy more likely. Doctors stopped prescribing DES to pregnant women in the early 1970s.  Endometriosis The disorder increases the chance of scar tissue and adhesions that interfere with the ability of the fertilized egg to reach the uterus.  History ofTubal Surgery Having had surgical procedures involving the fallopian tubes, such as tubal ligation, can make an ectopic pregnancy more likely.  Use of IUD device
  • 9. Causes Cont.. Moderate Risk Factors  History of sexually transmitted infections or pelvic inflammatory disease Sexually transmitted diseases can lead to pelvic inflammatory disease.  History of infertility Some medical factors that cause infertility might also make ectopic pregnancy more likely, and researchers also believe that the drugs commonly used to treat infertility might also increase ectopic pregnancy risk.  Multiple sexual partners The reason why having multiple sexual partners increases risk is most likely due to an increased chance of acquiring a sexually transmitted infection.  Exposure to cigarette smoke The greater the exposure to smoke, the higher the risk for ectopic pregnancy. One study found that women who smoked 20 or more cigarettes per day were almost four times more likely to have an ectopic pregnancy than women who never smoked. Low Risk Factors  Douching Some doctors think that douching could potentially cause abnormal bacteria present in the vagina to ascend higher in the reproductive tract and lead to inflammation of the tubes.  Past abdominal surgery In one study, women who had an appendectomy for a ruptured appendix had an increased risk of miscarriage.  Age Risk of an ectopic pregnancy appears to increase for older moms, with moms over 40 having the highest risk.
  • 10.
  • 11. Clinical Features  ACUTE (RECENT)  UNRUPTURED  SUB-ACUTE /CHRONIC /OLD
  • 12.  ACUTE ECTOPIC ( 30 % ) LESS COMMON : Associated with tubal rupture or tubal abortion with intraperitonel haemorrhage.  The four important symptoms - ◦ Amenorrhoea (no periods) of short duration – 6 – 8 weeks ◦ Severe abdominal pain – colicky pains, Causes of pain : 1. Distention of the tube by blood 2. Colic of the tubal muscless 3. Peritoneal irritation Pain may be referred to the shoulder due to diaphragmatic irritation.
  • 13. ◦ Cont…… ◦ Vaginal bleeding : slight,sanguinous or dark coloured & usually continuous. ◦ Feeling of Nausea, vomiting and fainting attacks even of syncope may be present.  On examination ◦ Patient is extremely pallor. ◦ features of shock : evidenced by the rapid & feeble pulse, fall in BP & cold & clammy extremities. ◦ Abdomen Examination :  Tense, timid & tender and painful to touch.  Tenderness limited to the lower abdomen
  • 14.  Cont……  Bimanual Examination: more intraperitonal bleeding due to manipulation. Vaginal mucosa – blanches white Uterus seems normal in size or slightly bulky Extreme tenderness on fornix palpation or on movement of the cervix ( 75 % ). No mass is felt through the fornix.  the uterus floats as in water.
  • 15. UNRUPTURED TUBAL ECTOPIC  Symptoms : ◦ Presence of delayed period or spotting with features suggestive of pregnancy. ◦ Uneasiness on one side of the flank which is continuous or at times colicky in nature.  Signs :
  • 16. CHRONIC OR OLD ECTOPIC  ◦ May be of slow onset. Symptoms of- ◦ Ammenorrhoea of short duration. ◦ Abdominal pain may have been an severe initially, from which patient recovers and has dull aching pain. ◦ Scanty bleeding from vagina. ◦ Other symptoms like frequency of urine, fever etc.  On examination patient looks sick, varying degree of paleness is present, features of shock are not there, rise of temperature, abdomen is painful to touch. On internal examination a mass is felt.
  • 17.
  • 18. DIAGNOSIS  Adominal Examination  Plvic Examination  Ultrasound Examination  Blood Examination  Culdocentesis  Laparoscopy  Dilatation & curettage  laparotomy
  • 19. Tubal Pregnancy :  The tubal pregnancy ends in following way-  Formation of some thing called a tubal mole  Tubal abortion through fimbrial end (one end of the tube).  Tubal rupture.
  • 20. Salpingotomy for unruptured ectobic pregnanccy
  • 21. Treatment Medical Surgical  Early treatment of an ectopic pregnancy with methotrexate is a viable alternative to surgical treatment since at least 1993. If administered early in the pregnancy, methotrexate terminates the growth of the developing embryo; this may cause an abortion, or the tissue may then be either resorbed by the woman's body or pass with a menstrual period. Contraindications include liver, kidney, or blood disease, as well as an ectopic mass > 3.5 cm.  If hemorrhage has already occurred, surgical intervention may be necessary. However, whether to pursue surgical intervention is an often difficult decision in a stable patient with minimal evidence of blood clot on ultrasound.  Surgeons use laparoscopy or laparotomy to gain access to the pelvis and can either incise the affected Fallopian and remove only the pregnancy (salpingostomy) or remove the affected tube with the pregnancy (salpingectomy).The first successful surgery for an ectopic pregnancy was performed by Robert LawsonTait in 1883.
  • 22. COMPLICATIONS  The most common complication is rupture with internal hemorrhage which may lead to hypovolaemic shock.  Death from rupture is rare in women who have access to modern medical facilities.
  • 23.
  • 24. DEFINITION  An abdominal pregnancy is a form of an ectopic pregnancy where the pregnancy is implanted within the peritoneal cavity outside the fallopian tube or ovary and not located in the broad ligament.  While rare, abdominal pregnancies have a higher mortality rate than ectopic pregnancies in general but, on occasion, can lead to a delivery of a viable infant. Incidence 1% of ectopic pregnancies in the United States are abdominal or about 10 out of every 100,000 pregnancies. Nigeria places the frequency in that country at 34 per 100,000 deliveries. Ectopic pregnancies occur in about 1 out of every 60 pregnancies. Over 40 percent of ectopic pregnancies occur in women between the ages of 20 and 29.
  • 25. Anatomy Implantation site  Peritoneum outside of the uterus  The rectouterine pouch (culdesac of douglas)  Omentum, bowel and its mesentery, mesosalpinx  Peritoneum of the pelvic wall and the abdominal wall  The growing placenta may be attached to several organs including tube and ovary. Rare other sites have been the liver and spleen. giving rise to a hepatic pregnancy or splenic pregnancy, respectively.Even an early diaphragmatic pregnancy has been described in a patient where an embryo began growing on the underside of the diaphragm.
  • 26. IMPLANTATION Primary implantation Secondary implantation  A primary abdominal pregnancy refers to a pregnancy that implanted directly in the abdominal cavity and its organs  Secondary implantation which means that it originated from a tubal (less common an ovarian) pregnancy and re-implanted.
  • 27. Abdominal pregnancy Symptoms Signs 1. H/o recurrent attacks of abdominal pain with vaginal bleeding in early pregnancy. 2. Minor ailments of normal uterine pregnancy are often exaggerated. 1. Abdominal swelling with foetus is felt superficial,tender,on one side of midline ; foetus is easily palpable. 2. Braxton hicks contraction absent. 3. FHS may be present or absent. 4. Foetus lies above brim in intraperitoneal pregnancy , remains low in pelvis in intraligamentary pregnancy.
  • 28. Diagnosis Sonography Outside an empty uterus, there is no amniotic fluid between the placenta and the fetus, no uterine wall surrounding the fetus, fetal parts are close to the abdominal wall, and the fetus is in abnormal lie. MRI Elevated alpha-fetoprotein levels Treatment Potential treatments consist of surgery with termination of the pregnancy (removal of the fetus) via laparoscopy or laparotomy, use of methotrexate, embolization, and combinations of these. Complication 1. Placental hemorrhage 2. Fetal death 3. Fetal malformation 4. Infection of gestational sac
  • 30. Introduction  Ovarian pregnancy refers to an ectopic pregnancy that is located in the ovary.Typically the egg cellis not released or picked- up at ovulation, but fertilized within the ovary where the pregnancy implants. Such a pregnancy usually does not proceed past the first four weeks of pregnancy.  An untreated ovarian pregnancy causes potentially fatal intra- abdominal bleeding and thus may become a medical emergency. Incidence  Ovarian pregnancies are rare  Only about 0.15-3% of ectopics occur in the ovary.  The incidence has been reported to be about 1:3,000 to 1:7,000 deliveries[
  • 31. Etiology and pathology  Etiology of ovarian pregnancy is unknown  suggested that patients who undergo IVF therapy are at higher risk for ovarian pregnancy.  An ovarian pregnancy is usually understood to begin when a mature egg cell is not expelled or picked up from its follicle and a sperm enters the follicle and fertilizes the egg, giving rise to an intra follicular pregnancy . It has also been debated that an egg cell fertilized outside of the ovary could implant on the ovarian surface, perhaps aided by a deicidal reaction or endometriosis .Ovarian pregnancies rarely go longer than 4 weeks; nevertheless, there is the possibility that the trophoblas finds further support outside the ovary and thus may affect the tube and other organs .In very rare occasions the pregnancy may find a sufficient foothold outside the ovary to continue as an abdominal pregnancy, and an occasional delivery has been reported.
  • 32. Diagnosis  Ultrasonography  pelvic examination : A unilateral adnexal mass may be found Symptoms Abdominal pain and, to a lesser degree Vaginal bleeding during pregnancy Patients may present with hypovolemia or be in circulatory shock because of internal bleeding. Spiegel berg's criteria in (1878 ) diagnosis of ovarian pregnancy :  The gestational sac is located in the region of the ovary.  The gestational sac is attached to the uterus by the ovarian ligament.  Ovarian tissue is histologically proven in the wall of the gestational sac.  The oviduct on the affected side is intact (This criterion, however, holds not true for a longer ongoing ovarian pregnancy).
  • 33. Management  Traditionally, an explorative laparotomy was performed  Once the ovarian pregnancy was identified, an oophorectomy or salpingo-oophorectomy was performed, including the removal of the pregnancy.  Today, the surgery can often be performed via laparoscopy  Ovarian pregnancies have been successfully treated with methotrexate
  • 34.
  • 36. Definition ◦ When the implantation occurs in the angle (or ) cornu of the uterus overlying the tubal ostium , it is called ‘ angular pregnancy’. Clinical features : 1. Pain on one side of midline 2. Astmmetric enlargement of uterus 3. Abortion occurs through uterine cavity 4. Retained placenta occurs
  • 38.  An interstitial pregnancy is a uterine but ectopic pregnancy; the pregnancy is located outside of the uterine cavity in that part of the Fallopian tube that penetrates the muscular layer of the uterus . The term cornual pregnancy is sometimes used as a synonym, but remains ambiguous as it is also applied to indicate the presence of a pregnancy located within the cavity in one of the two upper "horns" of a bicornuate uterus. Interstitial pregnancies have a higher mortality than ectopics in general.
  • 39. Cornual pregnancy  Pregnancy occurring on the rudimentary horn of a bicornuate uterus. Horn does not communicate with uterus.  Rupture usually occurrs at second trimester of pregnancy. Diagnosis :  Usually made on rupture. Management :  Rudimentary horn is removed.  If pedicle is wide , hysterectomy may be needed.
  • 40. Cervical pregnancy  Pregnancy implants on cervical mucosa below internal os.  It may may be due to rapid passage of the fertilized ovum for fertilization of the ovum after it reaches the cervical canal.  It is rare & seldom lasts beyond the 20th week. Signs &symptoms : 1. Painless bleeding soon after the time of implantation. 2. Palpation of the cervical mass with distention & thinning of the cervical wall. 3. Partial dilatation of the external os & a slightly enlarged uterine fundus. Treatment : Removal of the products of conception by curettage & packing of the cervical canal ( or ) total abdominal hysterectomy.
  • 41. REFERENCE  Bobak, I.M., & Leonard, D. (1995). Text Book Of Maternity & Gynecologic Care :The Nurse & The Family (4th ed.). Mosby Publication.  Diane., Fraser., & Margret. (2003). Text Book for Midwives (14th ed.). Elsevier Publishers.  Dutta, D.c., & Hiralal Konar. (2013). Text Book of Obstetrics (7th ed.). Jaypee Brothers Medical Publishers.  Elizabeth, M (2014). Midwifery for Nurses (2nd ed.). Sathish Kumar Jain Publishers.  Jacob, A. (2008). A Comprehensive textbook of Midwifery & Gynecological Nursing (4th ed.). Newyork: Jaypee Brothers Medical Publishers.  Kumari Neelam., Sharma Shivani., & Gupta Preethi. (2010). A Text Book of Midwifery and Gynecological Nursing.  Ladewig, L. Maternal & Newborn Nursing (3rd ed.). Cumming Publication.  Nurse Midwifery Helen Varney (2nd ed.).  Parulekar, V. S. Textbook for Midwives. (2nd ed.). Mumbai: Vora Medical Publications.  Raman, A. V. (2014). Maternity nursing (1st ed.). Wolters kluwer publishers.  Richa S. Snapshort In Obstetrical & Gynaecology. Jaypee Brother’s Medical Publisher.