Ectopic pregnancyImplantation of the fertilized ovum eitheroutside the uterus or in an abnormalposition within the uterus....
3. Cervical3. Cervical4. Abdominal - primary: implants initially4. Abdominal - primary: implants initiallyon abdominal org...
Causes of Ectopic PregnancyCauses of Ectopic Pregnancy1. Tubal abnomalities impeding the progress of fertilized1. Tubal ab...
d. surgical obstructionafter partial salpingectomy, tubal ligatione. tubal surgery:microsurgery, reversal of sterilization...
Diagnosis of Ectopic PregnancyDiagnosis of Ectopic Pregnancy1. Chronic Ectopic Pregnancy1. Chronic Ectopic PregnancySympto...
: slight vaginal bleeding, brownish discharge: slight vaginal bleeding, brownish discharge: syncope: syncope: other sympto...
Vaginal Examination:Vaginal Examination: pulsation in the fornix (of the affected side)pulsation in the fornix (of the af...
II. Acute (tubal rupture)II. Acute (tubal rupture)• There can be sudden massive intraperitonealThere can be sudden massive...
Signs:Signs: General - collapse, pale, cold clammy extremities,General - collapse, pale, cold clammy extremities,low BP, ...
Think of ECTOPICThink of ECTOPIC female of reproductive agefemale of reproductive age unexplained abdominal painunexplai...
InvestigationsInvestigationsClinically stable patientsClinically stable patientsa. Pregnancy tests- urine for UCGa. Pregna...
Differential diagnosis1. Threatened or Incomplete abortion- history of amenorrhoea +- bleeding PV- pain varies2. Bleeding ...
Management of Ectopic PregnancyAcutea. Resuscitation: - keep quiet, flat- injection morphia- IV line- blood rapidlyb. Surg...
Chronic Cases- Admission- operative proceduresa. laparoscopic surgery- unruptured ampullary orinfundibular-pregnancy < 3 c...
b. laparotomy- salpingectomy- salpingotomy- milking of the tubeNon- operative procedurePuncture and aspiration of gestatio...
Cornual pregnancy - diagnosis difficult - can have profuse intraperitonealbleeding - hysterectomy may be necessary
THE ENDTHE END
Ectopic   pregnancy  : house officer 's presentation
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Ectopic pregnancy : house officer 's presentation

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House officer 's presentation at North Okkalpa General Hospital, OG Ward

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Ectopic pregnancy : house officer 's presentation

  1. 1. Ectopic pregnancyImplantation of the fertilized ovum eitheroutside the uterus or in an abnormalposition within the uterus.Sites of ectopic pregnancy:1. Tubal (commonest 95%)ampullary, isthmus, fimbrial,interstitial2. Ovarian. - direct implantation- reimplantation after tubalabortion
  2. 2. 3. Cervical3. Cervical4. Abdominal - primary: implants initially4. Abdominal - primary: implants initiallyon abdominal organson abdominal organs- secondary: primary- secondary: primaryimplantation in tubes, ovaries or uterusimplantation in tubes, ovaries or uterus5. Ligamentory5. Ligamentory6. Cornual6. Cornual7. Rudimentary horn7. Rudimentary horn
  3. 3. Causes of Ectopic PregnancyCauses of Ectopic Pregnancy1. Tubal abnomalities impeding the progress of fertilized1. Tubal abnomalities impeding the progress of fertilizedovumovuma. developmental errors: hypoplasia, diverticula, accessorya. developmental errors: hypoplasia, diverticula, accessorylumina, undue tortuositylumina, undue tortuosityb. distortion of the tube: by adjacent large tumors orb. distortion of the tube: by adjacent large tumors orendometriosisendometriosisc. previous pelvic inflammatory disease:c. previous pelvic inflammatory disease:chronic PID, gonorrhoea, postabortal, secondary tochronic PID, gonorrhoea, postabortal, secondary topelvic peritonitis, TB, IUCD, infection from adjacent organspelvic peritonitis, TB, IUCD, infection from adjacent organseg: appendicitis, diverticulitiseg: appendicitis, diverticulitis
  4. 4. d. surgical obstructionafter partial salpingectomy, tubal ligatione. tubal surgery:microsurgery, reversal of sterilization, previous tubalpregnancy2. Assisted conception: in-vitro fertilization if tubes aredamaged but patent3. Overdevelopment of the ovum: external migration4. Endometriosis of the tubes and ovaries
  5. 5. Diagnosis of Ectopic PregnancyDiagnosis of Ectopic Pregnancy1. Chronic Ectopic Pregnancy1. Chronic Ectopic PregnancySymptoms: short period of amenorrhoeaSymptoms: short period of amenorrhoea: pain- aching in one or both iliac fossa: pain- aching in one or both iliac fossa(due to distention or contraction of the(due to distention or contraction of thetube)tube)- sharp stabbing pain- sharp stabbing pain(bleeding into peritoneal cavity due to(bleeding into peritoneal cavity due tochoriodecidual haemorrhage)choriodecidual haemorrhage)- shoulder tip pain or pain in epigastrium- shoulder tip pain or pain in epigastrium(due to diaphragmatic irritation by blood)(due to diaphragmatic irritation by blood)
  6. 6. : slight vaginal bleeding, brownish discharge: slight vaginal bleeding, brownish discharge: syncope: syncope: other symptoms of pregnancy: other symptoms of pregnancy: acute retention of urine due to: acute retention of urine due tolarge pelvic haematocoelelarge pelvic haematocoeleSignsSignsGeneral : pallor, increase in pulse rate, slight pyrexiaGeneral : pallor, increase in pulse rate, slight pyrexiaAbdomen: distention, tenderness, muscle guardingAbdomen: distention, tenderness, muscle guardingCullen`s sign(bluish discolouration around theCullen`s sign(bluish discolouration around theumbilicus)umbilicus)
  7. 7. Vaginal Examination:Vaginal Examination: pulsation in the fornix (of the affected side)pulsation in the fornix (of the affected side) irregular tender enlargement of appendageirregular tender enlargement of appendage small tender masssmall tender mass uterus slightly enlargeduterus slightly enlarged cervical excitation +cervical excitation + POD is full and tenderPOD is full and tender brownish discharge PV +brownish discharge PV +****** If symptoms strongly suggestive of ectopic, VE isIf symptoms strongly suggestive of ectopic, VE isnot advisable.not advisable.
  8. 8. II. Acute (tubal rupture)II. Acute (tubal rupture)• There can be sudden massive intraperitonealThere can be sudden massive intraperitonealhaemorrhage.haemorrhage.• Symptoms: short period of amenorrhoeaSymptoms: short period of amenorrhoea: severe lancinating pain in one iliac fossa: severe lancinating pain in one iliac fossaor hypogastriumor hypogastrium: immediate profound collapse: immediate profound collapse: bleeding or brownish discharge PV: bleeding or brownish discharge PV
  9. 9. Signs:Signs: General - collapse, pale, cold clammy extremities,General - collapse, pale, cold clammy extremities,low BP, increased PRlow BP, increased PR Abdomen- acutely tender lower abdomenAbdomen- acutely tender lower abdomendistension and free fluiddistension and free fluid Vaginal E- very tender pelvisVaginal E- very tender pelviscervical excitationcervical excitationtender enlarged adnexatender enlarged adnexafull and tender PODfull and tender PODblood-stained discharge on VE fingerblood-stained discharge on VE finger**** Diagnosis is missed in 20-25% of casesDiagnosis is missed in 20-25% of cases
  10. 10. Think of ECTOPICThink of ECTOPIC female of reproductive agefemale of reproductive age unexplained abdominal painunexplained abdominal pain + or - vaginal bleeding+ or - vaginal bleeding
  11. 11. InvestigationsInvestigationsClinically stable patientsClinically stable patientsa. Pregnancy tests- urine for UCGa. Pregnancy tests- urine for UCG- serum- serum ββ hCGhCGb. Ultrasound - no intrauterine pregnancyb. Ultrasound - no intrauterine pregnancy- extrauterine pregnancy- extrauterine pregnancysac can be seensac can be seen- transvaginal scan is more- transvaginal scan is moreaccurateaccuratec. Posterior Colpotomy (POD puncture)c. Posterior Colpotomy (POD puncture)--non-clottable bloodnon-clottable bloodd. Laparoscopy - for definitive diagnosisd. Laparoscopy - for definitive diagnosis--
  12. 12. Differential diagnosis1. Threatened or Incomplete abortion- history of amenorrhoea +- bleeding PV- pain varies2. Bleeding Corpus Luteum- diagnosis difficult- usually no overdue- laparoscopy necessary3. Accidents to Ovarian Cysts- no overdue
  13. 13. Management of Ectopic PregnancyAcutea. Resuscitation: - keep quiet, flat- injection morphia- IV line- blood rapidlyb. Surgery - immediate laparotomy- autotransfusion- salpingectomy
  14. 14. Chronic Cases- Admission- operative proceduresa. laparoscopic surgery- unruptured ampullary orinfundibular-pregnancy < 3 cm in diameter- salpingotomy- intratubal methotrexate injection- salpingectomy
  15. 15. b. laparotomy- salpingectomy- salpingotomy- milking of the tubeNon- operative procedurePuncture and aspiration of gestational sac,local PG, KCL, hyperosmolar glucose,methotrexateExpectant management (non interventional )
  16. 16. Cornual pregnancy - diagnosis difficult - can have profuse intraperitonealbleeding - hysterectomy may be necessary
  17. 17. THE ENDTHE END

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