management of ectopic oregnancy

1. MANAGEMENT OF ECTOPIC
PREGNANCY

2. DEFINITION
Ectopic Pregnancy is defined as
implantation of the conceptus any
where outside the uterine cavity

3. INCIDENCE
 Ranges between 0.25% - 1.5% of all
pregnancies
 Women between 35 – 44 years have
the highest risk
 More common in black than white
population

4. ETIOLOGY
 Previous tubal pregnancy
 Previous tubal surgery
 History of repeated PID
 Current use of IUCD
 History of induced abortions
 Assisted conception
 Smoking
 Endometriosis

5. Commonest Sites of Ectopic
Pregnancy
Sites %age
Fallopian Tube 99
Ampullary segment 80
Isthmic segment 12
Fimbrial end 5
Interstitial & cornual 1
Abdominal 1.4
Ovarian 0.2
Cervical 0.2

11. History
 Amenorhea
 Pregnancy test positive
 Sign and symptoms of pregnancy
 Abdominal pain
 Unilateral/bilateral/ radiating to shoulder
 Vaginal bleeding
 In case of ruptured ectopic --- syncopal
attacks and symptoms of shock

12. Examination
 GENERAL PHYSICAL EXAMINATION
 Blood pressure
 Pulse
 Respiration
 Pallor

13. Examination….contd
 ABDOMINAL EXAMINATION
 Tenderness
 Guarding
 Rigidity
 Shifting dullness
 Bowel sounds +/-

14. Examination….contd
 PELVIC EXAMINATION
 Small amount of vaginal bleeding +/-
 Uterine size less than gestational age
 Uterus may be shifted to one side because
of the unilateral adnexal mass
 Adnexal tenderness and fullness
 Cervical excitation. Cervical os is closed

15. PATHOPHYSIOLOGY OF
TUBAL PREGNANCY
It depends on the progression of
the pregnancy
 unruptured tubal pregnancy
 tubal rupture
 spontaneous involution
 complete tubal abortion
 carneous mole

16. Differential Diagnosis
 Threatened abortion
 Ectopic pregnancy
 Molar pregnancy
 Hemorrhagic corpus luteal cyst
 Degenerating fibroid with pregnancy

17. Investigations
 CBC
 Blood group & cross match
 Urine R/E
 Urine pregnancy test/ Serum beta hCG
 Ultrasound pelvis (transvaginal
/abdominal)

18. Diagnosis
Transvaginal ultrasound
Laproscopy
Diagnostic
Therapeutic
Culdocentesis

20. Treatment
General
Couple counseling
Correction of anemia
Management of shock
Maintain intravenous access
Blood transfusions and strict
maternal monitoring

21. Treatment…..contd
 Expectant management
 Medical options
 Surgical options
Laproscopy
Laparotomy

22. Ectopic Pregnancy
 Beta hCG <1000
Expectant management
monitoring of serial
ultrasound
beta hCG
 Beta hCG >1000
Medical management
methotrexate
mifepristone

23. Ectopic Pregnancy
 Beta hCG >10,000
Surgical options
LAPAROSCOPY LAPAROTOMY
o Tubal injection o End to end
o Salpingectomy anastomosis
• Salpingostomy o Salpingostomy
o Salpingotomy
o Salpingectomy

24. Management of non-tubal
pregnancy
 Ovarian and Abdominal pregnancy
require laparotomy for management
 Cervical ectopic need ligation of blood
supply at the cervical base

33. Sequele of Ectopic pregnancy
 Sub-fertility
 Infertility
 Repeat ectopic ( following an ectopic
pregnancy the chance of a future intra-
uterine pregnancy is 50%)