Presentation on Ectopic pregnancy

1. Ectopic
Pregnancy
Dr. Shahriar Ahmed
Intern Doctor
Gynae & Obs Unit 3
Clinical Case Presentation On

2. Particulars of the Patient
Name Mrs. Reshma
Age 35 years
Religion Islam
Occupation Homemaker
Husband’s Name Moidul Haque
Husband’s Occupation Businessmen
Address Faridpur Sadar, Faridpur
Date of Admission 21st August, 2023
Date of Examination 21st August, 2023

3. History of amenorrhea for 16 weeks
Lower abdominal pain for 3 days
01
02
Chief Complaints

4. History of Present Illness
According to the statement of the patient she was pregnant
for 16 weeks. She forgot her first day of last menstrual
period. According to USG report her EDD will be on 11.4.24.
It was her unplanned pregnancy. She has not history of
taking ovulation inducing drugs for two cycles. Then she
developed lower abdominal pain for 3 days which was
radiating to left side, not associated with vomiting and was
not relieved by taking medications.
There was no history of foul smelling vaginal discharge, any
abdominal surgery or trauma. Her bowel and bladder habit
was normal.
With above complaints, she was admitted to BSMMCH,
Faridpur for better treatment.

5. History of Past Illness
● She has no major illness previously.
● She had never undergone any major surgery.

6. Age of Menerche: 12 years
Menstrual Cycle: Regular
Menstrual Period:
Menstrual History
Flow: Average
LMP: ?
EDD: 11.04.24 (acc. to USG)

7. Married at: 15 years
Married for: 20 years
Para: 3 (VD) + 2 (Abortion)
Obstrtric History
Gravida: 6th

8. Personal History Contraceptive History
She is non smoker, non alcoholic. She does
not take betel nut or tobacco leaves. She
uses sanitary napkines during her
menstruation.
She did not follow any contaceptive
method.

9. Family History Immunization
History
All her family members
are in good health. She was duely immunized as
per EPI schedule. She was
vaccinated against COVID-19.
Socio-economic
History
She belongs to a average
earned family.

10. General Examination
Appearance Anxious
Body build Average
Co-operation Co-operative
Decubitus On choice
Anemia Moderate
Jaundice Absent
Cyanosis Absent
Edema Absent

11. General Examination
Dehydration Absent
Clubbing Absent
Koilonychia Absent
Leukonychia Absnet
Pulse 70 bpm
Blood Pressure 110/70 mmHg
Respiratory Rate 18 breaths per minute
Thyroid Gland Not enlarged

12. Examination of
Breast & Axilla
● Both breasts are symmetrical and there
was no lumpiness or no skin change.
● Axillary lymph nodes are not palpable.

13. Systemic Examination
Per abdominal examination:
On inspection,
• Lower abdomen was slightly distended.
• Umbilicus was centrally placed & inverted.
• There was no scar marks.
On palpation,
Temparature was normal.
Abdomen was tensed & tender, mainly over
the left hypogastrium & left iliac fossa.
On auscultation,
Bowel sound present.
All other systemic examination reveals no abnormality.

14. Per Vaginal
Examination
• On inspection, vulva & vagina appears to be
normal.
• Per speculum examination, no per vaginal bleeding
present.
• Bi-manual examination, size of uterus normal,
anteverted, left fornix shallow, cervical excitation
test positive.
• DRE- rectal mucosa free, others findings are
normal.

15. Salient Features
Mrs Reshma, 35 years old female, Muslim homemaker, normotensive, non diabetic, hailing
from Faridpur Sadar, was admitted to BSMMCH on 21.08.23 with the complaints of 16 weeks
of amenorrhea with severe lower abdominal pain for 3 days. It was her unplanned pregnancy.
She forgot her LMP and according to USG report, her EDD will be 11.04.24. She didn’t give
history of taking ovulation inducing drugs.
On general examination, she was ill looking, anxious, body built was average, moderately
anemic, non icteric, non edematous, non dehydrated, pulse was 70 bpm, blood pressure was
110/70 mmHg.
On per abdominal examination, lower abdomen was slightly distended, tense and tender,
mainly in left hypogastrium and left iliac fossa.
On Per vaginal examination, vulva and vagina appears to be normal, no pervaginal bleeding
was present.
All other systemic examination reveals no abnormality.

16. A case of 6th gravida with 16 weeks of
ruptured ectopic pregnancy
Provisional Diagnosis

17. Urinary tract infection
Acute pelvic inflammatory disease
01
02
Differential Diagnosis

18. Investigations
CBC
BG & RH
typing
Bleeding
time
Clotting
time
Hb%- 5.5 gm/dl
ESR- 91mm/1st hr
TWBC- 10,900/cumm
Platelet- 2,41,000/cumm
RBC- 1.56 M/cumm
O(+)ve
2 mins 45 secs
6 mins 30 secs
Prothrombin
time
Patient- 15 secs
Control- 13 secs
Ratio- 1.15
INR- 1.33
Index- 87%
Hematological reports

19. Investigations
HBsAg VDRL
S.
Creatinine
RBS
Negative
Non-Reactive
0.7 mg/dl
8 mmol/L
Urine RME
Epithelial cells- 1-3/HPF
Pus cells- 1-2/HPF
Hematological reports

20. Investigations
USG of Whole Abdomen
• Mild to moderate free peritoneal fluid
• Bulky uterus
• Left adnexal rupture ectopic pregnancy mass of about 4.5X3.3 cm,
volume 23.8 cc

21. A case of 6th gravida with 16 weeks of
Left sided ruptured ectopic pregnancy
Confirmatory Diagnosis

22. Management
General:
● Counseling and reassurance
● Open channel with wide bore IV cannula on both hands and start IV fluids
● Send blood for screening and cross matching followed by blood transfusion
● Continuous catheterization
● Completion of investigations for diagnosis confirmation and treatment purpose.
● Counseling regarding disease, prognosis, treatment options and risks and
benefit of surgery
● Informed written consent was taken
● Ready patient for emergency laparotomy.

23. Management
Surgical:
Laparotomy following left sided salpingectomy with right tubal ligation

24. With all available aseptic precaution, abdomen was opened by
Pfannenstiel incision. After opening peritoneal cavity huge clotted
blood was found. Left sided ruptured ectopic side was identified.
Left sided salpingectomy was done. Then right sided tubal
ligation was done. Peritoneal toileting was done by normal saline.
Drain tube was inserted. After counting mops, instruments,
maintaining hemostasis, abdomen was closed in layer by layer.
Skin was closed by vertical mattress sutures.
Procedure

25. Post-Operative Care
● Fresh order done on first post operative day
● Removal of urethral catheter on first POD
● Antibiotic coverage
○ Inj. Ceftriaxone 1gm BD
○ Tab. Metronidazole 400mg TDS
● Anti ulcerants:
○ Cap. Omeprazole 20mg BD
● Analgesics:
○ Tab. Paracetamol 500mg TDS
○ Supp. Diclofenac sodium 50mg TDS
● Check dressing and removal of drain tube on 3rd POD.

26. Hb% on 3rd POD- 10.9 gm/dl
Follow up

27. Advice on
Discharge
• Take nutritious food and maintain proper
hygiene
• Complete bed rest
• Follow up after one month

28. THANK
YOU