1) Ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, most commonly in the fallopian tubes. It is a serious condition that can lead to maternal death if left untreated.
2) Risk factors for ectopic pregnancy include previous pelvic infections, IUD use, infertility treatments, and previous ectopic pregnancies or pelvic surgeries.
3) Clinical presentation varies from acute abdominal pain and shock due to tubal rupture to more subtle symptoms like abdominal pain and vaginal bleeding. Diagnosis is confirmed through transvaginal ultrasound and tests of beta-hCG levels and progesterone.
4) Treatment depends on severity but may include medication with methotrexate
When fetal head is delivered, but shoulders are stuck and cannot be delivered it is known as shoulder dystocia.
The anterior shoulder becomes trapped behind on the symphysis pubis, whilst the posterior shoulder may be in the hollow of the sacrum or high above the sacral promontory.
When fetal head is delivered, but shoulders are stuck and cannot be delivered it is known as shoulder dystocia.
The anterior shoulder becomes trapped behind on the symphysis pubis, whilst the posterior shoulder may be in the hollow of the sacrum or high above the sacral promontory.
Oligohydramnios by dr alka mukherjee dr apurva mukherjee nagpur m.s.alka mukherjee
• Oligohydramnios refers to amniotic fluid volume that is less than expected for gestational age. It is typically diagnosed by ultrasound examination and may be described qualitatively (eg, reduced amniotic fluid volume) or quantitatively (eg, amniotic fluid index ≤5 cm, single deepest pocket <2 cm).
• Oligohydramnios may be idiopathic or have a maternal, fetal, or placental cause The fetal prognosis depends on several factors, including the underlying cause, the severity (reduced versus no amniotic fluid), and the gestational age at which oligohydramnios occurs. Because an adequate volume of amniotic fluid is critical to normal fetal movement and lung development and for cushioning the fetus and umbilical cord from uterine compression, pregnancies complicated by oligohydramnios from any cause are at risk for fetal deformation, pulmonary hypoplasia, and umbilical cord compression.
• Oligohydramnios is associated with an increased risk for fetal or neonatal death, which may be related to the underlying cause of the reduced amniotic fluid volume or due to sequelae of the reduced amniotic fluid volume.
• This topic will discuss issues related to oligohydramnios. Methods of amniotic fluid volume assessment are reviewed separately.
• Oligohydramnios occurs when the amniotic fluid is < 5th centile for gestational age.
• The most common causes are premature rupture of membranes (often missed by the mother) and placental insufficiency, however structural abnormalities such as renal agenesis should be considered.
• Prognosis is linked to gestation at diagnosis and likely development of pulmonary hypoplasia and premature delivery.
• Treatment is by optimising gestation of delivery
This topic contains detail information about all abnormalities during puerperium like puerperial pyrexia, sepsis, subinvolution, breast complications, urinary complications, puerperal venous thrombosis, pulmonary embolism, obstetric palsies, puerperal emergencies, psychiatric disroders, perinatal management
Majority of fetal deaths occur in the antepartum period.
There is progressive decline in maternal deaths all over the world. Currently more interest is focused to evaluate the fetal health. The primary objective of antenatal assessment is to avoid fetal death.
A serious pregnancy complication in which the placenta detaches from the womb (uterus).
Placental abruption occurs when the placenta detaches from the inner wall of the womb before delivery. The condition can deprive the baby of oxygen and nutrients.
Symptoms include vaginal bleeding, stomach pain and back pain in the last 12 weeks of pregnancy.
Depending on the degree of placental separation and how close the baby is to full-term, treatment may include bed rest or a Caesarean (C-section).
Ectopic Pregnancy - Obstetrical & Gynaecological NursingJaice Mary Joy
In ectopic pregnancy, implantation occupies at a site other than the endometrium. Ectopic pregnancies are responsible for approximately 10 percent of all maternal mortality. The prognosis for future reproduction is poor. Only one half of women having an ectopic pregnancy are eventually delivered of a liveborn infant. Various factors contribute to ectopic pregnancies, the most common being infection. Unlike intrauterine spontaneous abortions, genetic factors are not paramount in the etiology of ectopic pregnancy.
Oligohydramnios by dr alka mukherjee dr apurva mukherjee nagpur m.s.alka mukherjee
• Oligohydramnios refers to amniotic fluid volume that is less than expected for gestational age. It is typically diagnosed by ultrasound examination and may be described qualitatively (eg, reduced amniotic fluid volume) or quantitatively (eg, amniotic fluid index ≤5 cm, single deepest pocket <2 cm).
• Oligohydramnios may be idiopathic or have a maternal, fetal, or placental cause The fetal prognosis depends on several factors, including the underlying cause, the severity (reduced versus no amniotic fluid), and the gestational age at which oligohydramnios occurs. Because an adequate volume of amniotic fluid is critical to normal fetal movement and lung development and for cushioning the fetus and umbilical cord from uterine compression, pregnancies complicated by oligohydramnios from any cause are at risk for fetal deformation, pulmonary hypoplasia, and umbilical cord compression.
• Oligohydramnios is associated with an increased risk for fetal or neonatal death, which may be related to the underlying cause of the reduced amniotic fluid volume or due to sequelae of the reduced amniotic fluid volume.
• This topic will discuss issues related to oligohydramnios. Methods of amniotic fluid volume assessment are reviewed separately.
• Oligohydramnios occurs when the amniotic fluid is < 5th centile for gestational age.
• The most common causes are premature rupture of membranes (often missed by the mother) and placental insufficiency, however structural abnormalities such as renal agenesis should be considered.
• Prognosis is linked to gestation at diagnosis and likely development of pulmonary hypoplasia and premature delivery.
• Treatment is by optimising gestation of delivery
This topic contains detail information about all abnormalities during puerperium like puerperial pyrexia, sepsis, subinvolution, breast complications, urinary complications, puerperal venous thrombosis, pulmonary embolism, obstetric palsies, puerperal emergencies, psychiatric disroders, perinatal management
Majority of fetal deaths occur in the antepartum period.
There is progressive decline in maternal deaths all over the world. Currently more interest is focused to evaluate the fetal health. The primary objective of antenatal assessment is to avoid fetal death.
A serious pregnancy complication in which the placenta detaches from the womb (uterus).
Placental abruption occurs when the placenta detaches from the inner wall of the womb before delivery. The condition can deprive the baby of oxygen and nutrients.
Symptoms include vaginal bleeding, stomach pain and back pain in the last 12 weeks of pregnancy.
Depending on the degree of placental separation and how close the baby is to full-term, treatment may include bed rest or a Caesarean (C-section).
Ectopic Pregnancy - Obstetrical & Gynaecological NursingJaice Mary Joy
In ectopic pregnancy, implantation occupies at a site other than the endometrium. Ectopic pregnancies are responsible for approximately 10 percent of all maternal mortality. The prognosis for future reproduction is poor. Only one half of women having an ectopic pregnancy are eventually delivered of a liveborn infant. Various factors contribute to ectopic pregnancies, the most common being infection. Unlike intrauterine spontaneous abortions, genetic factors are not paramount in the etiology of ectopic pregnancy.
Incidence of ectopic pregnancy is rising while maternal mortality from it is falling.
ALWAYS suspect ectopic pregnancy in a woman of a child-bearing age c/o pain and/or p.v. bleeding
Subject: Midwifery and Obstetrical Nursing. Topic: Ectopic pregnancy, Its types, various Implantation sites, Pathophysiology, Risk factors, Diagnosis, Various Managements and Recent Advancements.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Triangles of Neck and Clinical Correlation by Dr. RIG.pptx
Ectopic Pregnancy
1. بسم ال الرحمن الرحيم
KHARTOUM NORTH TEACHING HOSPITAL
ECTOPIC PREGNANCY
INTRODUCTION :
Ectopic Pregnancy is one of the direct causes of maternal death, and
is an important cause of maternal mortality in the 1st trimester. It is the 8th
out 129 direct causes of maternal death in UK. It accounts for 9% of all
maternal deaths.
INCIDENCE:
Previously, it was 1 per 150 mature birth in UK, but the incidence is
rising all over the world. It has increased from 4.9/1000pregnancies up to
9.6/1000, but the case fatality rate has decreased. It has high incidence in
races other than white.
DEFINITION:
It is defined as pregnancy occurring outside the endometrial lining of
the uterus.
SITES:
1) 95% occur in the tubes: the commonest site is the Ampulla,
followed by the Isthmus.
2) The uterus:
I. Intramural.
II. Angular
III. Cervical
IV. Rudimentary Horn
3) The Ovary.
4) Broad Ligament
5) Abdominal:
I. Primary: first implantation occurs in a peritoneal
surface.
2. II. Secondary: original implantation occurs first in the
tube-ostia, aborted subsequently then reimplanted
into a peritoneal surface.
6) Multiple Ectopic: may occur:
a) Involving both tubes
b) Combined intra- & extra-uterine pregnancy
(Heterotopic Pregnancy): accounts for 1 in 4000 to 1
in 7000 pregnancies.
RISK FACTORS:
1. Infection
2. Contraception
3. previous Ectopic
4. Abdominal Surgery
5. Congenital tubal abnormalities
6. Assisted Reproductive Technology
7. Salpingitis Isthmica Nodosa
8. Endometriosis & lieomyomata
9. Diethyl Stilbesterol (DES)
10.others
INFECTION:
Inflammation and infection may cause damage of the tube without
tubl blockage.
Sexually Transmitted Diseases, mainly Chlamydia Trachomatis
infection, are common and major cause of PID. Difficulties occur in
diagnosing C. trachomatis due to its obligate intracellular life cycle
which makes lab. Isolation and diagnosis difficult.
Gonococcus and Tuberculosis infection.
Also Appendicitis.
CONTRACEPTION:
in form of IUD Progesterone and Progesterone Only pills. Women
who use IUDs are 6 to 10 times more likely to suffer Tubal pregnancy.
Minipills and Subdermal implants (Norplant) protect against both
intrauterine and Ectopic pegnancy when compared with no
contraception, but if pregnancy occurs, the chance of it being ectopic is
10% with minipills and 30% in Norplant.
~Ectopic Pregnancy was also reported after Emergency contraception
following rape.
3. TUBAL SURGERY:
1. Tubal Repair or reconstruction to correct obstruction-Lyses of
adhesions.
2. Sterilisation: this depends on the method used:
Site of tubal occlusion.
Residual tube length.
Surgical technique
Associated conditions, e.g.: infection.
PREVIOUS ECTOPIC.
CONGENITAL ANOMLIES OF THE TUBES:
Such as:
o Diverticula
o Accessory Ostia
o Hypoplasia
o Congenital anomalies of the cilia,e.g.: Young Syndrome and
Kartagner Syndrome.
ABDOMINAL SURGERY:
Such as:
o Ovarian Cystectomy
o Wedge resection.
This results in Peritubal scarring (adhesions interfere with
passage of the ovum).
4. ASSISTED REPRODUCTION:
IVF accounts for 10-15% of Ectopic pregnancy.
SALPINGITIS ISTHMICA NODOSA:
It is non inflammatory pathological condition of the tubes in which the
tubal epithelium extends into the myosalpinx and forms a true
diverticula. These diverticulae interfere with the myometrial electrical
activity over the divrticula.
ENDOMETRIOSIS, LIEOMYOMATA.
DIETHYL STILBESTEROL:
Exposure in utero causes tubal hypoplasia.
OTHERS:
Includes the following:
Smoking: strongly associated with : Abruptio Placentae;
Placenta Previa; and Ectopic pregnancy. Smokers have 2 times
higher than non-smokers. Smoking affects the cilia in the
nasopharynx as well as the cilia of the genital tract.
Multiple sexual partners.
Early age of first intercourse
Vaginal douching.
5. PATHOPHYSIOLOGY:
Most likely reason for Ectopic pregnancy is delay in passage of the
fertilized ovum down the tube due to damaged ciliated epithelium and
peristaltic activity of myosalpinx.
Implantation occurs in the muscle and connective tissues next to the
tubal serosa. There a decidual reaction (Areas Stella Phenomenon).
Hematoma is frequently seen surrounding the distal end of the tube.
Hemoperitoneum nearly always occur.
CLINICAL PRESENTATION:
♣ About 75% of patients present with subacute symptoms, while
25% or less present with acute abdomen.
♣ Symptoms: the TRIAD of:
1. abdominal pain
2. irregular menses
3. followed by vaginal bleeding or brown discharge ±
syncope.
♣ The vaginal bleeding is due to shedding of the decidua or decidual
cast when pregnancy fails.
♣ The diagnosis of Ectopic pregnancy is overshadowed by a wide
spectrum of clinical presentations ranging from acute abdomen to
hemodynamic shock. Therefore, it requires a high degree of
suspicion specially in areas where the prevalence of Ectopic
pregnancy is high, like in Sudan.
♣ This depends on history and examination.
♣ The presentation may be : Acute; Subacute; or Chronic
(asymptomatic).
⇒ ACUTE PRESENTATION:
6. In women with tubal rupture.
There will be acute abdominal pain and cardiovascular
collapse.
Pain is typically referred to shoulder tip or interscapular
region due to irritation of the diaphragm by blood (this may be
provoked by raising the foot of the bed-Kehr sign).
Signs:
o Shock: tachycardia+hypotension
o Peritoneal irritation
o PV.: cervix soft, uterus enlarged, Excitation Test +ive.
⇒ SUBACUTE PESENTATION:
Lady C/O:
1. abdominal pain localized to one of the iliac fossae.
2. delayed menstruation
3. episodes of vaginal bleeding
signs of peritoneal irritation are less marked than in the acute
presentation.
⇒ CHRONIC PRESENTATION:
There is usually history of PID→infertility.
Irregular vaginal bleeding
On-and-Off abdominal pain.
Patient is Hemodynamically Stable.
INVESTIGATIONS:
URINE FOR PREGNANCY TEST:
7. This is the standard test, it is 99% specific and 99% sensitive. It is
mainly a qualitative rather than a quantitative.
SERUM HCG DOUBLING TIME:
Usually in chronic cases. HCG Doubling time can differentiate an
Ectopic pregnancy from an intrauterine one. Normal pregnancy
causes HCG level to rise by 66% in 48hr.
If the serum HCG level is rising but the douling time is increased
then the likelihood of an extrauterine pregnancy is high.
Most omen with an HCG half life more than 7 days have an Ectopic
pregnancy.
SERIAL PROGESTERONE ESTIMATIONS:
The mean serum level of progesterone in patients with Ectopic
pregnancy is lower than in those with normal pregnancy. In normal
viable intrauterine pregnancy the level is 25ng/ml, wile in Ectopic
pregnancy it is less than 5ng/ml.
OTHER ENDOCRINE & PROTEN MONITORS:
1) MATERNAL SERUM CREATININE KINASE LEVEL:
significantly higher in all patients with tubal pregnancy when
compared to missed abortion and normal pregnancy.
2) PREGNANCY ASSOCIATED PLASMA PROTEIN C
(PAPPC)- SCHWANGER CHAFT’S PROTEIN: this is a β-
glycoproteinproduced by syncytiotrophoblasts, its level is low
in Ectopic pregnancy.
3) RELAXIN: is a hormonal protein produced by the corpus
luteum of pregnancy. It is signicantly lower in Ectopic
pregnancy and spontaneous abortion. A single reading of
33pg/ml excludes Ectopic pregnancy.
4) MATERNL SERUM α-FETO-PROTEIN: elevated in Ectopic
pregnancy.
8. 5) C-REACTIVE PROTEIN: is low in Ectopic pregnancy, but
high in infections like PID (enables differentiation).
U/S SCANNING:
includes the following:
Trans-Vaginal Scan: shows the following:
♦ Empty uterine cavity.
♦ In live Ectopic:intact tubal ring with a heart action
(in 20% of cases).
♦ In tubal abortion: pooly defined tubal ring ±fluid in
the pouch of Douglas.
♦ In ruptured Ectopic: fluid in the pouh of Douglas.
Trans-Abdominal Scan: may show:
♦ Life embryo in the adenexae (in 10% of cases).
♦ Pseudo-gestational sac in the uterus.
♦ Empty uterus ± adenexal sac ± fluid in the pouch
of Douglas.
CUL DOCENTESIS:
♦ The purpose is to find non-clotted blood
♦ METHOD: apply bivalve speculum, grip the posterior
cervical lip with a volsellum, then the pouch of Douglas
(Cul De Sac) is entered via the posterior vaginal fornix
by a needle through which the intraperitoneal content is
aspirated.
LAPARASCOPY:
♦ This is the gold standard for diagnosis and treatment of
Ectopic pregnancy.
9. ♦ The tubes are easily visualized and evaluated: Ectopic
pregnancy distorts the normal tube architecture.
♦ Small ectopics may be missed.
MANAGEMENT:
DEPENDS ON THE PRESENTATION:
ACUTE PRESENTATION - RESUSCITATION:
2 wide bore cannulae
Immediate IV fluids and blood as necessary.
As soon as possible: Video-Laparascopy or Lparatomy
should be done followed by Simple Salpingectomy with
conservation of the ovaries.
SUBACUTE & ASYMPTOMAIC PRESENTATION:
I. If the Δ is made BEFORE TUBAL RUPTURE:
it may be treated medically with methotrexate or by local
injection of drugs by laparscopy via tranvaginal or
transcervical tubal canulation.
II. Laparoscopic Surgery in both Ruptured & Intact Ectopic:
# Major contraindications to this are:
1. Massive intra-abdominal adhesions
2. Massive bleeding.
# Advantages include:
a) Reduced operating time
b) Reduced hospital stay
c) Reduced cost
d) Early return to activity
e) Cosmetically acceptable
10. III.Linear Salpingotomy: when the tube’s is intact. The tube
is left open after incision to heal by secondary intension.
IV.Fimbrial Evacuation: ONLY if pregnancy already is
aborting through the tube.
V. Radical Surgery (Salpingectomy without corneal resection
± Oopherectomy): in case of irreparably damaged tube
with heavy bleeding. After this procedure the rate of
intrauterine pregnancy is 45% and of repeated Ectopic is
9%.
ABDOMIAL ECTOPIC PREGNANCY:
It is a rare condition with high maternal mortality.
It is always secondary to implantation of a primary tubal
pregnancy.
If the fetus died & and retained: it may become infected or
calcified(Lithopedion) or it may form a fatty mass
(Adipocer)
In most cases the fetus should be delivered in which case
the placenta should left to avoid hemorrhage.
OVARIAN ECTOPIC PRGNANCY:
Is the commonest Extra-Tubal Ectopic.
Early on, it may confused with the corpus luteum.
Treatment:
a. Wedge resection of that part of the ovary containing
the sac.
b. Laser therapy
c. Oopherectomy
d. Use of Methotrexate.
11. CERVICAL ECTOPIC:
Very rare, 0.1%of all cases.
U/S shows an empty uterus with Hour-Glass appearance of
the cervix.
Treatment: Suction Curettage after vascular ligation by
cervical cerclage.
CORNUAL PREGNANCY:
Very rare.
Implantation occurs in an Atretic horn of a Bicornate Uterus.
Treatment is:Salpingectomy.
INTRAMURAL ECTOPIC:
Implantation occurs in the myometrium.
Occurs in cases of;
1. Women who had uterine perforation
2. After IVF.
HETEROTOPIC PREGNANCY:
Combination of intra- & extra-uterine pregnancy.
More common now after IVF-ET.
Up to 75% of intrauterine ones reach term.
Treatment of the Ectopic one is: injection of Potassium
Chloride or Methotrexate.