SlideShare a Scribd company logo
Ectopic pregnancy
Mohammad Yahya tailakh
5th year medical student
University of Jordan
DEFINITION
 “Any pregnancy where the fertilized ovum gets implanted & develops in a site
other than normal uterine cavity”.
 Ectopic pregnancy is accounted for 2% of all pregnancies, and is the most
common cause of maternal death during the first trimester (usually week 6-8
of pregnancy )
 It represents a serious hazard to a woman’s health and reproductive
potential, requiring prompt recognition and early aggressive intervention.
Sites:
 1-Fallopian tubes in 95% of the cases -Ampulla ( most common site) which is the
widest part ( 5-6 cm)
 -Isthmus
 -Fimbria
 2-Uterine Cornua or uterine horns. Which is the meeting point of the uterus and
the fallopian tubes. This site of ectopic pregnancy is the most dangerous of all due
to the high risk of rupture. This case needs around 10 weeks to appear.
 3- Cervical Implantation ( 0.2%)
 4- Ovarian Implantation (0.2%)
 5- Abdominal Implantation (2%) This type may reach term.
Risk factors
 1-The most important risk factor is previous history of ectopic pregnancy.
(30% risk of recurrence)
 2-Pelvic inflammatory disease (PID) and STD infections
 Any Assisted Reproductive techniques (ART) for eg, IVF
 History of any pelvic or tubal surgeryHistory of any pelvic or tubal surgery
 Contraceptive methods like Intrauterine device (IUD) .
 Smoking.
 Any congenital malformations of the tubes or the uterus
Signs and symptoms
 The classic clinical triad of ectopic pregnancy is as follows:
 Abdominal pain
 Amenorrhea
 Vaginal bleeding
 Unfortunately, only about 50% of patients present with all 3 symptoms.
 Patients may present with other symptoms common to early pregnancy (eg,
nausea, breast fullness). The following symptoms have also been reported:
 Painful fetal movements (in the case of advanced abdominal pregnancy)
 Dizziness or weakness
 Fever
 Flulike symptoms
 Vomiting
 Syncope
 Cardiac arrest
The presence of the following signs suggests
a surgical emergency:
 Abdominal rigidity
 Involuntary guarding
 Severe tenderness
 Evidence of hypovolemic shock (eg, orthostatic blood pressure changes,
tachycardia)
Findings on pelvic examination may include
the following:
 The uterus may be slightly enlarged and soft
 Uterine or cervical motion tenderness may suggest peritoneal inflammation
 An adnexal mass may be palpated but is usually difficult to differentiate from
the ipsilateral ovary
 Uterine contents may be present in the vagina, due to shedding of
endometrial lining stimulated by an ectopic pregnancy
INVESTIGATIONS:
 Serum β-HCG levels
 In a normal pregnancy, the β-HCG level doubles every 48-72 hours until it
reaches 10,000-20,000mIU/mL. In ectopic pregnancies, β-HCG levels usually
increase less. Mean serum β-HCG levels are lower in ectopic pregnancies than
in healthy pregnancies.
 No single serum β-HCG level is diagnostic of an ectopic pregnancy. Serial
serum β-HCG levels are necessary to differentiate between normal and
abnormal pregnancies and to monitor resolution of ectopic pregnancy once
therapy has been initiated.
 *Progesterone level - greater than 20 micrograms/ml indicates good
pregnancy and
 less than 5 micrograms/ml is a bad indicator ( ectopic or abortion)
 Anything in between 5-20 microgram/ml is a grey zone and not indicative.
 -Ultrasound imaging: it is usually inconclusive but the U/S findings
 suggestive of ectopic preg;
 - ABSENT intrauterine sac and the presence of ectopic sac
 - complex adnexal mass
 -Free fluid in cul de sac ( ruptured ectopic pregnancy)
 VALUES of discriminatory beta HCG:
 On ABDOMINAL U/S 6,000-6,500 m IU/ml
 On Transvaginal U/S 1,500-1,800 m IU/ml
Arias-Stella reaction (ASR)
 This finding may provide initial histologic "clue" of ectopic pregnancy
Differential diagnosis:
 Differential diagnosis of first trimester bleeding :
 -Ectopic pregnancy
 -Recent Abortion
 -Molar pregnancy
 the symptomatic picture of ectopic pregnancy:
 Appendicitis, salpingitis, ruptured corpus luteum…
Management:
 The method of management depends greatly on the hemodynamic stability of
the patient, so the vital signs indicates instability (hypotension) or decreased
level of consciousness or life threatening bleeding Laparotomy is indicated.
 observation:
 Indicated when: the patient is stable without any significant bleeding or pain/
the site of implantation is the tube/ size of gestational sac< 4 cm , FALLING
beta HCG levels .
Medical management
(METHOTREXATE):
 If the patient is stable, no IUP ,gestational sac < 3.5 cm and no FHA, but suffering of
significant pain or bleeding, METHOTREXATE is the drug of choice.
 MTX is an antimetabolite (folate antagonist). Usually, it is given as a single shot at a
dose of 50
 mg/m2 IM. Then Beta HCG is followed after 3-7 days a drop in the levels of beta HCG
of about 15% indicates successful treatment.
 Beta HCG levels should be followed up till levels are 0-5.
 If serum levels were in plateau or the drop was less than 15%, a second dose of MTX
should be given after 2 weeks.
 However if the level increased or if the patient became symptomatic, Surgery is
indicated.
Surgical Management:
 It is indicated if the patient was hemodynamically unstable (laparotomy) or failure of
medical treatment, or if FHA is present, or gestational sac size is > 4cm. If the patient is
stable, but has one of these indications, laparoscopy is done.
 Salpingectomy; removal of the tube. no need for follow up of beta HCG levels.
 Salpingostomy; Incision on the antimesentric portion of the tube is made, then after
removal of products of conception, the tube is sutured. Used for unruptured distal tube
ectopic preg.
 Salpingotomy : The same procedure as salpingostomy however the incision is not sutured
and is left to heal by secondary intention.
 In Salpingostomy and salpingiotomy, beta HCG levels should be followed up as in medical
treatment. ( till levels are 0-5 )
Contraindications of Methotrexate:
 -Unstable patient
 Beta HCG levels > 5,000
 -Fetal heart activity or any intrauterine pregnancy evidence
 -free fluid in cul de sac ( indicating ruptured ectopic preg. )
 -Active Peptic ulcer disease
 -Active pulmonary/ renal/ hepatic disease
 -Breast feeding
 - MTX sensitivity
 - Moderate/severe Anemia/ Thrombocytopenia / Leukopenia
 -Leukemia
 Note: Do not use MTX with NSAID, since this combination may potentiate
nephrotoxicity
Thank you

More Related Content

What's hot

Pelvic organ prolapse – Management
Pelvic organ prolapse – ManagementPelvic organ prolapse – Management
Pelvic organ prolapse – Management
Labeeb Pc
 
Management of Cervical Incompetence
Management of Cervical IncompetenceManagement of Cervical Incompetence
Management of Cervical Incompetence
Kattey Kattey
 
Vbac
VbacVbac
Multiple pregnancy
Multiple pregnancyMultiple pregnancy
Multiple pregnancy
Rosetta Davis
 
Face Presentation
Face PresentationFace Presentation
Face Presentation
Dr ABU SURAIH SAKHRI
 
Tocolysis for preterm labour: RCOG Guidelines
Tocolysis for preterm labour: RCOG GuidelinesTocolysis for preterm labour: RCOG Guidelines
Tocolysis for preterm labour: RCOG Guidelines
Aboubakr Elnashar
 
Shoulder Dystocia
Shoulder DystociaShoulder Dystocia
Shoulder Dystocia
Devender Kumar
 
Ectopic pregnancy
Ectopic pregnancyEctopic pregnancy
Ectopic pregnancy
Mohammad Tailakh
 
Normal and abnormal labour
Normal and abnormal labourNormal and abnormal labour
Normal and abnormal labour
Dr Kishwar Naheed
 
Cesarean section
Cesarean sectionCesarean section
Cesarean section
Ahmed Mowafy
 
Obs Exam Questions
Obs Exam QuestionsObs Exam Questions
Obs Exam Questions
Tsega Tilahun
 
First trimester mtp
First trimester mtpFirst trimester mtp
First trimester mtp
Dr.Jatheesh Mohan
 
Assisted vaginal delivery
Assisted vaginal deliveryAssisted vaginal delivery
Assisted vaginal delivery
Waill Altimeemi
 
Partogram and management of 1st and 2nd stages of labor
Partogram and management of 1st and 2nd stages of laborPartogram and management of 1st and 2nd stages of labor
Partogram and management of 1st and 2nd stages of labor
Ali S. Mayali
 
Malpresentations&malpositions
Malpresentations&malpositionsMalpresentations&malpositions
Malpresentations&malpositions
Ezmeer Emiral
 
Abnormal labour
Abnormal labourAbnormal labour
Abnormal labour
Areesha Khanzada
 
Cervical incompetence
Cervical incompetenceCervical incompetence
Cervical incompetence
Adil Muhammed
 
Seminar on gestational trophoblastic disease (gtd) (f inal)
Seminar on gestational trophoblastic disease (gtd) (f inal)Seminar on gestational trophoblastic disease (gtd) (f inal)
Seminar on gestational trophoblastic disease (gtd) (f inal)
Santosh Narayankar
 
Prior cesarean delivery (VBAC)
Prior cesarean delivery (VBAC)Prior cesarean delivery (VBAC)
Prior cesarean delivery (VBAC)
nishma bajracharya
 
MANAGEMENT OF VAULT PROLAPSE BY DR SHASHWAT JANI
MANAGEMENT OF VAULT PROLAPSE BY DR SHASHWAT JANIMANAGEMENT OF VAULT PROLAPSE BY DR SHASHWAT JANI
MANAGEMENT OF VAULT PROLAPSE BY DR SHASHWAT JANI
DR SHASHWAT JANI
 

What's hot (20)

Pelvic organ prolapse – Management
Pelvic organ prolapse – ManagementPelvic organ prolapse – Management
Pelvic organ prolapse – Management
 
Management of Cervical Incompetence
Management of Cervical IncompetenceManagement of Cervical Incompetence
Management of Cervical Incompetence
 
Vbac
VbacVbac
Vbac
 
Multiple pregnancy
Multiple pregnancyMultiple pregnancy
Multiple pregnancy
 
Face Presentation
Face PresentationFace Presentation
Face Presentation
 
Tocolysis for preterm labour: RCOG Guidelines
Tocolysis for preterm labour: RCOG GuidelinesTocolysis for preterm labour: RCOG Guidelines
Tocolysis for preterm labour: RCOG Guidelines
 
Shoulder Dystocia
Shoulder DystociaShoulder Dystocia
Shoulder Dystocia
 
Ectopic pregnancy
Ectopic pregnancyEctopic pregnancy
Ectopic pregnancy
 
Normal and abnormal labour
Normal and abnormal labourNormal and abnormal labour
Normal and abnormal labour
 
Cesarean section
Cesarean sectionCesarean section
Cesarean section
 
Obs Exam Questions
Obs Exam QuestionsObs Exam Questions
Obs Exam Questions
 
First trimester mtp
First trimester mtpFirst trimester mtp
First trimester mtp
 
Assisted vaginal delivery
Assisted vaginal deliveryAssisted vaginal delivery
Assisted vaginal delivery
 
Partogram and management of 1st and 2nd stages of labor
Partogram and management of 1st and 2nd stages of laborPartogram and management of 1st and 2nd stages of labor
Partogram and management of 1st and 2nd stages of labor
 
Malpresentations&malpositions
Malpresentations&malpositionsMalpresentations&malpositions
Malpresentations&malpositions
 
Abnormal labour
Abnormal labourAbnormal labour
Abnormal labour
 
Cervical incompetence
Cervical incompetenceCervical incompetence
Cervical incompetence
 
Seminar on gestational trophoblastic disease (gtd) (f inal)
Seminar on gestational trophoblastic disease (gtd) (f inal)Seminar on gestational trophoblastic disease (gtd) (f inal)
Seminar on gestational trophoblastic disease (gtd) (f inal)
 
Prior cesarean delivery (VBAC)
Prior cesarean delivery (VBAC)Prior cesarean delivery (VBAC)
Prior cesarean delivery (VBAC)
 
MANAGEMENT OF VAULT PROLAPSE BY DR SHASHWAT JANI
MANAGEMENT OF VAULT PROLAPSE BY DR SHASHWAT JANIMANAGEMENT OF VAULT PROLAPSE BY DR SHASHWAT JANI
MANAGEMENT OF VAULT PROLAPSE BY DR SHASHWAT JANI
 

Similar to Ectopic pregnancy

ectopic pregnancy.pptx
ectopic pregnancy.pptxectopic pregnancy.pptx
ectopic pregnancy.pptx
MohamadAbusaad
 
Ectopic Pregnancy-1.pptx
Ectopic Pregnancy-1.pptxEctopic Pregnancy-1.pptx
Ectopic Pregnancy-1.pptx
ImranKhan127540
 
Abdominal pain in pregnancy
Abdominal pain in pregnancyAbdominal pain in pregnancy
Abdominal pain in pregnancy
Tana Kiak
 
Ectopic pregnancy
Ectopic pregnancyEctopic pregnancy
Ectopic pregnancy
Geeta Yadav
 
ectopicpregnancydpg-170824070854.pdf
ectopicpregnancydpg-170824070854.pdfectopicpregnancydpg-170824070854.pdf
ectopicpregnancydpg-170824070854.pdf
AugustusCaesar7
 
Pph
PphPph
ANTE PARTUM HAEMORRHAGE (APH).pptx
ANTE PARTUM HAEMORRHAGE (APH).pptxANTE PARTUM HAEMORRHAGE (APH).pptx
ANTE PARTUM HAEMORRHAGE (APH).pptx
AFSALA18
 
Ectopic pregnancy new
Ectopic pregnancy newEctopic pregnancy new
Ectopic pregnancy new
ArunaVerma8
 
Gynaecological emergency
Gynaecological emergencyGynaecological emergency
Gynaecological emergency
obsgynhsnz
 
Gynecology 5th year, 3rd & 4th lectures (Dr. Muhabat Salih Saeid)
Gynecology 5th year, 3rd & 4th lectures (Dr. Muhabat Salih Saeid)Gynecology 5th year, 3rd & 4th lectures (Dr. Muhabat Salih Saeid)
Gynecology 5th year, 3rd & 4th lectures (Dr. Muhabat Salih Saeid)
College of Medicine, Sulaymaniyah
 
pph-150512151237-lva1-app6892.pptx
pph-150512151237-lva1-app6892.pptxpph-150512151237-lva1-app6892.pptx
pph-150512151237-lva1-app6892.pptx
dimasfujiansyah1
 
Bleeding in early & late pregnancy
Bleeding in early  & late pregnancyBleeding in early  & late pregnancy
Bleeding in early & late pregnancy
Rabi Satpathy
 
Abruptio Placenta (Original)
Abruptio Placenta (Original)Abruptio Placenta (Original)
Abruptio Placenta (Original)
boblhen
 
3rd stage of labour by dr shazia a khan 4 mar 19
3rd stage of labour by dr shazia a khan 4 mar 193rd stage of labour by dr shazia a khan 4 mar 19
3rd stage of labour by dr shazia a khan 4 mar 19
mahmoodayub2
 
Abortion-spontaneous miscarriage
Abortion-spontaneous miscarriageAbortion-spontaneous miscarriage
Abortion-spontaneous miscarriage
Kenson P Kanesious
 
Gynecology 5th year, 7th lecture (Dr. Muhabat Salih Saeid)
Gynecology 5th year, 7th lecture (Dr. Muhabat Salih Saeid)Gynecology 5th year, 7th lecture (Dr. Muhabat Salih Saeid)
Gynecology 5th year, 7th lecture (Dr. Muhabat Salih Saeid)
College of Medicine, Sulaymaniyah
 
High risk obstetrics
High risk obstetrics High risk obstetrics
High risk obstetrics
Niranjan Chavan
 
ECTOPIC PREGNANCY
ECTOPIC PREGNANCYECTOPIC PREGNANCY
ECTOPIC PREGNANCY
Arief Sobri
 
Postpartum hemorrhage for undergraduate
Postpartum hemorrhage for undergraduatePostpartum hemorrhage for undergraduate
Postpartum hemorrhage for undergraduate
Faculty of Medicine,Zagazig University,EGYPT
 
Antepartum bleeding
Antepartum bleedingAntepartum bleeding
Antepartum bleeding
Nada El-Absy
 

Similar to Ectopic pregnancy (20)

ectopic pregnancy.pptx
ectopic pregnancy.pptxectopic pregnancy.pptx
ectopic pregnancy.pptx
 
Ectopic Pregnancy-1.pptx
Ectopic Pregnancy-1.pptxEctopic Pregnancy-1.pptx
Ectopic Pregnancy-1.pptx
 
Abdominal pain in pregnancy
Abdominal pain in pregnancyAbdominal pain in pregnancy
Abdominal pain in pregnancy
 
Ectopic pregnancy
Ectopic pregnancyEctopic pregnancy
Ectopic pregnancy
 
ectopicpregnancydpg-170824070854.pdf
ectopicpregnancydpg-170824070854.pdfectopicpregnancydpg-170824070854.pdf
ectopicpregnancydpg-170824070854.pdf
 
Pph
PphPph
Pph
 
ANTE PARTUM HAEMORRHAGE (APH).pptx
ANTE PARTUM HAEMORRHAGE (APH).pptxANTE PARTUM HAEMORRHAGE (APH).pptx
ANTE PARTUM HAEMORRHAGE (APH).pptx
 
Ectopic pregnancy new
Ectopic pregnancy newEctopic pregnancy new
Ectopic pregnancy new
 
Gynaecological emergency
Gynaecological emergencyGynaecological emergency
Gynaecological emergency
 
Gynecology 5th year, 3rd & 4th lectures (Dr. Muhabat Salih Saeid)
Gynecology 5th year, 3rd & 4th lectures (Dr. Muhabat Salih Saeid)Gynecology 5th year, 3rd & 4th lectures (Dr. Muhabat Salih Saeid)
Gynecology 5th year, 3rd & 4th lectures (Dr. Muhabat Salih Saeid)
 
pph-150512151237-lva1-app6892.pptx
pph-150512151237-lva1-app6892.pptxpph-150512151237-lva1-app6892.pptx
pph-150512151237-lva1-app6892.pptx
 
Bleeding in early & late pregnancy
Bleeding in early  & late pregnancyBleeding in early  & late pregnancy
Bleeding in early & late pregnancy
 
Abruptio Placenta (Original)
Abruptio Placenta (Original)Abruptio Placenta (Original)
Abruptio Placenta (Original)
 
3rd stage of labour by dr shazia a khan 4 mar 19
3rd stage of labour by dr shazia a khan 4 mar 193rd stage of labour by dr shazia a khan 4 mar 19
3rd stage of labour by dr shazia a khan 4 mar 19
 
Abortion-spontaneous miscarriage
Abortion-spontaneous miscarriageAbortion-spontaneous miscarriage
Abortion-spontaneous miscarriage
 
Gynecology 5th year, 7th lecture (Dr. Muhabat Salih Saeid)
Gynecology 5th year, 7th lecture (Dr. Muhabat Salih Saeid)Gynecology 5th year, 7th lecture (Dr. Muhabat Salih Saeid)
Gynecology 5th year, 7th lecture (Dr. Muhabat Salih Saeid)
 
High risk obstetrics
High risk obstetrics High risk obstetrics
High risk obstetrics
 
ECTOPIC PREGNANCY
ECTOPIC PREGNANCYECTOPIC PREGNANCY
ECTOPIC PREGNANCY
 
Postpartum hemorrhage for undergraduate
Postpartum hemorrhage for undergraduatePostpartum hemorrhage for undergraduate
Postpartum hemorrhage for undergraduate
 
Antepartum bleeding
Antepartum bleedingAntepartum bleeding
Antepartum bleeding
 

More from mohammad tailakh

Fetal head diameters
Fetal head diametersFetal head diameters
Fetal head diameters
mohammad tailakh
 
Burns and sudden death
Burns and sudden deathBurns and sudden death
Burns and sudden death
mohammad tailakh
 
Empyema presentation
Empyema presentationEmpyema presentation
Empyema presentation
mohammad tailakh
 
Calcium channel blockers
Calcium channel blockersCalcium channel blockers
Calcium channel blockers
mohammad tailakh
 
Geriatrics health assessment
Geriatrics health assessmentGeriatrics health assessment
Geriatrics health assessment
mohammad tailakh
 
Knee disorders
Knee disordersKnee disorders
Knee disorders
mohammad tailakh
 
Lens and cataract
Lens and cataractLens and cataract
Lens and cataract
mohammad tailakh
 
Urinary tract infections
Urinary tract infectionsUrinary tract infections
Urinary tract infections
mohammad tailakh
 

More from mohammad tailakh (8)

Fetal head diameters
Fetal head diametersFetal head diameters
Fetal head diameters
 
Burns and sudden death
Burns and sudden deathBurns and sudden death
Burns and sudden death
 
Empyema presentation
Empyema presentationEmpyema presentation
Empyema presentation
 
Calcium channel blockers
Calcium channel blockersCalcium channel blockers
Calcium channel blockers
 
Geriatrics health assessment
Geriatrics health assessmentGeriatrics health assessment
Geriatrics health assessment
 
Knee disorders
Knee disordersKnee disorders
Knee disorders
 
Lens and cataract
Lens and cataractLens and cataract
Lens and cataract
 
Urinary tract infections
Urinary tract infectionsUrinary tract infections
Urinary tract infections
 

Recently uploaded

Adhd Medication Shortage Uk - trinexpharmacy.com
Adhd Medication Shortage Uk - trinexpharmacy.comAdhd Medication Shortage Uk - trinexpharmacy.com
Adhd Medication Shortage Uk - trinexpharmacy.com
reignlana06
 
Aortic Association CBL Pilot April 19 – 20 Bern
Aortic Association CBL Pilot April 19 – 20 BernAortic Association CBL Pilot April 19 – 20 Bern
Aortic Association CBL Pilot April 19 – 20 Bern
suvadeepdas911
 
Efficacy of Avartana Sneha in Ayurveda
Efficacy of Avartana Sneha in AyurvedaEfficacy of Avartana Sneha in Ayurveda
Efficacy of Avartana Sneha in Ayurveda
Dr. Jyothirmai Paindla
 
pathology MCQS introduction to pathology general pathology
pathology MCQS introduction to pathology general pathologypathology MCQS introduction to pathology general pathology
pathology MCQS introduction to pathology general pathology
ZayedKhan38
 
Complementary feeding in infant IAP PROTOCOLS
Complementary feeding in infant IAP PROTOCOLSComplementary feeding in infant IAP PROTOCOLS
Complementary feeding in infant IAP PROTOCOLS
chiranthgowda16
 
Integrating Ayurveda into Parkinson’s Management: A Holistic Approach
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachIntegrating Ayurveda into Parkinson’s Management: A Holistic Approach
Integrating Ayurveda into Parkinson’s Management: A Holistic Approach
Ayurveda ForAll
 
The Nervous and Chemical Regulation of Respiration
The Nervous and Chemical Regulation of RespirationThe Nervous and Chemical Regulation of Respiration
The Nervous and Chemical Regulation of Respiration
MedicoseAcademics
 
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
Holistified Wellness
 
Outbreak management including quarantine, isolation, contact.pptx
Outbreak management including quarantine, isolation, contact.pptxOutbreak management including quarantine, isolation, contact.pptx
Outbreak management including quarantine, isolation, contact.pptx
Pratik328635
 
The Electrocardiogram - Physiologic Principles
The Electrocardiogram - Physiologic PrinciplesThe Electrocardiogram - Physiologic Principles
The Electrocardiogram - Physiologic Principles
MedicoseAcademics
 
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
 
Abortion PG Seminar Power point presentation
Abortion PG Seminar Power point presentationAbortion PG Seminar Power point presentation
Abortion PG Seminar Power point presentation
AksshayaRajanbabu
 
Muscles of Mastication by Dr. Rabia Inam Gandapore.pptx
Muscles of Mastication by Dr. Rabia Inam Gandapore.pptxMuscles of Mastication by Dr. Rabia Inam Gandapore.pptx
Muscles of Mastication by Dr. Rabia Inam Gandapore.pptx
Dr. Rabia Inam Gandapore
 
All info about Diabetes and how to control it.
 All info about Diabetes and how to control it. All info about Diabetes and how to control it.
All info about Diabetes and how to control it.
Gokuldas Hospital
 
CHEMOTHERAPY_RDP_CHAPTER 3_ANTIFUNGAL AGENT.pdf
CHEMOTHERAPY_RDP_CHAPTER 3_ANTIFUNGAL AGENT.pdfCHEMOTHERAPY_RDP_CHAPTER 3_ANTIFUNGAL AGENT.pdf
CHEMOTHERAPY_RDP_CHAPTER 3_ANTIFUNGAL AGENT.pdf
rishi2789
 
Netter's Atlas of Human Anatomy 7.ed.pdf
Netter's Atlas of Human Anatomy 7.ed.pdfNetter's Atlas of Human Anatomy 7.ed.pdf
Netter's Atlas of Human Anatomy 7.ed.pdf
BrissaOrtiz3
 
CHEMOTHERAPY_RDP_CHAPTER 1_ANTI TB DRUGS.pdf
CHEMOTHERAPY_RDP_CHAPTER 1_ANTI TB DRUGS.pdfCHEMOTHERAPY_RDP_CHAPTER 1_ANTI TB DRUGS.pdf
CHEMOTHERAPY_RDP_CHAPTER 1_ANTI TB DRUGS.pdf
rishi2789
 
Chapter 11 Nutrition and Chronic Diseases.pptx
Chapter 11 Nutrition and Chronic Diseases.pptxChapter 11 Nutrition and Chronic Diseases.pptx
Chapter 11 Nutrition and Chronic Diseases.pptx
Earlene McNair
 
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
 
CBL Seminar 2024_Preliminary Program.pdf
CBL Seminar 2024_Preliminary Program.pdfCBL Seminar 2024_Preliminary Program.pdf
CBL Seminar 2024_Preliminary Program.pdf
suvadeepdas911
 

Recently uploaded (20)

Adhd Medication Shortage Uk - trinexpharmacy.com
Adhd Medication Shortage Uk - trinexpharmacy.comAdhd Medication Shortage Uk - trinexpharmacy.com
Adhd Medication Shortage Uk - trinexpharmacy.com
 
Aortic Association CBL Pilot April 19 – 20 Bern
Aortic Association CBL Pilot April 19 – 20 BernAortic Association CBL Pilot April 19 – 20 Bern
Aortic Association CBL Pilot April 19 – 20 Bern
 
Efficacy of Avartana Sneha in Ayurveda
Efficacy of Avartana Sneha in AyurvedaEfficacy of Avartana Sneha in Ayurveda
Efficacy of Avartana Sneha in Ayurveda
 
pathology MCQS introduction to pathology general pathology
pathology MCQS introduction to pathology general pathologypathology MCQS introduction to pathology general pathology
pathology MCQS introduction to pathology general pathology
 
Complementary feeding in infant IAP PROTOCOLS
Complementary feeding in infant IAP PROTOCOLSComplementary feeding in infant IAP PROTOCOLS
Complementary feeding in infant IAP PROTOCOLS
 
Integrating Ayurveda into Parkinson’s Management: A Holistic Approach
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachIntegrating Ayurveda into Parkinson’s Management: A Holistic Approach
Integrating Ayurveda into Parkinson’s Management: A Holistic Approach
 
The Nervous and Chemical Regulation of Respiration
The Nervous and Chemical Regulation of RespirationThe Nervous and Chemical Regulation of Respiration
The Nervous and Chemical Regulation of Respiration
 
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
 
Outbreak management including quarantine, isolation, contact.pptx
Outbreak management including quarantine, isolation, contact.pptxOutbreak management including quarantine, isolation, contact.pptx
Outbreak management including quarantine, isolation, contact.pptx
 
The Electrocardiogram - Physiologic Principles
The Electrocardiogram - Physiologic PrinciplesThe Electrocardiogram - Physiologic Principles
The Electrocardiogram - Physiologic Principles
 
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
 
Abortion PG Seminar Power point presentation
Abortion PG Seminar Power point presentationAbortion PG Seminar Power point presentation
Abortion PG Seminar Power point presentation
 
Muscles of Mastication by Dr. Rabia Inam Gandapore.pptx
Muscles of Mastication by Dr. Rabia Inam Gandapore.pptxMuscles of Mastication by Dr. Rabia Inam Gandapore.pptx
Muscles of Mastication by Dr. Rabia Inam Gandapore.pptx
 
All info about Diabetes and how to control it.
 All info about Diabetes and how to control it. All info about Diabetes and how to control it.
All info about Diabetes and how to control it.
 
CHEMOTHERAPY_RDP_CHAPTER 3_ANTIFUNGAL AGENT.pdf
CHEMOTHERAPY_RDP_CHAPTER 3_ANTIFUNGAL AGENT.pdfCHEMOTHERAPY_RDP_CHAPTER 3_ANTIFUNGAL AGENT.pdf
CHEMOTHERAPY_RDP_CHAPTER 3_ANTIFUNGAL AGENT.pdf
 
Netter's Atlas of Human Anatomy 7.ed.pdf
Netter's Atlas of Human Anatomy 7.ed.pdfNetter's Atlas of Human Anatomy 7.ed.pdf
Netter's Atlas of Human Anatomy 7.ed.pdf
 
CHEMOTHERAPY_RDP_CHAPTER 1_ANTI TB DRUGS.pdf
CHEMOTHERAPY_RDP_CHAPTER 1_ANTI TB DRUGS.pdfCHEMOTHERAPY_RDP_CHAPTER 1_ANTI TB DRUGS.pdf
CHEMOTHERAPY_RDP_CHAPTER 1_ANTI TB DRUGS.pdf
 
Chapter 11 Nutrition and Chronic Diseases.pptx
Chapter 11 Nutrition and Chronic Diseases.pptxChapter 11 Nutrition and Chronic Diseases.pptx
Chapter 11 Nutrition and Chronic Diseases.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
 
CBL Seminar 2024_Preliminary Program.pdf
CBL Seminar 2024_Preliminary Program.pdfCBL Seminar 2024_Preliminary Program.pdf
CBL Seminar 2024_Preliminary Program.pdf
 

Ectopic pregnancy

  • 1. Ectopic pregnancy Mohammad Yahya tailakh 5th year medical student University of Jordan
  • 2. DEFINITION  “Any pregnancy where the fertilized ovum gets implanted & develops in a site other than normal uterine cavity”.  Ectopic pregnancy is accounted for 2% of all pregnancies, and is the most common cause of maternal death during the first trimester (usually week 6-8 of pregnancy )  It represents a serious hazard to a woman’s health and reproductive potential, requiring prompt recognition and early aggressive intervention.
  • 3. Sites:  1-Fallopian tubes in 95% of the cases -Ampulla ( most common site) which is the widest part ( 5-6 cm)  -Isthmus  -Fimbria  2-Uterine Cornua or uterine horns. Which is the meeting point of the uterus and the fallopian tubes. This site of ectopic pregnancy is the most dangerous of all due to the high risk of rupture. This case needs around 10 weeks to appear.  3- Cervical Implantation ( 0.2%)  4- Ovarian Implantation (0.2%)  5- Abdominal Implantation (2%) This type may reach term.
  • 4.
  • 5. Risk factors  1-The most important risk factor is previous history of ectopic pregnancy. (30% risk of recurrence)  2-Pelvic inflammatory disease (PID) and STD infections  Any Assisted Reproductive techniques (ART) for eg, IVF  History of any pelvic or tubal surgeryHistory of any pelvic or tubal surgery  Contraceptive methods like Intrauterine device (IUD) .  Smoking.  Any congenital malformations of the tubes or the uterus
  • 6. Signs and symptoms  The classic clinical triad of ectopic pregnancy is as follows:  Abdominal pain  Amenorrhea  Vaginal bleeding  Unfortunately, only about 50% of patients present with all 3 symptoms.
  • 7.  Patients may present with other symptoms common to early pregnancy (eg, nausea, breast fullness). The following symptoms have also been reported:  Painful fetal movements (in the case of advanced abdominal pregnancy)  Dizziness or weakness  Fever  Flulike symptoms  Vomiting  Syncope  Cardiac arrest
  • 8. The presence of the following signs suggests a surgical emergency:  Abdominal rigidity  Involuntary guarding  Severe tenderness  Evidence of hypovolemic shock (eg, orthostatic blood pressure changes, tachycardia)
  • 9. Findings on pelvic examination may include the following:  The uterus may be slightly enlarged and soft  Uterine or cervical motion tenderness may suggest peritoneal inflammation  An adnexal mass may be palpated but is usually difficult to differentiate from the ipsilateral ovary  Uterine contents may be present in the vagina, due to shedding of endometrial lining stimulated by an ectopic pregnancy
  • 10. INVESTIGATIONS:  Serum β-HCG levels  In a normal pregnancy, the β-HCG level doubles every 48-72 hours until it reaches 10,000-20,000mIU/mL. In ectopic pregnancies, β-HCG levels usually increase less. Mean serum β-HCG levels are lower in ectopic pregnancies than in healthy pregnancies.  No single serum β-HCG level is diagnostic of an ectopic pregnancy. Serial serum β-HCG levels are necessary to differentiate between normal and abnormal pregnancies and to monitor resolution of ectopic pregnancy once therapy has been initiated.
  • 11.  *Progesterone level - greater than 20 micrograms/ml indicates good pregnancy and  less than 5 micrograms/ml is a bad indicator ( ectopic or abortion)  Anything in between 5-20 microgram/ml is a grey zone and not indicative.  -Ultrasound imaging: it is usually inconclusive but the U/S findings  suggestive of ectopic preg;  - ABSENT intrauterine sac and the presence of ectopic sac  - complex adnexal mass  -Free fluid in cul de sac ( ruptured ectopic pregnancy)  VALUES of discriminatory beta HCG:  On ABDOMINAL U/S 6,000-6,500 m IU/ml  On Transvaginal U/S 1,500-1,800 m IU/ml
  • 12. Arias-Stella reaction (ASR)  This finding may provide initial histologic "clue" of ectopic pregnancy
  • 13. Differential diagnosis:  Differential diagnosis of first trimester bleeding :  -Ectopic pregnancy  -Recent Abortion  -Molar pregnancy  the symptomatic picture of ectopic pregnancy:  Appendicitis, salpingitis, ruptured corpus luteum…
  • 14. Management:  The method of management depends greatly on the hemodynamic stability of the patient, so the vital signs indicates instability (hypotension) or decreased level of consciousness or life threatening bleeding Laparotomy is indicated.  observation:  Indicated when: the patient is stable without any significant bleeding or pain/ the site of implantation is the tube/ size of gestational sac< 4 cm , FALLING beta HCG levels .
  • 15. Medical management (METHOTREXATE):  If the patient is stable, no IUP ,gestational sac < 3.5 cm and no FHA, but suffering of significant pain or bleeding, METHOTREXATE is the drug of choice.  MTX is an antimetabolite (folate antagonist). Usually, it is given as a single shot at a dose of 50  mg/m2 IM. Then Beta HCG is followed after 3-7 days a drop in the levels of beta HCG of about 15% indicates successful treatment.  Beta HCG levels should be followed up till levels are 0-5.  If serum levels were in plateau or the drop was less than 15%, a second dose of MTX should be given after 2 weeks.  However if the level increased or if the patient became symptomatic, Surgery is indicated.
  • 16. Surgical Management:  It is indicated if the patient was hemodynamically unstable (laparotomy) or failure of medical treatment, or if FHA is present, or gestational sac size is > 4cm. If the patient is stable, but has one of these indications, laparoscopy is done.  Salpingectomy; removal of the tube. no need for follow up of beta HCG levels.  Salpingostomy; Incision on the antimesentric portion of the tube is made, then after removal of products of conception, the tube is sutured. Used for unruptured distal tube ectopic preg.  Salpingotomy : The same procedure as salpingostomy however the incision is not sutured and is left to heal by secondary intention.  In Salpingostomy and salpingiotomy, beta HCG levels should be followed up as in medical treatment. ( till levels are 0-5 )
  • 17. Contraindications of Methotrexate:  -Unstable patient  Beta HCG levels > 5,000  -Fetal heart activity or any intrauterine pregnancy evidence  -free fluid in cul de sac ( indicating ruptured ectopic preg. )  -Active Peptic ulcer disease  -Active pulmonary/ renal/ hepatic disease  -Breast feeding  - MTX sensitivity  - Moderate/severe Anemia/ Thrombocytopenia / Leukopenia  -Leukemia  Note: Do not use MTX with NSAID, since this combination may potentiate nephrotoxicity