Ectopic pregnancy
•Download as PPTX, PDF•
0 likes•391 views
Ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, most commonly in the fallopian tubes. Risk factors include previous ectopic pregnancy, tubal surgery or infections, IUD use, smoking, and assisted reproduction. Diagnosis is made based on symptoms, examination findings, ultrasound imaging, and beta-HCG levels. Treatment options include expectant management for early, stable ectopics; medical management with methotrexate; or surgical management via laparoscopy or laparotomy. Prognosis depends on the location and severity of the ectopic pregnancy.
More Related Content
What's hot
What's hot (20)
Viewers also liked
Viewers also liked (16)
Similar to Ectopic pregnancy
Similar to Ectopic pregnancy (20)
Recently uploaded
Recently uploaded (20)
Ectopic pregnancy
- 2. Ectopic Pregnancy By Dr. Umtal Batool PGR – 1, Unit 3
- 3. Definition “It is defined as implantation of fertilized ovum at a site other than uterine endometrium” Etiology Delay in the ovum transport.
- 4. Risk Factors •Previous history of tubal pregnancy •Previous tubal surgery •PID •Termination of pregnancy •IUCD Use •Assisted Conception •Smoking •DES •Salpingitis
- 5. Pathophysiology “Abnormality in either tubal morphology or function” •Damage to tubal mucosa •Dysfunction of myoelectrical activity •Dysfunction of cilia Incidence 11.1% in 1000 pregnancies in UK
- 6. 2% 12% 80% 5% 1.4% 0.2% 0.2%
- 7. Progression of Tubal Pregnancy •Ruptured •Unruptured •Abortion •Involution •Tubal Mole Timing of Rupture Depends upon location & duration of gestation
- 9. Diagnosis Diagnosis is made upon •History •Examination •Complete Workup On History Classical alarming triad •Amenorrhea •Abd Pain •Abnormal Uterine Bleeding
- 10. On Examination Hemodynamically Stable Hemodynamically Unstable On P/A •Generalized Tenderness •Localized Tenderness •Rebound Tenderness Cullen’s Sign
- 11. On PV Inconclusive Types of Presentation •Acute •Sub acute
- 12. Investigations •Biochemical •Radio Imaging •Diagnostic Laparoscopy •Culdo centesis
- 13. Biochemical •Beta HCG •Serum Progesterone Beta HCG •Secreted by syncitiotrophoblast Normal Doubling Time •2.2 days Normal Half Life •32 – 37hrs
- 14. RCOG Says “An increase in BETA HCG of < 66% over 48hrs means ectopic pregnancy” ACOG Says “An increase in BETA HCG of < 53% over 48hrs means ectopic pregnancy”
- 15. Serum Progesterone •C21 Compound •Useful in diagnosis and management of pregnancy of unknown location Progesterone Levels >60 nmol / L Viable IUP <20 nmol / L Failing PUL
- 16. USG •TVS •Abdominal •Doppler •3D Normal IUP Sign Double decidual sac sign
- 19. Pseudo Sac
- 20. Management •Expectant •Medical •Surgical Expectant Management •ACOG: “If initial HCG level < 200 mu/ml. 88% Ectopic resolve spontaneously.” •Carefully selected patients desire to retain fertility.
- 21. Criteria •Clinically stable asymptomatic woman. •B HCG conc <1000-2000 1U/L •Haemo peritoneum of < 50- 100 ml •Adnexal mass of < 2cm •Absent FCA or fetal parts Disadvantage Morbidity •Need of MX •Need of surgery Mortality • Rupture
- 22. Medical Management Methotrexate •Offered to the patient desiring to retain fertility in presence of contralateral tube damage. •Antimetabolite Folic Acid Antagonist (Inhibits DNA synthesis in rapidly dividing cells) Side Effects • GIT • Skin and Hair • Renal Toxicity • Myelo Suppression Criteria of Patient Selection • Initial BHCG < 3000 iu / L •Adnexal mass < 2cm •Absent FCA
- 23. Pre Requisite Investigations for MTX • CBC and platelets • LFT’s & RFT’s Routes • Systemic • Local Routes • Single standard dose protocol • Multiple fixed dose protocol Mifepristone & MTX Combination
- 24. Day Single Dose Multiple Dose 1 HCG Conc. MTX 50 mg/m2 body surface area i/m HCG Conc. MTX 1mg/kg body wt i/m 2 Folinic acid .1mg/kg body wt po 3 HCG Conc If <15% ↓ from day 1-3, Give MTX 1mg/kg i/m If ≥ 15% decline from day 1-3, begin weekly HCG 4 HCG protocols vary Folinic acid .1mg/kg body wt po 5 HCG Conc If <15% ↓ from day 3-5, Give MTX 1mg/kg i/m If ≥ 15% ↓from day 3-5, ,begin weekly HCG 6 Folinic acid .1mg/kg body wt po 7 HCG Conc If <15% ↓ HCG from day 4-7 Or <25% ↓ HCG from day 1-7 Additional dose of MTX 50mg/m2 i/m If ≥ 15% ↓from day 4-7 If ≥ 25% ↓from day 1-7 Draw HCG conc. Weekly until HCG is undetectable. HCG Conc If <15% ↓ from day 5-7, Give MTX 1mg/kg i/m If ≥ 15% ↓from day 5-7, ,begin weekly HCG 8 Folinic acid .1mg/kg body wt po 14 HCG Conc If <15% ↓ hcg from day 7-14 Additional dose of MTX 50mg/m2 i/m If ≥ 15% ↓ from day 7 - 14 check HCG weekly untill undetectable HCG Conc If <15% ↓ hcg from day 7-14 Additional dose of MTX 1mg/kg i/m If ≥ 15% ↓ from day 7 - 14 check HCG weekly untill undetectable 15 Folinic acid .1mg/kg body wt po 21-28 If 3 doses given and there is 15% decline from day 21-28 proceed with laparoscopic surgery If 5 doses have been given and there is< 15% decline from day 14-21 proceed with laparoscopic surgery
- 25. Surgical • Laparoscopy • Laparotomy Selection Criteria • Hemodynamic condition of patient. • Size and location of pregnancy • Expense of surgery • Availability of instruments Conservative Surgery Salpingotomy Radical Salpingectomy
- 26. Laparoscopy
- 27. Laparoscopic salpingtomy Considered primary Rx of tubal Ectopic if contra lateral tube damage is there and patient wants to retain fertility. Disadvantages • Retention of troproblastic tissue and need if MTX
- 28. Salpingectomy •Radical •Partial Indications •Ruptured tubal pregnancy •Recurrent Ectopic pregnancy •Prev. n/o sterilization & reversal. •Prev. tubal surgery for infertility. •Pre existing tubal damage.
- 32. Fertility after Ectopic Pregnancy • IUP Rate 50% – 70% • Recurrent Ectopic 6% - 16 % Abdominal Ectopic Pregnancy
- 34. Cornual / Interstitial Ectopic Pregnancy
- 35. PT +ve + Suspected Eptopic TVS IUP Ectopic seen USG inconclusive Stable Unstable Surgical Expectant Medical Surgical Follow up BHCG BHCG Serial BHCG Till 20iu / L > 15 Fall of BHCG on Day 4 - 7 < 15 Fall of BHCG on Day 4 - 7 BHCG on Day 4 - 7 Repeat BHCG serially Consider 2nd dose Surgical Management
- 36. PT +ve + Suspected Ectopic TVS PUL Stable Unstable OPD Management BHCG Levels Inpatient Management >66% Inc in BHCG in 48hrs < 66% Inc in BHCG in 48hrs >15% dec in BHCG in 48hrs or < 15% dec in BHCG in 48hrs IUP Seen Ectopic Seen + Stable Patient Rescan after one week IUP Confirmed Ectopic Confirmed PUL Rescan for Viability Manage as indicated Repeat BHCG Failing PUL Repeat BHCG Serial BHCG till < 20 iu / L
- 37. Thank You Very Much