An ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, usually in the fallopian tubes. Risk factors include previous ectopic pregnancy, infections, scarring of the fallopian tubes, and fertility treatments. Ectopic pregnancies can cause life-threatening bleeding if not treated properly. Diagnosis involves beta-hCG levels and ultrasound exams. Treatment options include medication with methotrexate, expectant management with close monitoring, or surgery depending on the severity of symptoms and beta-hCG levels. Prognosis is good with early diagnosis and treatment, but women with a history of ectopic pregnancy remain at slightly higher risk of recurrence.
It is the expulsion or extraction from its mother of an embryo or fetus weighing 500 gm or less when it is not capable of independent survival (WHO).
The 500gm of fetal development is attained approximately at 22 weeks of gestation.
Expelled fetus- Abortus
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.
This slide presents some Gynecologic diseases and disorders in females and their proper management. It is a third-year course for those wishing to major PA or Nursing.
It is the expulsion or extraction from its mother of an embryo or fetus weighing 500 gm or less when it is not capable of independent survival (WHO).
The 500gm of fetal development is attained approximately at 22 weeks of gestation.
Expelled fetus- Abortus
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.
This slide presents some Gynecologic diseases and disorders in females and their proper management. It is a third-year course for those wishing to major PA or Nursing.
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This is a presentation by Dada Robert in a Your Skill Boost masterclass organised by the Excellence Foundation for South Sudan (EFSS) on Saturday, the 25th and Sunday, the 26th of May 2024.
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Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
The Indian economy is classified into different sectors to simplify the analysis and understanding of economic activities. For Class 10, it's essential to grasp the sectors of the Indian economy, understand their characteristics, and recognize their importance. This guide will provide detailed notes on the Sectors of the Indian Economy Class 10, using specific long-tail keywords to enhance comprehension.
For more information, visit-www.vavaclasses.com
We all have good and bad thoughts from time to time and situation to situation. We are bombarded daily with spiraling thoughts(both negative and positive) creating all-consuming feel , making us difficult to manage with associated suffering. Good thoughts are like our Mob Signal (Positive thought) amidst noise(negative thought) in the atmosphere. Negative thoughts like noise outweigh positive thoughts. These thoughts often create unwanted confusion, trouble, stress and frustration in our mind as well as chaos in our physical world. Negative thoughts are also known as “distorted thinking”.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
2. Ectopic Pregnancy
Definition: It is defined as an implantation of a
conceptus outside the normal uterine cavity
Or
In theory, any mechanical or functional factors that
prevent or interfere with the passage of the fertilized
egg to the uterine cavity may be aetiological
factors for an ectopic pregnancy.
If not diagnosed on time, it may be life
threatening!!
Incidence (11.1/1000 pregnancies)
5. ETIOLOGY ,INCIDENCE
Mostly unknown
Premature implantation (infection –damage to tubes-
delay of passage of fertilized ovum along tubes)
One in 90 pregnancies is ectopic .
A combined intra uterine and extra uterine pregnancy
is very rare and occurs in 1;40000 spontaneous
pregnancies and 1;1000 IVF pregnancies.
“ Heterotopic pregnancy ”
6.
7. RISK FACTORS
Congenital anomalies of the fallopian tubes
Scarring due to a ruptured appendix
Previous ectopic pregnancy
Infections of the female genital organs
History of PID
Maternal age more than 35 yrs
IUCD
IVF- fertility treatment
Tubal ligation/ reversal of tubal ligation
Smoking
Progesterone only contraceptive pills
8. OUTCOME
Ectopic gestation mostly terminates between 6-10 weeks:
1) TUBAL ABORTION- 65 % of cases, usually in the fimbrial and
ampullary implantations. Repeated small hemorrhages from
the invaded area of the tubal wall detach the ovum, which dies
and :
1. Is absorbed completely
2. Is aborted completely through the tubal ostium into the
peritoneal cavity
3. Is absorbed incompletely with the result that the clot covered
conceptus distends the ostium
4. Forms a tubal blood mole
9.
10. Outcome
2) TUBAL RUPTURE- 35 % of the cases more
common when the implantation is in the
isthmus. This may occur earlier then the 6th
week.
The trophoblast burrows deeply and erodes
the serosal coat of the tube, causing it to break
and rupture.
If this is seen on the mesenteric side of the
tube a broad ligament hematoma will form
11.
12. Outcome
3) SECONDARY ABDOMINAL PREGNANCY
– very rarely the extruded ovum continues to
grow and attaches to the abdominal organs. A
few advance to term, the fetus dies and is
converted to a lithopaedion
14. CLINICAL PATTERNS:
1) Subacute presentation
Mild lower abdominal pain
Occasionally sharp pain and faintness
Slight vaginal bleeding
On examination lower abdominal tenderness, vaginal
examination may show a tender fornix or vague
mass.
Acute collapse ( incase of ruptured or incomplete
tubal abortion)
Cessation of symptoms (incase of complete abortion
with or without a pelvic hematocoele)
15. 2) Acute presentation
Sudden collapse (especially in isthmal tubal
pregnancy)
Acute lower abdominal pain
Fainting
Signs of Internal haemorrhage (leading to pallor,
collapse, falling blood pressure, rapid weak pulse )
Pain maybe either epigastric or shoulder tip pain
(referred)
Abdominal examination may reveal tenderness with
some fullness and muscle guarding.
Vaginal examination will reveal extreme cervical
tenderness.
16. Vitals:
BP, Pulse, Temperature, R/R
Laboratory Investigations:
CBC(complete blood count),
Blood Grouping and Cross Matching
Beta hCG ( Levels double every 48 hrs a rise <66%=EP )
Progesterone (Viable Preg: >79nmol/L, EP: <15.9 nmol/L)
Ultrasound
TVS (Transvaginal U/S Scan)
• Can detect 75-80% on initial scan and further 25% on follow
up.
• Transabdominal U/S has a limited role.
Laparoscopy
(Advantage: Diagnostic and Therapeutic)
17. Clinical suspicion of ectopic gestation
Measure B hCG
Negative
Ectopic
gestation
ruled out
Positive
Gestational
sac in uterus
Gestational
sac in tube
Doubtful
Laparotomy/
Laparoscopy/
Medical treatment
Laparoscopy
Laparoscopy/
Laparotomy
US not
available
Ultrasound
D
I
A
G
N
O
S
I
S
18.
19.
20. TREATMENT / ACTION TO BE TAKEN:
CHECK: Airway, Breathing, Circulation
In cases of shock maintain I/V line .
Morphine as a painkiller can be given.
Ambulatory ultrasound for confirmation of diagnosis if
its an intrauterine or extra uterine pregnancy
Management may be:
A) Medical
B) Expectant
C) Surgical
21. Medical management
Methotrexate (Anticancer antifolate drug)
DOSE: Single intramuscular injection calculated from patients,
body surface area as 50mg/m2 or in 4 doses IM every
alternate day with 7.5mg cover of leucovorin on the other
alternative days
Investigation
Renal Function tests
Liver Function Tests
Complete blood count
Contraindication:
Chronic liver, renal and hematological disorder
Active infection
Immunodeficiency/ Breast feeding
22. Criteria:
Haemodynamically stable patient, no evidence of
haemoperitoneum on scan, mild or no pain
Serum βhCG <3000IU/L
No contraindication to the use of Methotrexate.
Adnexal mass, <4 cm size on ultrasound.
No fetal cardiac activity in the ectopic sac.
Patient compliance with follow up visits.
Monitoring
Check serum βhCG levels on days four and seven
A further dose, if βhCG levels have failed to fall by more
than 15% between day four and day seven.
Then check weekly till level falls to <5000IU/L
Active intervention is needed If patient become symptomatic
or Serum βhCG levels rises above (3000 IU/L) or plateau
23. Expectant management
Based on the assumption of spontaneous resolution of
pregnancy through regression i.e. without treatment:
CRITERIA:
Hemodynamically stable and asymptomatic
Serum βhCG at initial presentation <1000IU/L.
Adnexal mass <4cm on Transvaginal scan (TVS)
Less than 100 ml free fluid in pelvis
24. Women managed expectantly should be followed by:
Serial βhCG twice weekly measurements (ideally less than
50% of its initial level within seven days)
Weekly by transvaginal ultrasound (a reduction in the size of
adnexal mass by seven days)
Transvaginal ultrasound weekly βhCG, until levels are less
than 10IU/L.
Counsel about the importance of compliance with follow-up
and should be with in easy access to the hospital in question.
Active intervention is needed:
If patients become symptomatic
Serum βhCG rises or levels start to plateau.
25. Surgical management
If Serum βhCG is >3000IU/L
Patient is symptomatic(or hemodynamically unstable)
Salpingotomy: Removal of conceptus with conservation of
tubes
Done in women with diseased contralateral tube and fertility
desired
Salpingectomy: Removal of tube in the presence of healthy
contra lateral tube
Can be done by two methods;
Laparoscopy
Laparotomy
26. CRITERIA
Laparoscopy
Pt hemodynamically
stable
No previous surgeries
Unruptured ectopic
Adnexal mass<4cm
Laparotomy
Hemodynamically
unstable
Previous surgeries
Ruptured ectopic
Expertise for laparoscopy
is not available
27. Prognosis:
10-20 % are at risk of having a second
gestation with ectopic.
60 % will become pregnant again with a
normal intrauterine gestation.
Early careful monitoring is required in women
who become pregnant with previous history
of ectopic gestation. It is recommended to get
a TVS between 6-10 weeks .