A 28-year-old woman presented to the emergency department at 10 weeks of pregnancy with acute abdominal pain, dyspnea and hypotension. Initial examination revealed signs of shock. Laboratory tests showed signs of anemia. Ultrasound showed free intraperitoneal fluid and a normal intrauterine gestation consistent with 10 weeks gestation. The patient's condition deteriorated further. Differential diagnosis included ectopic pregnancy, threatened abortion, inevitable abortion or molar pregnancy. Prompt diagnosis and treatment is needed in emergencies during early pregnancy to save lives.
This patient is a 30-year-old female who presented with vaginal spotting during her first trimester of pregnancy. An ultrasound was ordered which did not show an intrauterine or ectopic pregnancy. The patient's beta-hCG level was measured at 1056. At follow-up two days later, the patient's symptoms had resolved but her beta-hCG had risen to 1465. A repeat ultrasound now showed a right tubal ectopic pregnancy, so the patient underwent a laparoscopic right salpingectomy to remove the ectopic pregnancy from her fallopian tube.
This document provides information on ectopic pregnancy, including:
- Definitions and sites of ectopic pregnancy, with the fallopian tubes being the most common site.
- Clinical presentations can include amenorrhea, abdominal pain, vaginal bleeding, and signs of instability in cases of rupture.
- Ultrasound is used to diagnose ectopic pregnancies, identifying adnexal masses or fluid in the pelvis. Serum hCG levels also aid in diagnosis and monitoring.
- Treatment options include expectant management for early, low risk cases; medical management with methotrexate; or surgical intervention by laparoscopy or laparotomy for more advanced or higher risk ectopic pregnancies.
1. The document discusses two cases of early pregnancy problems involving vaginal bleeding and a positive pregnancy test in women aged 23 and 34.
2. It provides guidelines for evaluating bleeding in early pregnancy, including taking a history, examining the patient, performing an ultrasound, and considering potential causes like miscarriage, ectopic pregnancy, or molar pregnancy.
3. Management depends on the diagnosis and may include expectant management, medical treatment, or surgical evacuation of the uterus. The goal is to control bleeding, rule out life-threatening causes, and determine if the pregnancy is viable.
Ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, most commonly in the fallopian tubes. It accounts for 1-2% of pregnancies and risk factors include previous pelvic inflammatory disease, IUD use, infertility, and smoking. Clinical features range from asymptomatic to acute abdominal pain and vaginal bleeding. Transvaginal ultrasound and quantitative beta-hCG levels are used to confirm the diagnosis. Treatment options include surgical removal by laparoscopy or laparotomy, or medical management with methotrexate depending on the stability of the patient. Expectant management may be considered for some stable cases. Ruptured ectopic pregnancies require emergency surgery and blood transfusions to stabilize the patient.
This document discusses ectopic pregnancy, which occurs when a fertilized egg implants outside the uterus, most commonly in the fallopian tubes. It details the risk factors, symptoms, diagnostic process, and management options for ectopic pregnancies. Management may involve expectant monitoring, medical treatment with methotrexate, or surgical intervention depending on the individual case. Proper treatment is important to preserve future fertility and prevent life-threatening complications from tubal rupture.
Postpartum haemorrhage (PPH) is a major cause of maternal mortality. The main causes are uterine atony (80%), trauma (20%), and coagulopathy (rare). Clinical PPH is blood loss >500mL after vaginal delivery or >1000mL after c-section. Treatment involves monitoring vitals, IV fluids, uterotonics like oxytocin and misoprostol, bimanual compression, and blood transfusion. For refractory cases, procedures like balloon tamponade, ligation of uterine arteries, or hysterectomy may be needed. Prevention focuses on risk assessment, active management of third stage of labor, and treatment of secondary PPH if bleeding reoccurs after 24
An ectopic pregnancy occurs when a fertilized egg implants outside the uterus, usually in a fallopian tube. A 27-year-old woman presented with lower abdominal pain and spotting since day 7 of her menstrual cycle and a 10-day history of fever. Ultrasound revealed a heterogenous lesion in her left adnexa and a ring lesion in her left fallopian tube, and her beta-hCG level was 672 mIU/ml, confirming an ectopic pregnancy. Ectopic pregnancies can be treated medically with methotrexate or surgically with salpingectomy.
This document discusses ectopic pregnancy, including:
- A case presentation of a woman presenting with right lower quadrant pain and vaginal spotting. Differential diagnoses include ectopic pregnancy.
- Ectopic pregnancies most commonly occur in the fallopian tubes. Risk factors include STDs, previous ectopic pregnancy, IUD use, and smoking.
- Clinical features include vaginal bleeding, abdominal or pelvic pain, and shock if ruptured. Diagnosis involves beta-hCG levels, progesterone levels, ultrasound identifying absence of intrauterine pregnancy.
- Treatment options are medical management with methotrexate or surgical management like laparoscopy or laparotomy. The take home message is
This patient is a 30-year-old female who presented with vaginal spotting during her first trimester of pregnancy. An ultrasound was ordered which did not show an intrauterine or ectopic pregnancy. The patient's beta-hCG level was measured at 1056. At follow-up two days later, the patient's symptoms had resolved but her beta-hCG had risen to 1465. A repeat ultrasound now showed a right tubal ectopic pregnancy, so the patient underwent a laparoscopic right salpingectomy to remove the ectopic pregnancy from her fallopian tube.
This document provides information on ectopic pregnancy, including:
- Definitions and sites of ectopic pregnancy, with the fallopian tubes being the most common site.
- Clinical presentations can include amenorrhea, abdominal pain, vaginal bleeding, and signs of instability in cases of rupture.
- Ultrasound is used to diagnose ectopic pregnancies, identifying adnexal masses or fluid in the pelvis. Serum hCG levels also aid in diagnosis and monitoring.
- Treatment options include expectant management for early, low risk cases; medical management with methotrexate; or surgical intervention by laparoscopy or laparotomy for more advanced or higher risk ectopic pregnancies.
1. The document discusses two cases of early pregnancy problems involving vaginal bleeding and a positive pregnancy test in women aged 23 and 34.
2. It provides guidelines for evaluating bleeding in early pregnancy, including taking a history, examining the patient, performing an ultrasound, and considering potential causes like miscarriage, ectopic pregnancy, or molar pregnancy.
3. Management depends on the diagnosis and may include expectant management, medical treatment, or surgical evacuation of the uterus. The goal is to control bleeding, rule out life-threatening causes, and determine if the pregnancy is viable.
Ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, most commonly in the fallopian tubes. It accounts for 1-2% of pregnancies and risk factors include previous pelvic inflammatory disease, IUD use, infertility, and smoking. Clinical features range from asymptomatic to acute abdominal pain and vaginal bleeding. Transvaginal ultrasound and quantitative beta-hCG levels are used to confirm the diagnosis. Treatment options include surgical removal by laparoscopy or laparotomy, or medical management with methotrexate depending on the stability of the patient. Expectant management may be considered for some stable cases. Ruptured ectopic pregnancies require emergency surgery and blood transfusions to stabilize the patient.
This document discusses ectopic pregnancy, which occurs when a fertilized egg implants outside the uterus, most commonly in the fallopian tubes. It details the risk factors, symptoms, diagnostic process, and management options for ectopic pregnancies. Management may involve expectant monitoring, medical treatment with methotrexate, or surgical intervention depending on the individual case. Proper treatment is important to preserve future fertility and prevent life-threatening complications from tubal rupture.
Postpartum haemorrhage (PPH) is a major cause of maternal mortality. The main causes are uterine atony (80%), trauma (20%), and coagulopathy (rare). Clinical PPH is blood loss >500mL after vaginal delivery or >1000mL after c-section. Treatment involves monitoring vitals, IV fluids, uterotonics like oxytocin and misoprostol, bimanual compression, and blood transfusion. For refractory cases, procedures like balloon tamponade, ligation of uterine arteries, or hysterectomy may be needed. Prevention focuses on risk assessment, active management of third stage of labor, and treatment of secondary PPH if bleeding reoccurs after 24
An ectopic pregnancy occurs when a fertilized egg implants outside the uterus, usually in a fallopian tube. A 27-year-old woman presented with lower abdominal pain and spotting since day 7 of her menstrual cycle and a 10-day history of fever. Ultrasound revealed a heterogenous lesion in her left adnexa and a ring lesion in her left fallopian tube, and her beta-hCG level was 672 mIU/ml, confirming an ectopic pregnancy. Ectopic pregnancies can be treated medically with methotrexate or surgically with salpingectomy.
This document discusses ectopic pregnancy, including:
- A case presentation of a woman presenting with right lower quadrant pain and vaginal spotting. Differential diagnoses include ectopic pregnancy.
- Ectopic pregnancies most commonly occur in the fallopian tubes. Risk factors include STDs, previous ectopic pregnancy, IUD use, and smoking.
- Clinical features include vaginal bleeding, abdominal or pelvic pain, and shock if ruptured. Diagnosis involves beta-hCG levels, progesterone levels, ultrasound identifying absence of intrauterine pregnancy.
- Treatment options are medical management with methotrexate or surgical management like laparoscopy or laparotomy. The take home message is
This document discusses two cases of high risk obstetrics. Case 1 involves a woman at 34 weeks gestation presenting with abdominal pain and bleeding. Her examination and investigations indicate signs of placental abruption. Case 2 involves a woman at 34.5 weeks gestation with a history of two previous cesarean sections and placenta previa diagnosed at 21 weeks. Her examination and ultrasound confirm placenta previa and possible placenta accreta. The document then discusses various questions related to the differential diagnosis, risk factors, complications, management, and delivery approach for conditions like placental abruption and placenta previa.
The document provides protocols and guidelines for the Department of Obstetrics including definitions, classifications, investigations, and management guidelines for various obstetric conditions. It covers protocols for pre-eclampsia and eclampsia, liver diseases in pregnancy, deep venous thrombosis in pregnancy, preterm labour, preterm PROM, breech presentation, APH, induction of labour, normal labour and delivery, PPH, umbilical cord prolapse, Rh prophylaxis, and GDM. The department aims to provide high quality, empathetic and research-based care through comprehensive training and by reviewing and creating protocols according to population needs.
An ectopic pregnancy occurs when a fertilized egg implants and grows somewhere other than inside the uterus, usually in one of the fallopian tubes. It is a serious condition, as it threatens the health and fertility of the woman. Risk factors include a previous ectopic pregnancy, pelvic inflammatory disease, IUD use, and assisted reproduction. Patients often present with abdominal pain, vaginal bleeding, and amenorrhea. Diagnosis involves evaluating serum hCG levels and transvaginal ultrasound findings. Treatment depends on the stability of the patient and may involve expectant management, medical management with methotrexate, or surgical intervention like salpingostomy or salpingectomy.
1) Ectopic pregnancy occurs when a fertilized egg implants outside the uterus, most commonly in the fallopian tubes, and can cause life-threatening bleeding if left untreated.
2) Risk factors include previous pelvic infections, surgery, or injuries that damage the fallopian tubes.
3) Diagnosis involves testing for the pregnancy hormone hCG and ultrasound imaging to locate any pregnancy inside or outside the uterus.
An ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, most commonly in the fallopian tubes. Risk factors include previous pelvic inflammatory disease, especially from chlamydia or gonorrhea, previous ectopic pregnancy, infertility, and assisted reproduction. Symptoms can include vaginal bleeding and abdominal pain, but may also be absent. Diagnosis is made through ultrasound imaging, serial beta-hCG level measurements, and sometimes laparoscopy. Treatment options include medication with methotrexate or surgical intervention like salpingostomy or salpingectomy. Rare sites of ectopic implantation include the ovaries, cervix, and abdomen.
An ectopic pregnancy occurs when a fertilized egg implants and grows outside the uterus, usually in the fallopian tubes. It can be life-threatening because it may cause internal bleeding. The document discusses the definition, incidence, risk factors, types (acute, unruptured, chronic), clinical presentation, investigations, and management approaches for ectopic pregnancies, including expectant, medical, and surgical options depending on the individual case. The goal of treatment is to preserve fertility when possible through conservative approaches like salpingostomy or systemic methotrexate administration.
An ectopic pregnancy occurs when a fertilized egg implants outside the uterus, usually in the fallopian tubes. Risk factors include a history of pelvic inflammatory disease or previous ectopic pregnancy. Symptoms include vaginal bleeding and abdominal pain. Diagnosis is made through blood tests showing human chorionic gonadotropin and ultrasound showing no intrauterine pregnancy when hCG is over 1,500. Treatment options include methotrexate injection or laparoscopic surgery depending on size and location of ectopic pregnancy. Proper follow up with blood tests is important after any treatment.
An ectopic pregnancy occurs when a fertilized egg implants outside the uterus, usually in the fallopian tubes. Damage to the fallopian tubes from infections or other causes is a major risk factor. Clinical presentation includes abdominal pain, delayed or abnormal vaginal bleeding. Diagnosis involves testing hCG levels in blood and ultrasound imaging. Treatment options are medical, using methotrexate, or surgical, typically laparoscopic surgery. Methotrexate can be used for stable patients with unruptured ectopic pregnancies.
This document discusses ectopic pregnancy, which occurs when a fertilized egg implants outside the uterus, most commonly in the fallopian tubes. It defines ectopic pregnancy and outlines the various sites it can occur. It identifies risk factors like STIs, previous pelvic infections or surgeries. Signs and symptoms depend on whether the ectopic pregnancy has ruptured or not. Diagnosis involves blood tests, ultrasound and laparoscopy. Treatment options include expectant management for early, stable ectopics or surgery like salpingectomy if ruptured or unstable. The goal is to resolve the ectopic pregnancy while preserving future fertility when possible.
Ectopic pregnancy occurs when a fertilized egg implants outside the uterus, most commonly in a fallopian tube. It accounts for 1-2% of pregnancies and has a risk of life-threatening bleeding. Diagnosis is usually made using ultrasound to detect an empty uterus with a mass or fluid outside the uterus, and a beta-hCG test. Treatment depends on stability and includes expectant management, methotrexate injection, or surgery such as laparoscopy. Tubal ectopic pregnancies make up 95% of cases and are most often treated surgically, while interstitial or cervical ectopics may be treated nonsurgically in some cases.
This document defines ectopic pregnancy and discusses its causes, signs and symptoms, diagnostic tests, and treatment options. Key points:
- Ectopic pregnancy occurs when a fertilized egg implants outside the uterus, most commonly in the fallopian tubes.
- Risk factors include previous ectopic pregnancy, pelvic inflammatory disease, assisted reproduction, and IUD use.
- Patients often experience abdominal pain, amenorrhea, and vaginal bleeding. Serum hCG levels and ultrasound are used for diagnosis.
- Treatment depends on stability and includes observation, methotrexate injection, or surgery like salpingectomy or salpingostomy. The goal is to resolve the ectopic pregnancy safely while preserving fertility when
This document defines ectopic pregnancy and discusses its causes, signs and symptoms, diagnosis, and treatment options. Some key points:
- Ectopic pregnancy occurs when a fertilized egg implants outside the uterus, most commonly in the fallopian tubes. It requires prompt treatment due to risks to a woman's health.
- Risk factors include previous ectopic pregnancy, pelvic inflammatory disease, assisted reproduction, pelvic surgery, IUD use, smoking, and uterine abnormalities.
- Symptoms may include abdominal pain, amenorrhea, vaginal bleeding, as well as symptoms of early pregnancy like nausea. Advanced cases can cause painful fetal movements.
- Diagnosis involves serum hCG level testing, ultrasound imaging,
This document discusses ectopic pregnancy, which occurs when a fertilized egg implants outside the uterus, most commonly in the fallopian tubes. It defines ectopic pregnancy and lists risk factors and causes. Symptoms can include abdominal pain and vaginal bleeding. Diagnosis involves beta-hCG levels, ultrasound, and laparoscopy. Management options for unruptured ectopic pregnancies include expectant monitoring, medical treatment with methotrexate, and surgical treatment such as salpingostomy or salpingotomy.
1. Ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, most commonly in the fallopian tubes. Risk factors include prior tubal surgery or infections, IUD use, smoking, and assisted reproductive technologies.
2. Clinical features may include abdominal pain, vaginal bleeding, and cervical motion tenderness. Diagnosis is made through ultrasound and beta-hCG levels. Treatment options include medical management with methotrexate or surgical management via laparoscopy or laparotomy.
3. Proper diagnosis and treatment are important to prevent potential complications of ectopic pregnancy such as tubal rupture and hemorrhage. Serial beta-hCG and ultrasound exams are used to monitor
An ectopic pregnancy occurs when a fertilized egg implants and grows outside of the uterus, usually in a fallopian tube. Risk factors include prior pelvic inflammatory disease, tubal surgery or ectopic pregnancy, smoking, and intrauterine device use. Patients often present with abdominal pain and vaginal bleeding. Diagnosis involves transvaginal ultrasound and quantitative beta-hCG levels. Treatment options include expectant management for early, stable ectopic pregnancies; methotrexate injection for select cases; or surgery such as salpingectomy for ruptured or unstable ectopic pregnancies. Prompt diagnosis and treatment are important to prevent life-threatening complications.
Ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, most commonly in the fallopian tubes. Risk factors include previous tubal surgery or infection, the use of an intrauterine device, infertility treatments, and a history of ectopic pregnancy. Clinical findings may include abdominal or pelvic pain, vaginal bleeding, and a tender mass in the affected area. Diagnosis involves testing blood for human chorionic gonadotropin and ultrasound imaging. Treatment depends on the stability of the patient and size of the ectopic mass, and may involve medication with methotrexate or surgical intervention like laparoscopy or laparotomy. The goal is to preserve the patient's future fertility when possible.
This document discusses the case of a 31-year-old woman, G3P2, who presented at 12 weeks and 1 day post-amnenorrhea with a suspected molar pregnancy. Ultrasound findings showed multiple cysts in the uterine cavity with no fetal echo, and her hCG level was 7513 IU/ml. She was diagnosed with a leaking ectopic pregnancy and underwent a laparoscopic left salpingectomy. Intraoperatively, 700cc of hemoperitoneum was found along with a left tubal ectopic pregnancy, while the right fallopian tube and ovaries were normal. The patient was discharged well with advice on contraception.
This document provides definitions and guidelines for diagnosing and managing preeclampsia and related hypertensive disorders during pregnancy. It discusses:
- Definitions of preeclampsia, severe preeclampsia, gestational hypertension, and chronic hypertension
- Diagnosis criteria for preeclampsia of new hypertension and proteinuria or organ dysfunction after 20 weeks
- Tests to evaluate severity and organ involvement
- General management principles of expectant monitoring or delivery depending on gestational age and severity
- Specific guidelines for magnesium sulfate administration, fetal monitoring, hypertension treatment, and postpartum care
This document discusses two cases of high risk obstetrics. Case 1 involves a woman at 34 weeks gestation presenting with abdominal pain and bleeding. Her examination and investigations indicate signs of placental abruption. Case 2 involves a woman at 34.5 weeks gestation with a history of two previous cesarean sections and placenta previa diagnosed at 21 weeks. Her examination and ultrasound confirm placenta previa and possible placenta accreta. The document then discusses various questions related to the differential diagnosis, risk factors, complications, management, and delivery approach for conditions like placental abruption and placenta previa.
The document provides protocols and guidelines for the Department of Obstetrics including definitions, classifications, investigations, and management guidelines for various obstetric conditions. It covers protocols for pre-eclampsia and eclampsia, liver diseases in pregnancy, deep venous thrombosis in pregnancy, preterm labour, preterm PROM, breech presentation, APH, induction of labour, normal labour and delivery, PPH, umbilical cord prolapse, Rh prophylaxis, and GDM. The department aims to provide high quality, empathetic and research-based care through comprehensive training and by reviewing and creating protocols according to population needs.
An ectopic pregnancy occurs when a fertilized egg implants and grows somewhere other than inside the uterus, usually in one of the fallopian tubes. It is a serious condition, as it threatens the health and fertility of the woman. Risk factors include a previous ectopic pregnancy, pelvic inflammatory disease, IUD use, and assisted reproduction. Patients often present with abdominal pain, vaginal bleeding, and amenorrhea. Diagnosis involves evaluating serum hCG levels and transvaginal ultrasound findings. Treatment depends on the stability of the patient and may involve expectant management, medical management with methotrexate, or surgical intervention like salpingostomy or salpingectomy.
1) Ectopic pregnancy occurs when a fertilized egg implants outside the uterus, most commonly in the fallopian tubes, and can cause life-threatening bleeding if left untreated.
2) Risk factors include previous pelvic infections, surgery, or injuries that damage the fallopian tubes.
3) Diagnosis involves testing for the pregnancy hormone hCG and ultrasound imaging to locate any pregnancy inside or outside the uterus.
An ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, most commonly in the fallopian tubes. Risk factors include previous pelvic inflammatory disease, especially from chlamydia or gonorrhea, previous ectopic pregnancy, infertility, and assisted reproduction. Symptoms can include vaginal bleeding and abdominal pain, but may also be absent. Diagnosis is made through ultrasound imaging, serial beta-hCG level measurements, and sometimes laparoscopy. Treatment options include medication with methotrexate or surgical intervention like salpingostomy or salpingectomy. Rare sites of ectopic implantation include the ovaries, cervix, and abdomen.
An ectopic pregnancy occurs when a fertilized egg implants and grows outside the uterus, usually in the fallopian tubes. It can be life-threatening because it may cause internal bleeding. The document discusses the definition, incidence, risk factors, types (acute, unruptured, chronic), clinical presentation, investigations, and management approaches for ectopic pregnancies, including expectant, medical, and surgical options depending on the individual case. The goal of treatment is to preserve fertility when possible through conservative approaches like salpingostomy or systemic methotrexate administration.
An ectopic pregnancy occurs when a fertilized egg implants outside the uterus, usually in the fallopian tubes. Risk factors include a history of pelvic inflammatory disease or previous ectopic pregnancy. Symptoms include vaginal bleeding and abdominal pain. Diagnosis is made through blood tests showing human chorionic gonadotropin and ultrasound showing no intrauterine pregnancy when hCG is over 1,500. Treatment options include methotrexate injection or laparoscopic surgery depending on size and location of ectopic pregnancy. Proper follow up with blood tests is important after any treatment.
An ectopic pregnancy occurs when a fertilized egg implants outside the uterus, usually in the fallopian tubes. Damage to the fallopian tubes from infections or other causes is a major risk factor. Clinical presentation includes abdominal pain, delayed or abnormal vaginal bleeding. Diagnosis involves testing hCG levels in blood and ultrasound imaging. Treatment options are medical, using methotrexate, or surgical, typically laparoscopic surgery. Methotrexate can be used for stable patients with unruptured ectopic pregnancies.
This document discusses ectopic pregnancy, which occurs when a fertilized egg implants outside the uterus, most commonly in the fallopian tubes. It defines ectopic pregnancy and outlines the various sites it can occur. It identifies risk factors like STIs, previous pelvic infections or surgeries. Signs and symptoms depend on whether the ectopic pregnancy has ruptured or not. Diagnosis involves blood tests, ultrasound and laparoscopy. Treatment options include expectant management for early, stable ectopics or surgery like salpingectomy if ruptured or unstable. The goal is to resolve the ectopic pregnancy while preserving future fertility when possible.
Ectopic pregnancy occurs when a fertilized egg implants outside the uterus, most commonly in a fallopian tube. It accounts for 1-2% of pregnancies and has a risk of life-threatening bleeding. Diagnosis is usually made using ultrasound to detect an empty uterus with a mass or fluid outside the uterus, and a beta-hCG test. Treatment depends on stability and includes expectant management, methotrexate injection, or surgery such as laparoscopy. Tubal ectopic pregnancies make up 95% of cases and are most often treated surgically, while interstitial or cervical ectopics may be treated nonsurgically in some cases.
This document defines ectopic pregnancy and discusses its causes, signs and symptoms, diagnostic tests, and treatment options. Key points:
- Ectopic pregnancy occurs when a fertilized egg implants outside the uterus, most commonly in the fallopian tubes.
- Risk factors include previous ectopic pregnancy, pelvic inflammatory disease, assisted reproduction, and IUD use.
- Patients often experience abdominal pain, amenorrhea, and vaginal bleeding. Serum hCG levels and ultrasound are used for diagnosis.
- Treatment depends on stability and includes observation, methotrexate injection, or surgery like salpingectomy or salpingostomy. The goal is to resolve the ectopic pregnancy safely while preserving fertility when
This document defines ectopic pregnancy and discusses its causes, signs and symptoms, diagnosis, and treatment options. Some key points:
- Ectopic pregnancy occurs when a fertilized egg implants outside the uterus, most commonly in the fallopian tubes. It requires prompt treatment due to risks to a woman's health.
- Risk factors include previous ectopic pregnancy, pelvic inflammatory disease, assisted reproduction, pelvic surgery, IUD use, smoking, and uterine abnormalities.
- Symptoms may include abdominal pain, amenorrhea, vaginal bleeding, as well as symptoms of early pregnancy like nausea. Advanced cases can cause painful fetal movements.
- Diagnosis involves serum hCG level testing, ultrasound imaging,
This document discusses ectopic pregnancy, which occurs when a fertilized egg implants outside the uterus, most commonly in the fallopian tubes. It defines ectopic pregnancy and lists risk factors and causes. Symptoms can include abdominal pain and vaginal bleeding. Diagnosis involves beta-hCG levels, ultrasound, and laparoscopy. Management options for unruptured ectopic pregnancies include expectant monitoring, medical treatment with methotrexate, and surgical treatment such as salpingostomy or salpingotomy.
1. Ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, most commonly in the fallopian tubes. Risk factors include prior tubal surgery or infections, IUD use, smoking, and assisted reproductive technologies.
2. Clinical features may include abdominal pain, vaginal bleeding, and cervical motion tenderness. Diagnosis is made through ultrasound and beta-hCG levels. Treatment options include medical management with methotrexate or surgical management via laparoscopy or laparotomy.
3. Proper diagnosis and treatment are important to prevent potential complications of ectopic pregnancy such as tubal rupture and hemorrhage. Serial beta-hCG and ultrasound exams are used to monitor
An ectopic pregnancy occurs when a fertilized egg implants and grows outside of the uterus, usually in a fallopian tube. Risk factors include prior pelvic inflammatory disease, tubal surgery or ectopic pregnancy, smoking, and intrauterine device use. Patients often present with abdominal pain and vaginal bleeding. Diagnosis involves transvaginal ultrasound and quantitative beta-hCG levels. Treatment options include expectant management for early, stable ectopic pregnancies; methotrexate injection for select cases; or surgery such as salpingectomy for ruptured or unstable ectopic pregnancies. Prompt diagnosis and treatment are important to prevent life-threatening complications.
Ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, most commonly in the fallopian tubes. Risk factors include previous tubal surgery or infection, the use of an intrauterine device, infertility treatments, and a history of ectopic pregnancy. Clinical findings may include abdominal or pelvic pain, vaginal bleeding, and a tender mass in the affected area. Diagnosis involves testing blood for human chorionic gonadotropin and ultrasound imaging. Treatment depends on the stability of the patient and size of the ectopic mass, and may involve medication with methotrexate or surgical intervention like laparoscopy or laparotomy. The goal is to preserve the patient's future fertility when possible.
This document discusses the case of a 31-year-old woman, G3P2, who presented at 12 weeks and 1 day post-amnenorrhea with a suspected molar pregnancy. Ultrasound findings showed multiple cysts in the uterine cavity with no fetal echo, and her hCG level was 7513 IU/ml. She was diagnosed with a leaking ectopic pregnancy and underwent a laparoscopic left salpingectomy. Intraoperatively, 700cc of hemoperitoneum was found along with a left tubal ectopic pregnancy, while the right fallopian tube and ovaries were normal. The patient was discharged well with advice on contraception.
This document provides definitions and guidelines for diagnosing and managing preeclampsia and related hypertensive disorders during pregnancy. It discusses:
- Definitions of preeclampsia, severe preeclampsia, gestational hypertension, and chronic hypertension
- Diagnosis criteria for preeclampsia of new hypertension and proteinuria or organ dysfunction after 20 weeks
- Tests to evaluate severity and organ involvement
- General management principles of expectant monitoring or delivery depending on gestational age and severity
- Specific guidelines for magnesium sulfate administration, fetal monitoring, hypertension treatment, and postpartum care
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3. History
A 28-year-old woman, gravid III Para II, was admitted to the emergency
department at 10 weeks of amenorrhea, with acute abdominal pain, dyspnea
and hypotension. She had no vaginal bleeding. Her current pregnancy occurred
spontaneously. This was a spontaneous conception with no previous fertility
treatment and she did not use any contraception. Her medical history did not
suggest any history of pelvic inflammatory disease, abortions, infertility or
abdominal surgery or trauma.
4. Physical examination and Lab
The physical examination revealed a conscious
woman with discolored conjunctives and
cutaneous paleness, systolic blood pressure of
70 mmHg, shortness of breath, profuse
sweating and a tachycardia, with a weak and
rapid pulse rate of 130 beat per minute.
Abdominal examination was suggestive of an
acute abdomen with severe tenderness,
guarding and rigidity.
Laboratory data on admission showed a white
blood cell count of 7900 cells/mm3, a
hematocrit of 18% and serum hemoglobin
concentration of 9.1 g/dl, with a normal blood
platelet level (390,000/mm3), a blood urea of 45
mg/dL and a creatinine level of 1 mg/dL.
Hemostasis laboratory data, chemistry and
serum lipase were within normal limits
5. Radio diagnosis and its Limitations
After hemodynamic stability, an abdominal
ultrasonography (US) was realized, which
demonstrated free intraperitoneal fluid and a
normal-looking IU gestation with a sac of 33.79
mm in diameter and a crown-rump length (CRL)
of 28 mm, with a positive fetal heart rate
consistent with a fetal age of approximately 10
weeks and 2 days of amenorrhea
The patient became acutely hypotensive with an
associated increase in abdominal girth. This
episode of hypotension was minimally
responsive to fluid resuscitation. A stat
hemogram confirmed an acute decrease in her
hematocrit
7. Initial Patient
Presentation
Triad of Symptoms (50%)
● Abdominal Pain
● Bleeding per vagina
● Amenorrhea
● Abdominal pain or discomfort is the most common
symptom of ectopic pregnancy and is reported in 90% of
ectopic pregnancies.
● The classic pain of rupture is lateralized, sudden, sharp,
and severe . Shoulder Pain maybe present due to
diaphragmatic irritation
● Any lateral or bilateral abdominal discomfort or tenderness
in a woman of childbearing age requires consideration of
ectopic pregnancy
● Lack of pain in a woman with vaginal spotting or
bleeding does not exclude ectopic pregnancy.
● Bleeding per vaginum (PV) is usually scanty, brownish and
altered which occurs due to withdrawal of hormonal
support on rupture or total abortion of ectopic pregnancy.
● No missed menses are reported in 15% of ectopic
pregnancy cases.
● Dyspepsia, vomiting and loose motions , Syncopal attacks
with sudden unexplained episodes of fainting
8. Focused History
Major Risk Factors for Ectopic Pregnancy
● Pelvic inflammatory disease, history of sexually transmitted
infections
● History of tubal surgery or tubal sterilization
● Conception with intrauterine device in place
● Maternal age 35–44 (age-related change in tubal function)
● Previous ectopic pregnancy
● Assisted reproduction techniques (cause unknown, as tube
is bypassed in implantation)
● Cigarette smoking (may alter embryo tubal transport)
● Prior pharmacologically induced abortion
● Pregnancy in a patient with
prior tubal surgery for
sterilization is assumed to
be an ectopic pregnancy
until proven otherwise
9. Focused Physical Examination
Hemodynamically stable patient :
● Vitals in normal range
● Rule out Cryptic shock
● We can't diagnose or exclude
ectopic pregnancy based on
physical examination ( pelvic
examination )
Hemodynamically unstable patient : SI > 0.9
Patient will be presented in shock - Decompensated state
● Hypotension (<65 mmhg)
● Tachycardia (>100 bpm)
● Tachypnea (>22 cpm)
● Oliguria (<0.5 ml/kg/hr)
● JVP (<8 cm)
● Cool extremities , CFT ( >3 secs) , weak pulse
10. Differential Diagnosis for
UPT positive patient
having atleast either one
of the 3 symptoms
● Ectopic pregnancy
● Threatened abortion
● Inevitable abortion
● Molar pregnancy
● Heterotopic pregnancy*
● Implantation bleeding
● Corpus luteum cyst
● Threatened Abortion is presumed when bloody vaginal
discharge or bleeding appears through a closed
cervical os during the first 20 weeks.
● Every woman with an early pregnancy, vaginal bleeding,
and pain should be evaluated. The primary goal is
prompt diagnosis of ectopic pregnancy, and serial
quantitative serum Beta-hCG levels and transvaginal
sonography are integral tools
● No Single Beta-HCG level can reliably distinguish
between a Normal and a pathologic pregnancy
● Serial measurements of Beta - HCG are used to
heighten or lower the suspicion for ectopic pregnancy
but are not diagnostic
● PPROM with gush of vaginal fluid is diagnostic of
inevitable abortion
● Molar pregnancy and corpus luteum cyst can be
diagnosed definitively with US
● Spotting at 7th day after fertilisation is characteristic of
implantation bleeding
11. Diagnosis of
Ectopic
Pregnancy
Multimodality Diagnosis :
● TVS
● Beta-HCG
● Physical findings
The definitive diagnosis of ectopic
pregnancy is made by US, by direct
visualization by laparoscopy, or at
surgery. No single or combination
of laboratory tests has a sufficient
negative or positive predictive value
to completely exclude ectopic
pregnancy or to definitively
establish the diagnosis.
12.
13. Laboratory
Serum Beta-HCG :
● Absolute levels of Beta-HCG tend to be
lower in pathologic pregnancies than in
IUPs but there is much Overlap
● Longer Doubling time indicate ectopic
and other pathologic pregnancies
● HCG levels that fail to increase by 53%
or more in 2 days are suggestive but
not diagnostic of ectopic pregnancy
Serum Progesterone levels :
● <5ng/ml ~ 100% of pregnancies will be
pathologic
● >25ng/ml ~ 97% sensitive for viable IUP
● An empty uterus or non specific fluid
collection on US associated with
progesterone <5ng/ml is highly predictive
of Abnormal IUP or ectopic pregnancy
14. Ultrasonography
● The sequencing of transabdominal versus transvaginal US
is situation and operator dependent
● An empty uterus with embryonic cardiac activity visualized
outside the uterus is diagnostic of ectopic pregnancy
● When US reveals an unequivocal IUP and no other
abnormalities, ectopic pregnancy is effectively excluded
unless the patient is at high risk for heterotopic pregnancy
● Risk of ectopic pregnancy with US findings : Free pelvic
fluid ~86% Adnexal mass with free fluid ~97% ,
Hepatorenal free fluid ~100%
15. The Discriminatory Zone
● The discriminatory zone is the level of β-hCG at which findings of an IUP are
expected on US
● If US fails to reveal a definite IUP or fails to show findings strongly suggestive or
diagnostic of an ectopic pregnancy, the test should be considered indeterminate
and interpreted in light of quantitative serum β-hCG levels
● With transvaginal scanning, the discriminatory zone is often considered to be 1500
mIU/mL. For transabdominal scanning, an IUP should be detectable when the β-hCG
level reaches about 6000 mIU/mL
● Further, decision to intervene on a pregnancy should not be made solely on a single
hCG level; if the patient is hemodynamically stable with a β-hCG greater than the
discriminatory zone and no visible intrauterine or extrauterine pregnancy, watchful
waiting is an appropriate management strategy with close follow-up and strict
return precautions.
● When ectopic pregnancy is suspected, US should be performed even in patients with
low β-hCG levels, because ectopic pregnancy can occur even at very low (<500
mIU/mL) β-hCG levels.
16. Management of ectopic pregnancy
Hemodynamically Stable : Ruled out Rupture
equivocally with US
● Medical Management : Beta-HCG
<5000miu/ml , Mass < 3.5 cms
● Methotrexate + Leucovorin
● Single dose - MTX - 50mg/m2
● Multidose -MTX - 1mg/kg on Day 1,3,5,7
with leucovorin - 0.1 mg/kg on Day 2,4,6,8
● Serial serum Beta HCG on Day 1,4,7 -15%
expected decline after weekly testing until
undetectable
● Laparoscopic Salpingectomy
Hemodynamically unstable : SI >0.9
● Initial resuscitation
● Surgical management : Laparotomy with
Salpingectomy/salpingostomy
17. Ruptured Ectopic Pregnancy Management
1. Secure the airway , and passive leg raising in supine position
2. Intravenous volume resuscitation with Blood products and limited crystalloids
3. Damage control resuscitation : Strategy begins in the Emergency room and continues into
the operating room and into the ICU ,
4. Initial resuscitation is limited to keep SBP around 80-90 mmhg
5. Any delay in Surgery for control of hemorrhage increases mortality ; with uncontrolled
hemorrhage attempting to achieve normal bp may increase mortality
6. Early use of Tranexamic acid limits rebleeding and reduces mortality
7. Thromboelastography - quicker more comprehensive determination of coagulopathy
8. FFP and platelets transfusion indicated based on presence of coagulopathy and
thrombocytopenia respectively
9. Hypotension non responsive to fluids can be started with vasopressors
Noradrenaline Iv infusion - 80mcg/ml - 6-9 ml/hr initially , 1.5-3 ml/hr Maintenance
● STAT LAB : CBC ,S/E , ABG , RFT , PT , APTT , INR , Urinalysis, ABG , ECG Lactate
18. Septic abortion
● A septic abortion is a spontaneous or other abortion complicated by a
pelvic infection.
● with spontaneous or induced abortion, organisms may invade myometrial
tissues and extend to cause parametritis, peritonitis, and septicemia
● Causative agents - Group A strep - Strep Pyogenes , Clostridium
perfringens ,sordelli
● The most common causes are retained products of conception due
to incomplete spontaneous or therapeutic abortion and introduction of
either normal or pathologic vaginal bacteria by instrumentation.