etopic pregnancy

8/8/2019 Etopic Pregnancy

1/15


2/15

y Definitiono Outside ofutere cavity

o Pregnancy erodes into blood vassel

o Rupture structure

y Incidenceo 1970 4.5 per 1000

o 1992 19.7 per 1000

o Decreace mortality

o 95% (tubal pregnancy)


3/15


4/15

y Tubal pregnancy may result in

1. Tubal rupture with intra peritoneal hemorrhage

2. Tubal abortion3. Tubal abortion with subsequent implantation

y Increase resk: morbidity and mortality

anatomic damagereduce fertility rate

y Causes of ectopic pregnancyo History salpingitis (scar)

o Previous ectopic pregnancy 10 foldo 35 44 year 3 fold

o Black and hispanic women

o Intrauterine contraception device

o

Previous sterilization


5/15

y Symptoms of ectopic pregnancy


6/15

Physical fending in tubal pregnancyo Normal examination (unrupture ectopic)

o Hipovolemic shock and acute abdomeno BP Pulse


7/15

y Diferential diagnosiso Abortion (threadtened, complete, incomplete abortion

o Acute and chronic salpingitis

o Follicularorrupture corpus luteum

o Endometrioris

o Anexial torsion

o Gastroenteritis, appendiatis

y Diagnostic procedureso Pragnancy test

- urine detecHCG as early as 14 days after conception

- serum detecHCG as early as 5 days after conceptiono Quantitative HCG followed at 2 day intervals

increase at least 66%

o USG TA identify intrauterine gestation 5000 6000

TV identify intrauterine gestation 1500 UI


8/15

y Diagnostic Procedures


9/15


10/15

y Hemogramao Leucocitosis < 20.000

o Progesterona ( used as screening test for ectopic pragnancy)

- Less than 6.0 ng/ml suggest a nonviable pragnancy orextrauterene

o Curettagen of the uterine cavity

- can rule out ectopic pregnancy- chorionic villi identifies an intrauterine location

- Aris Stella reaction Hypersecretory endometrium ofpregnancy no only in ectopicpregnancy but also intrauterine pregnancy

Ongoing pregnancy might be interrupted


11/15

o Culdo centesis

o Laparoscopy the most accurate technique

2 -5% misdiagnosis (extremely early)

y Management of ectopic pregnancyo

Conservative surgical techniques- Linear salpingostomy

- Segmental resection

o Traditional management

- Salpingectomy


12/15

y Management of ectopic pregnancy


13/15

o Non surgical therapy

- Earlyunruptered ectopic pregnancy

- Methotrexate Oral, IM, direct injestion into the ectopic

- Less 3.5 cmt

- No cardiac activity

o Followed post therapy

-S

erial quantitative H

CG to monitorregression ofpregnancy

- RH (-) (Rho GAM)

o Combined pregnancy

- Heterotopic pregnancy 1 in 3000 4000pregnancies

Survival 10 20% signicont deformity

Removal placenta not attempted

methotrexate


14/15


15/15

y Cervical pregnancy

y Ovarion pragnancy

etopic pregnancy

Documents