Ectopic pregnancy

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Ectopic pregnancy. : 

Ectopic pregnancy.

Ectopic Pregnancy Overview : 

Ectopic Pregnancy Overview An ectopic pregnancy is a pregnancy that develops outside a woman's uterus (womb). This happens when the fertilized egg from the ovary does not implant itself normally in the uterus. Instead, the egg develops somewhere else in the abdomen. The products of this conception are abnormal and cannot develop into fetuses. Ectopic pregnancy is usually found in the first 5-10 weeks of pregnancy.

Place. : 

Place. The most common place that ectopic pregnancy occurs is in one of the fallopian tubes. Ectopic pregnancies also can be found on the outside of the uterus, on the ovaries, or attached to the bowel.

In the Fallopian tubes : 

In the Fallopian tubes

Slide 5: 

Ovarian ectopic pregnancyOvary is the white structure in the middlePregnancy implanted on the far right side of the ovary at the "X"Clotted blood are seen around the ovaryOvarian pregnancies are rare

Ectopic Pregnancy Causes : 

Ectopic Pregnancy Causes In a typical ectopic pregnancy, the embryo does not reach the uterus, but instead adheres to the lining of the Fallopian tube. The implanted embryo burrows actively into the tubal lining. Most commonly this invades vessels and will cause bleeding. This intratubal bleeding (hematosalpinx) expels the implantation out of the tubal end as a tubal abortion. Some women thinking they are having a miscarriage are actually having a tubal abortion. There is no inflammation of the tube in ectopic pregnancy. The pain is caused by prostaglandins released at the implantation site, and by free blood in the peritoneal cavity, which is a local irritant

Common conditions that increase the risk of ectopic pregnancy include the following: : 

Common conditions that increase the risk of ectopic pregnancy include the following: Previous tube infections (salpingitis), such as pelvic inflammatory disease (PID), chlamydia, and gonorrhea Previous surgery inside the abdomen, especially involving the fallopian tubes, ovaries, uterus, lower abdomen, or bowels Use of fertility medications at the time of conception The use of an intrauterine device (IUD) does not increase the risk of ectopic pregnancy. However, a normal pregnancy is unlikely with an IUD in place, so if a woman becomes pregnant while using an IUD, it is more likely the pregnancy is not inside the uterus. Prior history of tubal pregnancy

Ectopic Pregnancy Symptoms : 

Ectopic Pregnancy Symptoms Symptoms of an ectopic pregnancy are often confused with those of a miscarriage or pelvic inflammatory disease. The most common symptoms are abdominal and pelvic pain and vaginal bleeding. A ruptured ectopic pregnancy is a true medicalemergency. Common symptoms of a ruptured ectopic pregnancy include the following: dizziness, pale complexion, sweaty, fast heartbeat (over 100 beats per minute) Abdominal or pelvic pain so severe that you can't even stand up

Diagnosis : 

Diagnosis An ectopic pregnancy should be considered in any woman with abdominal pain or vaginal bleeding who has a positive pregnancy test. An ultrasound showing a gestational sac with fetal heart in the fallopian tube is clear evidence of ectopic pregnancy. An abnormal rise in blood βhCG levels may also indicate an ectopic pregnancy.

Slide 11: 

A laparoscopy or laparotomy can also be performed to visually confirm an ectopic pregnancy. Often if a tubal abortion has occurred, or a tubal rupture has occurred, it is difficult to find the pregnancy tissue. A laparoscopy in very early ectopic pregnancy rarely shows a normal looking fallopian tube. A less commonly performed test, a culdocentesis, may be used to look for internal bleeding. In this test, a needle is inserted into the space at the very top of the vagina, behind the uterus and in front of the rectum. Any blood or fluid found there likely comes from a ruptured ectopic pregnancy. Cullen's sign can indicate a ruptured ectopic pregnancy. (Cullen's sign is blue-black bruising of the area around the umbilicus. )

Nontubal ectopic pregnancy : 

Nontubal ectopic pregnancy Two percent of ectopic pregnancies occur in the ovary, cervix, or are intraabdominal. Transvaginal ultrasound examination is usually able to detect a cervical pregnancy. An ovarian pregnancy is differentiated from a tubal pregnancy by the .[7] While a fetus of ectopic pregnancy is typically not viable, very rarely, a live baby has been delivered from an abdominal pregnancy. In such a situation the placenta sits on the intraabdominal organs or the peritoneum and has found sufficient blood supply. This is generally bowel or mesentery, but other sites, such as the renal (kidney), liver or hepatic (liver) artery or even aorta have been described. Support to near viability has occasionally been described, but even in third world countries, the diagnosis is most commonly made at 16 to 20 weeks gestation. Such a fetus would have to be delivered by laparotomy. Maternal morbidity and mortality from extrauterine pregnancy is high as attempts to remove the placenta from the organs to which it is attached usually lead to uncontrollable bleeding from the attachment site. If the organ to which the placenta is attached is removable, such as a section of bowel, then the placenta should be removed together with that organ. This is such a rare occurrence that true data are unavailable and reliance must be made on anecdotal reports.[8][9][10] However, the vast majority of abdominal pregnancies require intervention well before fetal viability because of the risk of hemorrhage. On 19 April 2008 an English woman, Jayne Jones (age 37) who had an ectopic pregnancy attached to the omentum, the fatty covering of her large bowel, gave birth. The baby was delivered by a laparotomy at 28 weeks gestation. The surgery, the first of its kind to be performed in the UK, was successful, and both mother and baby survived.[11] On May 29, 2008 an Australian woman, Meera Thangarajah (age 34), who had an ectopic pregnancy in the ovary, gave birth to a healthy full term 6 pound 3 ounce (2.8 kg) baby girl, Durga, via Caesarean section. She had no problems or complications during the 38 week pregnancy

Heterotopic pregnancy : 

Heterotopic pregnancy In rare cases of ectopic pregnancy, there may be two fertilized eggs, one outside the uterus and the other inside. This is called a heterotopic pregnancy. Often the intrauterine pregnancy is discovered later than the ectopic, mainly because of the painful emergency nature of ectopic pregnancies. Since ectopic pregnancies are normally discovered and removed very early in the pregnancy, an ultrasound may not find the additional pregnancy inside the uterus. When hCG levels continue to rise after the removal of the ectopic pregnancy, there is the chance that a pregnancy inside the uterus is still viable. This is normally discovered through an ultrasound.

Complications : 

Complications The most common complication is rupture with internal bleeding that leads to shock. Death from rupture is rare in women who have access to modern medical facilities. Infertility occurs in 10 - 15% of women who have had an ectopic pregnancy.

Medical Management with Methotrexate : 

Medical Management with Methotrexate If the hCG level is below a certain limit and there is no risk of imminent rupture, the doctor may prescribe a drug called methotrexate to treat the ectopic pregnancy. Methotrexate is also used in chemotherapy and works to stop rapidly growing cells from multiplying. The drug is administered as an injection.

Surgery : 

Surgery Surgery is the final possibility in treatment of an ectopic pregnancy. If the ectopic pregnancy is continuing to develop and is posing a threat of rupture, or if it has already ruptured, surgical treatment is the default and unavoidable.

Surgery : 

Surgery In surgical treatment of an ectopic pregnancy, the doctor operates to remove the pregnancy tissue from the fallopian tube. The surgery may involve laparascopy. Sometimes there is no way to repair the damage to the fallopian tube and the doctor must remove the affected tube.

Slide 22: 

Procedures: Salpingotomy (or -ostomy): Making an incision on the tube and removing the pregnancy. Salpingectomy: Cutting the tube out. Segmental resection: Cutting out the affected portion of the tube. Fimbrial expression: "Milking" the pregnancy out the end of the tube.

Chances of future pregnancy : 

Chances of future pregnancy The chance of future pregnancy depends on the status of the adnexa left behind. The chance of recurrent ectopic pregnancy is about 10% and depends on whether the affected tube was repaired (salpingostomy) or removed (salpingectomy).

Slide 24: 

Photo of a right tubal ectopic pregnancy at laparoscopy surgeryThe swollen right tube containing the ectopic pregnancy is on the right at EThe stump of the left tube is seen at L - this woman had a previous tubal ligation

Slide 25: 

Close view of the same ectopic pregnancy

Slide 26: 

After laparoscopic resection of the tube, the tubal stump is seen at S

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