ECTOPIC PREGNANCY

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Gynaecology

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ECTOPIC PREGNANCY:

ECTOPIC PREGNANCY

DEFINITION:

DEFINITION An ectopic pregnancy is a complication of pregnancy in which the fertilized ovum is developed in any tissue other than uterine wall. Implantation sites: Fallopian Tube (Tubal) Ovarian Abdominal Cervix

IMPLANTATION SITES:

IMPLANTATION SITES

ETIOLOGY:

ETIOLOGY Factors preventing or delaying the migration of fertilized ovum to the uterine cavity Pelvic Inflammatory Disease (PID) Loss of cilia of the lining epithelium and impairment of muscular peristalsis Narrowing of tubal lumen Formation of pockets due to adhesions between mucosal folds Peritubal adhesions resulting in kinking and angulation of the tube

ETIOLOGY:

ETIOLOGY Iatrogenic Contraception Failure IUD Sterilisation operation Use of progestin only pill Tubal surgery Intrapelvic adhesion following pelvic surgery ART Others Previous ectopic pregnancy Prior induced abortion Development of defects of tube Transperitoneal migration of ovum

ETIOLOGY:

ETIOLOGY Factors facilitating nidation in the tube Early resumption of the trophoblastic activity is probably due to premature degeneration of zona pellucida Increased decidual reaction Tubal endometriosis

CLINICAL FEATURES:

CLINICAL FEATURES Acute ectopic Symptoms Amenorrhea Abdominal pain Vaginal bleeding Nausea, vomiting, fainting attacks extent of syncope (Syncopal Attack)

CLINICAL FEATURES:

CLINICAL FEATURES On examination Patient lies quiet and concious, perspires and looks blanched Pallor Features of shock Abdomen- tense, tumid and tender Bimanual examination Vaginal mucosa: blanched white Uterus: Normal size or slightly bulky Extreme tenderness on fornix palpation No mass felt through the fornix Uterus floats as if in water

CLINICAL FEATURES:

CLINICAL FEATURES Unruptured tubal ectopic Symptoms Presence of delayed period or spotting with features suggestive of pregnancy Uneasiness on one side of the flank (continuous or colicky in nature) Examination Bimanual examination Uterus is slightly smaller than the period of amenorrhea A pulsatile small, well circumscribed tender mass maybe felt through one fornix separated from the uterus

CLINICAL FEATURES:

CLINICAL FEATURES Chronic or old ectopic Symptoms Amenorrhea Lower abdominal pain Vaginal bleeding Others: dysuria, frequency or even retention of urine,rectal tenesmus

CLINICAL FEATURES:

CLINICAL FEATURES On examination Patient looks ill Varying degree of pallor Persistent high pulse rate even during rest Features of shock absent Temperature slightly elevated Abdominal examination-tenderness and muscle guard on the lower abdomen,Cullen’s sign, mass- tender and irregular

CLINICAL FEATURES:

CLINICAL FEATURES Bimanual examination(painful) Vaginal mucosa- pale Uterus-normal size or bulky Extreme tenderness on movement of cervix An ill defined, boggy, and extremely tender mass is felt through the posterolateral fornix extending to the pouch of Douglas

DIAGNOSIS:

DIAGNOSIS Blood examination- Hb, ESR, Rh grouping and ABO, white cell count Culdocentesis Urine pregnancy test Sonography Laparoscopy Dilatation and curettage Serum progesterone Laparotomy

TREATMENT:

TREATMENT ACUTE Resuscitation (Anti-shock treatment) Ringer solution Blood transfusion Volume replacement with colloids (haemaccel) Laparotomy Indications: Haemodynamically unstable, Laparoscopy contraindicated, evidence of rupture

TREATMENT:

TREATMENT CHRONIC Patient kept under observation, investigations are done and patient is put up for laparotomy at the earliest convenient time. Usually pelvic haematocele is found. Blood clots are removed. The affected tube is identified and salpingectomy is commonly done.

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