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    Ectopic Pregnancy BW

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    Ziya Akhtar
    1. An ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, most commonly in the fallopian tubes. 2. Risk factors for ectopic pregnancy include previous pelvic inflammatory disease, intrauterine device use, smoking, assisted reproductive technology, tubal damage or surgery, and increasing maternal age. 3. Ectopic pregnancies are typically diagnosed based on symptoms of abdominal pain and vaginal bleeding in early pregnancy, along with transvaginal ultrasound findings and beta-hCG levels. Management options include expectant monitoring, medical treatment with methotrexate, or surgical treatment by salpingotomy or salpingectomy.

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    Ectopic Pregnancy BW

    Uploaded by

    Ziya Akhtar
    45 views28 pages
    1. An ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, most commonly in the fallopian tubes. 2. Risk factors for ectopic pregnancy include previous pelvic inflammatory disease, intrauterine device use, smoking, assisted reproductive technology, tubal damage or surgery, and increasing maternal age. 3. Ectopic pregnancies are typically diagnosed based on symptoms of abdominal pain and vaginal bleeding in early pregnancy, along with transvaginal ultrasound findings and beta-hCG levels. Management options include expectant monitoring, medical treatment with methotrexate, or surgical treatment by salpingotomy or salpingectomy.

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    Ectopic-pregnancy-BW

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    1. An ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, most commonly in the fallopian tubes. 2. Risk factors for ectopic pregnancy include previous pelvic inflammatory disease, intrauterine device use, smoking, assisted reproductive technology, tubal damage or surgery, and increasing maternal age. 3. Ectopic pregnancies are typically diagnosed based on symptoms of abdominal pain and vaginal bleeding in early pregnancy, along with transvaginal ultrasound findings and beta-hCG levels. Management options include expectant monitoring, medical treatment with methotrexate, or surgical treatment by salpingotomy or salpingectomy.

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    45 views28 pages

    Ectopic Pregnancy BW

    Uploaded by

    Ziya Akhtar
    1. An ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, most commonly in the fallopian tubes. 2. Risk factors for ectopic pregnancy include previous pelvic inflammatory disease, intrauterine device use, smoking, assisted reproductive technology, tubal damage or surgery, and increasing maternal age. 3. Ectopic pregnancies are typically diagnosed based on symptoms of abdominal pain and vaginal bleeding in early pregnancy, along with transvaginal ultrasound findings and beta-hCG levels. Management options include expectant monitoring, medical treatment with methotrexate, or surgical treatment by salpingotomy or salpingectomy.

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    Early pregnancy bleeding

    Ectopic pregnancy

    Dr. Kakali Saha


    MBBS, FCPS, MS (Obs & Gynae)
    Associate Professor
    Medical College for Women & Hospital
    Ectopic pregnancy

    • Definition : An ectopic pregnancy is one in which the fertilised ovum


    becomes implanted in a site other than the normal uterine cavity.

    • Extrauterine pregnancy -but rudimentary horn of a bicornuate uterus.

    • It is the consequence of an abnormal implantation of the blastocyst.


    Incedence

    • Worldwide 3-4% of all pregnancy.


    • In USA 2%
    • Some study 16 in 1000. Past 20 years incidence risen

    ✦ After one ectopic - there is a7-13 fold increase risk of subsequent ectopic
    ✦ Subsequent intrauterine preg —50-80%
    ✦ Tubal preg 10-25%
    ✦ Infertile — remaining patient
    Sites of ectopic pregnancy
    According to frequency

    • Fallopian tubes 95-98% (At fimbriated end 17%, Ampulla-55%,Isthmus 25%


    interstitial 3%)
    • Uterine cornu 2-2.5%
    • Ovary, Cervix & abdominal cavity <1%

    • Right side is more common than left.


    Risk factors

    • PID (pelvic inflammatory diseases —6 fold increases risk


    • Use of IUCD —3-5% increased risks
    • Smoking 2.5% increased risks
    • ART 3-5% increased risks
    • Tubal damage
    • Tubal surgery 5.8%
    • Salpingitis isthmica nodes 3.5% increased risks
    • Prior ectopic pregnancy cont.
    Risk factor

    • Age 3 fold increased risks in 35-44 years compared to 18 -24 yrs


    • Non white race 1.5 fold increased risks
    • Endometriosis 1.5 increased risks
    • Developmental errors
    • Overdevelopment of ovum & external migration .
    Aetiology

    • Tubal damage or altered motility results improper transport of blastocyst


    • Most common cause is acute salpingitis 50%
    • In 40% no risk factors apparent
    • Salpingitis causes peritubal adhesion , lumen occlusion , intratubal
    adhesion diverticula & disturbed tubal function.
    • PID due to infections eg Chlamydia, gonococcal, tuberculosis,
    postabortal, puerperal, pelvic peritonitis also appendicitis
    • Altered tubo- ovarian relationship in endometriosis.
    Sites of ectopic
    pregnancy
    Outcome / Fate

    • Tubal abortion
    • Complete absorption
    • Complete abortion
    • Incomplete abortion
    • Missed abortion
    • Tubal rupture
    • Chronic ectopic adnexal mass
    • Foetal survival to term
    Clinical features
    Symptom & signs

    • Normal symptom & signs of pregnancy ( amenorrhoea and uterine softening )


    • Acute abdominal pain(dull, cramps or colicky )
    • Evidence of haemodynamically instability (hypotension, collapse, S/S of shock)
    • Adnexal mass (with or without tenderness)
    • Vaginal bleeding
    • Signs of peritoneal irritation
    • Absence of G. Sac in uterine cavity on USG with a beta HCG > 2500 mlU/ml
    • Abdominal pregnancy
    Classical triad

    A pt. with amenorrhoea, pain, vaginal bleeding should always be


    suspected to have an ectopic pregnancy.

    The dictum to early diagnosis & successful management is to “Think


    Ectopic” but also not to “Over Think Ectopic”.
    Differential diagnosis

    The picture of Ectopic is


    extremely variable & mimic
    with intraabdominal disease.
    Diagnosis

    Classical triad of pelvic pain, vaginal spotting and


    amenorrhoea5-9weeks
    Others
    Adnexal mass or tenderness, S/S pregnancy, dizziness, passage of
    clot or tissue.
    In case of rupture - shoulder pain due to diaphragmatic irritation
    S/Sign of shock
    Tests and aid to diagnosis

    • Urine for PT -50% case positive


    • Serum beta HCG- is less as compared to normal pregnancy. (TVS detect
    sac when beta HCG >2400mIU/ml.
    ✤ Serial beta HCG in 48 hours not double

    • Serum Progesterone >25 ng/dl is associated with an intrauterine preg in


    97.5%
    • Ultrasound .
    Ultrasound
    Uterine findings

    • Empty uterus
    • Thickened endometrium
    • Pseudogestational sac
    Ultrasound
    Extrauterine

    • No findings
    • Live tubal pregnancy
    • Adnexal ring sign
    • Complex adnexal mass
    • Free fluid in pouch of Douglas.

    ✤ Colour dopplar will classically


    identify “ring of fire” around the
    ectopic on the same side of corpus
    luteum.
    Other placental marker

    • Serum creatine kinase (CK)


    • Pregnancy specific beta(1)- glycoprotein(sp1)
    • Human placental lactogen(HPL)
    • Pregnancy associated plasma proteins A (PAPP-A)
    • Vascular endothelial growth factors, progesterone and PAPP -triple marker
    test
    • Cancer antigen 125 (CA125)
    • Serum IL-8,IL6,and TNF-𝛼 increases in ectopic.
    0thers

    • Pelvic examination under GA


    • Culdocentesis
    • Posterior colpotomy
    • Laparoscopy
    • Curettage
    • Others lab test -CBC, blood grouping and typing etc
    Manangement & Treatment Options

    • Hospitalisation
    • Shock must be treated before she is moved.
    • Options depends on
    ✦ Condition of patient like acute chronic ,ruptured , enraptured , ectopic
    other than fallopian tube eg uterine scar, ovarian, cervical, abdominal.
    Options

    • Expectant management
    • Medical
    • Surgical
    Expectant management
    In case of early diagnosis

    • When beta HCG < 1000mIU/ml


    • Gestational sac diameter < 2 cm on TVS
    • Free fluid haemoperitoneumat POD < 50 ml

    ★ Nearly 2/3rd patient will undergo spontaneous resolution within 3-5


    weeks
    ❖ Regular monitoring with hCG and USG required.
    Medical management

    • Absolute
    ✴ Haemodynamicaly stable patient
    ✴ No evidence of acute intra-abdominal bleeding
    ✴ Compliance of regular follow up
    ✴ No contraindications for MTX (methotrexate)
    Cont.

    • Preferable
    • When beta HCG < 10,000mIU/ml
    • Absent or mild symptom
    • Absent of embryo heart activity
    • Gestational sac diameter < 4 cm on TVS
    • No Free fluid POD #
    Surgical management

    • After laparotomy or laparoscopy


    ✤ Salpingotomy
    ✤ Salpingectomy
    ✤ Salpingo-ophrectomy is never recommend unless ovary itself is grossly
    damaged or diseases.

    ❖ Rh Negative patient when hopeful of further pregnancy Anti -D


    immunoglobulin must be given immediate postoperative period.
    Abdominal pregnancy
    Primary or secondary

    • The foetus develops in the peritoneal cavity, its amniotic sac becoming
    supported by an outer coat of organising lymph and blood exudate
    • Some preg proceed to term when spurious labour ensues
    • Uterus contract , some dilatation of cervix
    • C/F normal pregnancy sign except it is unusually uncomfortable, pain abd.
    distention, occasional slight P/V bleeding
    • Uterus felt like tumours , separated from preg sac which not contract
    • P/V exam cervix displaced, often upwards & forwards with fatal parts lying
    below & behind it.
    Cont

    • USG may help or miss


    • Treatment - laparotomy
    • Placental management - not to removed , umbilical cord is cut short left it
    to be absorbed during the next 1-2 years
    • Only need to removed when abscess formed.
    • Follow up must. Beta hCG & progesterone fall during Course of 8-12. Weeks.
    • If fetes dies -defer operation to allow the placental sinuses to become
    thrombosed & follow up coagulation profile.
    The End
    Thank you all

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