Ce diaporama a bien été signalé.
Nous utilisons votre profil LinkedIn et vos données d’activité pour vous proposer des publicités personnalisées et pertinentes. Vous pouvez changer vos préférences de publicités à tout moment.

Ectopic pregnancy- Define, Type, Etiology, Sign and Symptoms, Treatment, Surgery

14 vues

Publié le

Ectopic pregnancy- Define, Type, Etiology, Sign and Symptoms, Treatment, Surgery made By sonal patel

Publié dans : Santé & Médecine
  • Soyez le premier à commenter

Ectopic pregnancy- Define, Type, Etiology, Sign and Symptoms, Treatment, Surgery

  1. 1. ECTOPIC PREGNANCY
  2. 2. ECTOPIC PREGNANCY Definition An Ectopic Pregnancy is one in which fertilized ovum is implanted and develops outside the normal uterine cavity. Type • Acute Ectopic • Chronic Ectopic
  3. 3. Extra Uterine Tubal Ampulla Isthmus Infundibulum Interstitial Ovarian Abdominal Primary Secondary Extra Peritonium Intra Peritonium
  4. 4. Uterine Cervical pregnancy Angular pregnancy Cornual pregnancy
  5. 5. INCIDENCE • Recent evidence indicates that the incidence of ectopic pregnancy has been rising in many countries. • USA- 5 fold: UK- 2 fold • India - 1 in 100 deliveries • Recurrence rate 15% after 1 ectopic pregnancy 25 % after 2 ectopic pregnancies
  6. 6. AETIOLOGY Factors Preventing OR delaying migration of fertilized ovum. CHRONIC PID DEFECT OF TUBE IATROGENIC TRANS PERITONIAL MIGRATION TUBAL SPASM
  7. 7. Chronic PTD • Loss of Cilia • Narrowing of tubal lumen • Adhesions between mucosal Folds • Kinking Peritubal adhesions Defects of tube • Elongation • Diverticula's • Accessory Ostia
  8. 8. Iatrogenic Surgery • Tubal ligation • Microsurgery of tube • IUCD
  9. 9. Factors facilitating nidation in tube Premature degeneration of zona pellucida Increased decidual reaction Tubal endometriosis
  10. 10. Tubal Mole • Complete absorption • Abortion Tubal Abortion • Complete • Incomplete
  11. 11. Tubal Rupture • Floor • Roof Tubal Perforation • Secondary abdominal Pregnancy • Secondary intra ligamentary Pregnancy
  12. 12. Acute Ectopic : Clinical Presentation • Reproductive age • Stable to shock • Amenorrhoea • Abdominal pain • Fainting attack • Vaginal bleeding
  13. 13. Signs • Pallor • Tachycardia • Hypotension • Tenderness / Guarding / Rigidity • Cx Movement Tenderness • Fornixial Tenderness
  14. 14. Differential Diagnosis • Acute PID • Acute Appendicitis • Rupture corpus luteal cyst • Twisted ovarian tumour
  15. 15. Diagnosis • Routine Blood Investigations • UPT • Culdocentesis • Ultrasonography • Laproscopy
  16. 16. EARLY DIAGNOSIS At 4-5 weeks: • TVS can visualize a G-sac • serum beta HCG levels are > 1600 mIU/ml • When Beta HCG levels are greater than above levels and there is an empty uterine cavity on TVS, ectopic pregnancy can be suspected. • when the value of Beta HCG does not double in 48 hrs, ectopic pregnancy is suggestive
  17. 17. EARLY DIAGNOSIS After 5 weeks • tubal ring by 6 wks. • After 5 mm D : as a complete sonoluscent sac with the yolksac & embryonic pole with or without fetal heart activity. • Demonstration of the G sac with or without a live embryo (Begel’s sign)- • Ruptured ectopic with fluid in POD and an empty uterus. color doppler, the vascular colour in a characteristic placental shape fire pattern can be seen outside the uterine cavity while the uterine cavity is cold in respect to blood flow.
  18. 18. Management RUPTURED ECTOPIC • Treatment of shock • Laprotomy UNRUPTURED ECTOPIC • Conservative Management Medical Surgery
  19. 19. Medical • Methotrexate, folinic acid • GA less than 6 wks • Tubal mass is less than 3.5cm diameter • Fetus is dead • Intramuscular Methotrexate 1.0mg /kg • Alternating folinic acid 0.1mg/kg • Monitoring of B-HCG levels daily / Alternate day Monitor • HMG • RFT • LFT
  20. 20. • Methotrexate OR Potassium Chloride into amniotic sac through laparoscopy OR Sonography guidance Surgical Conservative Management Laparoscopic • Linear Salpingectomy • Salpingectomy • Segmental resection Anastomosis • Fimbrial Evacuation – Milking
  21. 21. Surgical Treatment • Salpingostomy/ Salpingotomy indicated when • Pt Desire to conserve her fertility • Patient is haemodinamically stable • Tubal preg is accessible • Unruptured & < 5 cm Size • Contralateral tube absent or damaged. • Chapron et al (1993) have described a scoring system to decide which surgical treatment to be taken up based on patients previous gynae history & appearance of pelvic organs-
  22. 22. FERTILITY REDUCING FACTOR SCORE • Antecedent one ectopic 2 • Antecedent each further ectopic 1 • Antecedent Adhesiolysis 1 • Antecedent Tubal microsugery 2 • Antecedent salpingitis 1 • Solitary tube 2 • Homolateral Adhesions 1 • Contralateral Adhesions 1 • Conservative surgery is indicated with a score of 1-4 only, while radical treatment to be performed if score is 5 or more. • Rationale behind the scoring system is to decide the risk of recurrent ectopic preg.
  23. 23. • Medical Treatment by Methotrexate • The Antineoplastic drug which acts as a folic acid antagonist and is highly effective against rapidly proliferating trophoblast. • Used when 1. Ectopic mass size < 3.5 cm 2. Preg < 6 wks. 3. beta HCG levels < 15,000 MIU/ ml. • Dose – Single dose - 50 mg / m2 IM. Measure beta HCG levels on days 4 & 7 . If difference is > 15% : repeat weekly until undetectable If Difference is < 15% : repeat 2nd dose of methotrexate & begin now day 1 If fetal cardiac activity present on day 7, repeat dose & begin day 1. Surgical treatment if beta HCG levels not decreasing or fetal cardiac activity present after 3 doses.
  24. 24. PERSISTENT ECTOPIC PREGNANCY (PEP) • This is a complication of salpingotomy/ salpingostomy • When residual trophoplast continues to survive because of incomplete evacuation of ectopic preg. • Diagnosis made because of raised postoperative beta HCG. • Treatment reoperation & Salpingectomy Administration of IM/ oral Methotrexate in a single dose of 50 mg/m2
  25. 25. CHRONIC ECTOPIC PREGNANCY • INVESTIGATIONS : 1. Laboratory/ Chemical Test- • Serial quantitative beta HCG level by RIA • Serum progesterone level ( < 5 ng / ml in ectopic ) • Low levels of tropholastic proteins such as SPI & PAPP – Placental protein 14 & 12. 2. USG – usually haematocele is found. 3. Laparoscopy • TREATMENT : Mainly Surgical • Salpingectomy of the offending tube • If pelvic haematocele is infected, posterior colpotomy is to be done to drain the pelvic abscess. • Salpingoopherectomy
  26. 26. Surgical Laparotomy Laparoscopy • Hospital Cost More? Less? • Post op Adhesions More Less • Recurrence Same Same • Future fertility Same Same • Experience Surgeon Trained Special

×