Ectopic Pregnancy BADUA

7/23/2019 Ectopic Pregnancy BADUA

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ECTOPIC

PREGNANCY


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Defnition: Any pregnancy occurring outside the uterus

Incidence: Increasing due to P.I.D./ infertility

1-2% of all irths

!% after I"#-$

&ite of i'plantation:

Blastocyst normally implants in the endometrial

lining of uterine cavity. Implantation elsewhere is

considered ectopic.


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SITES OF ECTOPIC PREGNANCY

1(#i'rial 2(A'pullary )(Isthe'ic *(Interstitial +(,arian

(erical 0(ornual-udi'entary horn (&econdary

ado'inal !(3road liga'ent 14(Pri'ary ado'inal

Ampulla (>85%)

Isthmus (8%)

ornual (! "%)

#vary (! "%)

A$domen (! "%)

ervi (! "%)


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Risk Factors:

Any factor that leads, directly or indirectly, to a reduction intubalmotility increases the risk for tubalpregnancy

Prior tual da'age fro' preious ectopic pregnancy or fro'

tual surgey to rliee infertility or for strerili5ation. 67I87$&

I&9 Pelic infla''atory disease/ &I

Assisted conception particularly I"# if tues are patent and

da'aged ;

&'o


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Pathology o EctoicPregnancy

TUBES LACKS A SUBMUCUSAL LAYER ->

Fertilized ovum borrows trou! te e"itelium

#$!ote re%&es te mus&ul%r w%ll Tro"obl%sti& &ells %t z$!ote "eri"er$ "roli'er%te( i)v%de( %)d

erode %d*%&e)t mus&ul%ris

M%ter)%l blood vessels disru"ted le%di)! to emorr%!e

Outcome:tub%l %bortio) or ru"ture wit emorr%!e


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TUBAL RU+TURE

First 'ew wee,s- istmi& "ortio)

-. wee,s- i)terstiti%l "ortio)

. wee,s or more- %m"ull%

Ru"ture m%$ 'ollow &oitus or bim%)u%l e/%mi)%tio)0


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T!"al Pregnancy

Most &ommo)site o' e&to"i& "re!)%)&$12234

Te %m"ull%is te most 're5ue)t lo&%tio) o'im"l%)t%tio) 16734

Symptoms:

Amme)ore% Abdomi)%l "%i) 8%!i)%l bleedi)!

Signs: Abdomi)%l te)der)ess 1234 sttrimester bleedi)! 19234

Common associated fndings: Ad)e/%l te)der)ess 1734 ( Ame)orre% E%rl$ "re!)%)&$ s$m"toms Culle);s si!) 1+eriumbili&%l bruisi)!4


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Other Signs: T%&$&%rdi%( Low !r%de 'ever C%dwi&,;s si!) 1&ervi/ %)d v%!i)%l &$%)osis4 =e!%r;s si!) 1so'te)ed uteri)e istmus4 Cervi&%l Motio) Te)der)ess E)l%r!ed uterus Te)der "elvi& or %d)e/%l m%ss

Cul-de-s%& 'ull)ess

Signs suggestive o ruptured ectopic pregnancy: Usu%ll$ betwee) 6 %)d . wee,s !est%tio)

Severe %bdomi)%l te)der)ess wit rebou)d(!u%rdi)!

rtost%ti& $"ote)sio)


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Di#erential Diagnosis

Appendicitis Threatened Abortion Ruptured ovarian cyst

PID Ovarian torsion Intrauterine pregnancy

Alternative diagnoses:

Dysmenorrhea Dysfunctional uterine bleed

Mesenteric lymphadenitis


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$y%to%s & $igns:

In a =o'an of child earing age =ith a pelic

/ado'inal pain and/ or aginal leeding =ith

a'ennorhea >> A&'A*.thin+

Pregnancy

,ormal-

ctopic


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?@A


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MET=?S F EARLY ?@A


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?i%!)osti& mod%lities

1. Pregnancy test.a( ?rinary 3-h8> sensitie@ detects 2+-+4 'l I.?/'l.. Positie

efore 'issing the net period

( &eru' 3-h8>> Bainly used for Cuantitatie rather than

Cualitatie purposes

2. Pelic ultrasound scan

a( Ado'inal. &ac at + =


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MET=?S F EARLY ?@A


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MET=?S F EARLY ?@A


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$arly Pregnancy Assess'ent linic $PA;:

If early pregnancy prole's>. ?rine 3-h8 A&canIntra-uterine pregnancy >>.8,,D

Eo Intra-uterine gestation &een>> seru' 3-h8 "&.

=ith seru' 3-h8 of 1+44-2444 'l I.?/'l Intra uterine gestation should eseen using "&>> other=ise suspect $ctopic pregnancy

). Diagnostic Faparoscopy.


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$arly Pregnancy Assess'ent linic $PA;:

.

Gith Adance in diagnosis and i'proe'ent in patient a=areness

ectopic pregnancy is 'ore and 'ore eing diagnosed in its early

stages. &o@ to reduce the incidence of 'aternal 'ortality and serious

'oridity this dedicated clinic is a 'ust in regional hospitals.

Patients =ith early pregnancy prole's to report to

#acilities to perfor' urine and seru' P.. onsite

#acilities and epertise in perfor'ing "&

Access to operating theatre and lood an


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MA.. Eot co''on approach

1. urgical


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SUR@CAL TREATME


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SALPINGECTOMY

VS

SALPINGOSTOMY / SALPINGOTOMY

&alpingosto'y / &alpingoto'y is only

indicated =hen:1. he patient desires to consere her fertility2. Patient is hae'odin'ically stale

). ual pregnancy is accessile

*. ?nruptured and H +'. In si5e+. ontralateral tue is asent or da'aged


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he choice of surgical treat'ent does notinfluence the post treat'ent fertility@ ut priorhistory of infertility is associated =ith a 'ar


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#ertility reducing factor &core

Antecedent one $ctopic pregnancy 2 Antecedent each further

$ctopic pregnancy 1 Antecedent Adhesiolysis 1 Antecedent ual 'icro surgery 2 Antecedent &alpingitis 1

&olitary tue 2 7o'olateral Adhesions 1

ontralateral Adhesions 1

SALPINGECTOMY

VS



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he rationale ehind the scoring syste'

is to decide the ris< of recurrent ectopicpregnancy. onseratie surgery is indicated =ith a

score of 1-* only@ =hile radical treat'entis to e perfor'ed if the score is + or

'ore.

SALPINGECTOMY

VS


2 tilit t t i


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2ertility post ectopic surgery*

The overall subsequent conception rate in women with ectopicpregnanciesis about 60%

less than half of these pregnanciesresult in another ectopicor spontaneous abortion, so only about one third of womenwith ectopic pregnancieshave subsequent live births

. The subsequent fertility rate is significantly higher in parouswomen younger than 0 years. !f the ectopic pregnancyis a

women"s first pregnancy, her subsequent conception rate isonly about #%. $n the other hand, women with high paritymore than three pregnancies& who develop an ectopicpregnancyhave a relatively high rate of conception '0%&.The subsequent conception rate is lower in women who have ahistory of salpingitis and in those who have gross evidence ofdamage to the opposite oviduct as a result of previoussalpingitis. (uture fertility is significantly higher in women whohave unruptured tubalpregnanciesthan in those who haveruptured ectopic pregnancies) hence, early diagnosis withserial h*+ and ultrasound is desirable.

Repeat Ectopic Pregnancy


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Repeat Ectopic Pregnancy

The rate of repeat ectopic pregnancy

after a single ectopic pregnancyrangesfrom 8% to 20%,with a mean of #%.$nly about one of three nulliparouswomen who have an ectopic pregnancyever conceives again #%&, and aboutone third have another ectopicpregnancy%&. After two ectopic

pregnancies, infertility rates as high as-0% have been reported


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REMEMBER

ctopic pregnancy is a life threatening condition 3 on the

increase

,ot all cases present with a classical picture

A&'A suspect ectopic pregnancy in a woman of a child4

$earing age co pain andor p.v. $leeding

6ailor your management on the patient presentation.7 2.up

Ectopic Pregnancy BADUA

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