Ectopic Pregnancy.
Ectopic Pregnancy
Define Ectopic Pregnancy : It may be defined as when implantation of the fertilized ovum occurs at any site others than the normal uterine cavity.
We have described:
What are the type of ectopic pregnancy?
Site of ectopic pregnancy.
How will you manage a case of ectopic pregnancy?
Risk factor of ectopic pregnancy :
Why ectopic pregnancy is increasing day by day?
Types of ectopic pregnancy: Clinically 3 distinct types :
- Acute (tubal rupture or abortation)
- Unruptured
- Subacute.
Risk factor of ectopic pregnancy :
- Pelvic inflammatory disease (6 folds increased risk)
- Use of IUCD’s (3-5% increased risk)
- Smoking (2.5% increased risk)
- ART pregnancies. (3-5% increased risk)
- Tubal damage ( surgical occlusions or cilial damage)
- Tubal surgery (5.8% Increased risk.)
- Salpingitis isthmica nodusa (3.5% increased risk)
- Prior ectopic pregnancy. (10 folds increased risk)
- Age 35-44 years women have 3 fold greater risk than age 18-24 years.
- Nonwhite race (1.5 folds increased risk).
- Endometriosis.
- Development errors.
- Overdevelopment of ovum and external genitalia
Symptoms of rupture ectopic pregnancy :
- Short period of amenorrhoea.
- Sudden severe lancinating lower abdominal pain.
- Per vaginal bleeding.
- Patients may go into collapse and shock.
Sign of rupture ectopic pregnancy :
A. General Examination :
- Anaemia
- Low blood pulse
- Rapid thready pulse
- Cold clammy skin.
B. Per abdominal examination :
- Lower abdominal tenderness, rigid and distended.
- Shifting dullness may be elicited.
- Gut may be distended
C. Per vaginal examination :
- Extreme tenderness on palpation of the fornix.
- No mass usually felt through the cervix
Investigations of rupture ectopic pregnancy :
1. Blood:
.Tc,DC
.HB%- fall
.ESR – raised
.Blood grouping, cross matching, Rh typing
- USG of uterus.
- Pregnancy test: Positive in 50% cases.
- Colpometry or colpopuncture.
- Curettage: Reveal only decidual tissue, no chorionic tissue.
- Laparoscopy : Confirmatory
Treatment of rupture ectopic pregnancy :
General treatment :
- Immediate hospitalization
- Wide bore IV channel opening.
- Blood is sent for grouping and cross matching.
- IV infusion: Hartman solution
- Blood transfusion if needed
- Catheterization
- Analgesics: Inj. Pethidine 100 mg IM.
- Antibiotics
B. Specific Treatment :
- .If the family is complete : Salpingectomy + Other sided tubectomy.
- .IF family is incomplete and other sided tube healthy : Salpingectomy
- .If family is incomplete and other sided tube unhealthy : partial salpigectomy if the tube is ruptured and anastomosis done in later sitting .
- .If tube is intact:
- .Salpingotomy
- .Salpingostoy
- .MIlking.
Cause of ectopic pregnancy in developing country:
Ectopic pregnancy is common is developing country because of the following reasons:
1.Increased prevalence of chronic pelvic inflammatory disease (PID).
2.Contraceptive failure :
.IUCD : It prevents intrauterine pregnancy effectively. Thus there is relative increase of tubal pregnancy.
.Sterilization operation.
.Use of progesterone only pill
. post coital oestrogen pill.
3. Prior induced abortion.
4. Previous ectopic pregnancy.
5.Intra-pelvic adhesion following pelvic surgery.
6.Developmental defects of tube.
7. Use of ovulation inducing drugs.
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