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    DR Manavita Mahajan MD (PGI Chandigarh), FRCOG (London) SR Consultant Obstetrician & Gynecologist

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    ﻣﻠﻚ عيسى
    This document discusses ectopic pregnancy, which occurs when a fertilized egg implants outside the uterus, most commonly in the fallopian tubes. It has a prevalence of around 2% and can be dangerous due to potential internal bleeding. Risk factors include a history of pelvic inflammatory disease, previous ectopic pregnancy, or fertility treatments. Patients may experience abdominal pain, vaginal bleeding, or no symptoms. Diagnosis involves pregnancy tests, transvaginal ultrasounds to locate the pregnancy, and beta hCG level monitoring if the pregnancy is not initially located. Treatment options include surgery or medication with methotrexate, depending on the stability of the patient. Early diagnosis and treatment improves outcomes for women with this condition.

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    DR Manavita Mahajan MD (PGI Chandigarh), FRCOG (London) SR Consultant Obstetrician & Gynecologist

    Uploaded by

    ﻣﻠﻚ عيسى
    37 views21 pages
    This document discusses ectopic pregnancy, which occurs when a fertilized egg implants outside the uterus, most commonly in the fallopian tubes. It has a prevalence of around 2% and can be dangerous due to potential internal bleeding. Risk factors include a history of pelvic inflammatory disease, previous ectopic pregnancy, or fertility treatments. Patients may experience abdominal pain, vaginal bleeding, or no symptoms. Diagnosis involves pregnancy tests, transvaginal ultrasounds to locate the pregnancy, and beta hCG level monitoring if the pregnancy is not initially located. Treatment options include surgery or medication with methotrexate, depending on the stability of the patient. Early diagnosis and treatment improves outcomes for women with this condition.

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    This document discusses ectopic pregnancy, which occurs when a fertilized egg implants outside the uterus, most commonly in the fallopian tubes. It has a prevalence of around 2% and can be dangerous due to potential internal bleeding. Risk factors include a history of pelvic inflammatory disease, previous ectopic pregnancy, or fertility treatments. Patients may experience abdominal pain, vaginal bleeding, or no symptoms. Diagnosis involves pregnancy tests, transvaginal ultrasounds to locate the pregnancy, and beta hCG level monitoring if the pregnancy is not initially located. Treatment options include surgery or medication with methotrexate, depending on the stability of the patient. Early diagnosis and treatment improves outcomes for women with this condition.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    37 views21 pages

    DR Manavita Mahajan MD (PGI Chandigarh), FRCOG (London) SR Consultant Obstetrician & Gynecologist

    Uploaded by

    ﻣﻠﻚ عيسى
    This document discusses ectopic pregnancy, which occurs when a fertilized egg implants outside the uterus, most commonly in the fallopian tubes. It has a prevalence of around 2% and can be dangerous due to potential internal bleeding. Risk factors include a history of pelvic inflammatory disease, previous ectopic pregnancy, or fertility treatments. Patients may experience abdominal pain, vaginal bleeding, or no symptoms. Diagnosis involves pregnancy tests, transvaginal ultrasounds to locate the pregnancy, and beta hCG level monitoring if the pregnancy is not initially located. Treatment options include surgery or medication with methotrexate, depending on the stability of the patient. Early diagnosis and treatment improves outcomes for women with this condition.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 21

    Dr Manavita Mahajan

    MD (PGI Chandigarh) , FRCOG (London)


    Sr Consultant Obstetrician & Gynecologist
    What is Ectopic
    Pregnancy
    Pregnancy
    1. Inside uterus –
    NORMAL Pregnancy
    Location
    2. Outside Uterus –
    ECTOPIC PREGNANCY
    Incidence – approx. 2%
    Commonest Site – Fallopian
    tube
    Other sites – Ovary , Cervix ,
    Abdomen
    Why Worry
    About Ectopic
    Pregnancy
    DANGEROUS
    Intra-abdominal
    Haemorrhage &
    Death
    Loss of TUBE -
    Fertility
    Compromised
    Risk Factors / Etiology

     ETIOLOGY of Ectopic Pregnancies is unknown

     RISK FACTORS
    1. Current or previous Pelvic Inflammatory Disease
    2. Previous Ectopic pregnancy
    3. Previous Tubal surgery (including reversal of tubal sterilisation
    operation)
    4. Pregnancy with Intra Uterine Contraceptive Device still in place
    5. Pregnancies resulting from Fertility Treatments (including IVF)
    6. Failed Emergency Contraceptive Pill (progestin only)
    7. Prior Abdominal Surgeries ( esp. Ruptured appendix)
    8. Congenital Uterine Malformations
    SYMPTOMS
    Women with Ectopic Pregnancy may present in
    many different ways and a high index of clinical
    suspicion is needed to diagnose this condition.
     Missed Period
     Abdominal Pain
     Vaginal Bleeding
     Dizziness/ Fainting/Shoulder tip pain
     ASYMPTOMATIC
    SIGNS
     Tachycardia
     Hypotension
     Pallor
     Distended Abdomen / free fluid / tenderness
     Vaginal Assessment – Tender Pelvis
    Differential Diagnosis
     Abortion (Intrauterine Pregnancy)
     Ovarian Cyst – Torsion / Haemorrhage
     Corpus Luteal Haematoma
     Acute Appendicitis
     UTI
     Ureteric Colic
     Acute Abdomen
    FINAL VERDICT

     WHO IS AT RISK - ALL PREGNANT WOMEN

     HIGH INDEX OF SUSPICION

    All women of the childbearing age presenting with


    acute abdomen or cramping and abnormal
    vaginal bleeding should have a pregnancy test
    performed to confirm or exclude the possibility of
    pregnancy (Intrauterine or Ectopic).
    HOW TO DIAGNOSE ECTOPIC
    PREGNANCY EARLY?
    STEP 1 Correct Diagnosis of Pregnancy
     History of Missed Period – UNRELIABLE
     Urine Pregnancy Test – Usually Positive
     Beta hCG ( Blood Pregnancy Test) – positive in all
    pregnant women. Level less than 5 rules out
    pregnancy
     Ultrasound
    1. TRANSABDOMINAL - Unreliable
    2. TRANSVAGINAL –very early pregnancy not
    diagnosed
    DIAGNOSIS OF PREGNANCY

     Urine Pregnancy Test

     Blood Pregnancy Test


    DIAGNOSIS OF ECTOPIC
    PREGNANCY
     Clinical Scenario 1 – Woman presents to Emergency
    with acute abdomen & is in Haemorrhagic Shock &
    pregnancy test is positive

     Clinical Scenario 2 – Asymptomatic patient with +ve


    pregnancy test +/- risk factors for ectopic pregnancy

     Clinical Scenario 3 – Patient with pain abdomen


    and/or bleeding per vaginum in early pregnancy
    DIAGNOSIS IN STABLE PATIENT
     Perform Trans Vaginal Sonography(TVS)

    1. Intrauterine pregnancy confirmed ( I.U. Gestational


    Sac with yolk sac +/- embryo)

    2. Ectopic Pregnancy confirmed ( Empty Uterus ,


    Adnexal Mass with Gestational Sac , Free fluid in pelvis/
    abdomen)

    3. Empty uterus , no adnexal mass (NO EVIDENCE of


    PREGNANCY)
    DIAGNOSTIC DILEMMNA –
    POSITIVE PREGNANCY TEST ,EMPTY
    UTERUS ON TVS
    Beta hCG test should be performed

     Beta hCG < 1500 . The test should be repeated at 48 hours


    and if doubling of the previous titre is seen then it is likely
    to be intrauterine pregnancy. Transvaginal Ultrasound should
    then be repeated by an experienced sonographer when the level
    is >1500 and intrauterine pregnancy should be identified
    .
     Beta hCG > 1500-2000 with an empty uterus on Transvaginal
    sonography by an experienced sonographer generally
    implies an ectopic pregnancy (exception being a multiple
    gestation) and the woman should be counselled accordingly.
    Let’s Remember
     Diagnose pregnancy by pregnancy test (urine or
    beta hCG)

     Perform pregnancy test in all cases of acute


    abdomen in women of childbearing age

     Trans Vaginal Sonography should detect


    pregnancy in all cases when beta hCG > 1500.
    Failure to detect ( empty Uterus)implies possible
    Ectopic Pregnancy
    Management of Ectopic Pregnancy
     Case 1 – Patient presents with Haemorrhagic
    Shock
    IMMEDIATE RESUSCITATION WITH LAPAROTOMY

     Case 2 – Stable Patient with Ectopic Pregnancy

    1. Laparoscopy & Surgical Management

    2. Medical Management with Methotrexate


    ROLE of LAPAROSCOPY
     Tubal Ectopic pregnancies are readily diagnosed and
    treated by laparoscopic approach.

     Surgical procedures that are performed are


    1. removal of the involved tube (Salpingectomy)
    2. removal of the pregnancy tissue with conservation
    of tube (salpingostomy).
    Salpingectomy video
    What is Medical Management of
    Ectopic Pregnancy?
     Methotrexate (folate antagonist) has good activity against pregnancy tissue
    (trophoblastic tissue) and has been used to destroy the ectopic gestation in
    carefully selected women.

     The prerequisites for methotrexate administration are

    1. Haemodynamically stable patient with no intraabdominal bleed.


    2. Beta hCG </=3000
    3. No cardiac activity demonstrated in the fetus on Ultrasound(TVS)
    4. Ectopic size<3.5 cm
    5. No Medical problems in the women (exclude anaemia, kidney or liver or
    haematological disorders)
    6. Good patient compliance with follow up visits as tubal ruptures have been
    known to occur in some women in the resolution phase of the disease.

    Post Ectopic pregnancy -Some
    Counselling Points

     Risk of Ectopic Pregnancy in next pregnancy is


    around 7-10% and hence she must report early in next
    pregnancy.
     Contraception – Barrier methods or OC Pills are
    advocated. Should avoid Intra Uterine Contraceptive
    Device and progestin only emergency pills
     Anti D should be administered to Rhesus negative
    non sensitised women.

    SUMMARY
     To summarise , early diagnosis of Ectopic pregnancies
    requires constant vigilance on the part of the
    clinician and we have been greatly helped in this
    endeavour by the modern improved pregnancy
    diagnosis(serum Beta hCG)methods and
    Transvaginal Scanning.This ,along with operative
    laparoscopic techniques , has improved the
    outcomes for great majority of women with Ectopic
    Pregnancies.
    Thank you

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