Ectopic Pregnancy (1).pptx .

Ectopic preganancy .

1. Ectopic Pregnancy Definition ; is the implantation of fertilized ovum in area other than endometrium lining. 95 of ectopic implant in the fallopian tube(55% in the ampulla, 25% in the isthmus, 2% in the interstitial, 17% in the fibria ). Other site include – ovary, cervix, intra-ligamentous, abdominal cavity.

2. Incidence: occur in about 1 in every 5pregnancies (20 out of 1,000). Incidence on the increase due to increase in cases of salpingitis and assisted reproductive technology (IVF) and BTL. Ectopic is a maor cause of maternal mortality Heterotopic pregnancy – as a situation where ectopic pregnancy occurs in combination with an intrauterine pregnancy. (1% in invitero fertilization )

3. An untreated ectopic pregnancy can be a medical emergency. Prompt treatment reduces your risk of complications from the ectopic pregnancy, increases your chances for future, healthy pregnancies, and reduces future health complications.

4. causes cause of ectopic pregnancy not always clear however its associated with ; - tubal factors Salpingitis (25% after single infection, 50% after second ) . inflammation and scarring (adhesions) of the fallopian tubes from a previous medical condition/ surgery for infertility long tubes (> 10 cm) tubal abnormalities secondary to DES

5. BTL (16 – 50% incidence) Uterine fibroid (pressure) Zygote anomalies – chromosomal and genetical anomalies Ovarian factors unextruded ovum become fertilized Exogenous hormone (4 – 6%) eg postinor 2 IUCD associated with salpingitis Smoking Increase in Age(> 35 years) Previous ectopic Endometriosis – leads to adhesions

6. Time of rupture; a , Isthmus – 6 – 8 weeks b , Ampulla – 8 – 12 weeks c , interstitial – 12 – 16 weeks    

7. symptoms Sharp / stabbing pain in the abdomen/pelvis that radiate to the shoulder or neck Spotting to light per vaginal bleeding (in 75%) Amenorrhoea - half of pt present at the time of expected next menses dizziness or fainting(in 1/3 to ½ of cases) rectal pressure

8. signs pt appear very weak despite hx of scanty bleeding signs of hypotension walk with stoop, supporting abdomen localized or generalized tenderness (80%) cervical motion tenderness (in 75% of the cases) adnexal mass

9. investigations pregnancy test – positive in 100% of the cases pelvic u/s – absence of IUP presence of adnexal mass dilated tube with fluid in the POD laparascopy coldoscentesis – non-clotting blood

10. Management Unrutured ectopic treated medically with methotrexate (cytotoxic drug) Milking of unruptured ectopic out of distal end Surgery – linear salpingostomy (< 3 cm), salpingectomy, hysterectomy (especially in interstitial with extensive destruction of maor blood vessel), Oophorectomy for ovarianectopy .