ECTOPIC PREGNANCY BLEEDING IN EARLY PREGNANCY.pptx

PREGNANCY OUTSIDE THE UTERINE CAVITY

1. ECTOPIC PREGNANCY MRS. U SREEVIDYA PROFESSOR

2. DEFINITION An ectopic pregnancy is one in which the fertilized ovum is implanted and develops outside the normal endometrial cavity. - DC DUTTA An ectopic pregnancy is one where implantation occurs at a site other than the uterine cavity. Sites can be in the uterine tube, ovary, cervix and the abdomen. - ANNAMMA JACOB An ectopic pregnancy is defined as a pregnancy where implantation occurs in a site other than the uterine cavity. The most common site is the fallopian tube (95%). - SHEILA BALAKRISHNAN

3. SITES OF IMPLANTATION

4. MODE OF TERMINATION

5. CLINICAL MANIFESTATIONS abdominal pain (100%), acute, agonising or colicky preceded by amenorrhea (75%) 6-8 weeks appearance of vaginal (Spotting) bleeding (70%) Shoulder tip pain (25%) (Referred pain due to diaphragmatic irritation from hemoperitoneum) may be Present. Vomiting, fainting attack Syncopal attack (10%) is due to reflex vasomotor disturbances following peritoneal irritation from hemoperitoneum. General look (diagnostic): The patient lies quiet and conscious, perspires and looks blanched. Pallor: Severe and proportionate to the amount of internal hemorrhage. Features of shock: Pulse – rapid and feeble, hypotension, extremities—cold clammy.

6. MANAGEMENT OF UNRUPTURED TUBAL PREGNANCY Expectant Management: Where only observation is done hoping spontaneous resolution. Indications are: Initial serum hCG level < 1000 IU/L and the subsequent levels are falling (ii) Gestation sac size < 4 cm (iii) No fetal heart beat on TVS. (v) No evidence of bleeding or rupture.

7. MANAGEMENT OF INTERSTITIAL ECTOPIC PREGNANCY It is the rarest variety of tubal pregnancy. Because of the thick and vascular musculature of the uterine wall with greater distensibility, the fetus grows dissecting the muscle fibres for a longer period (12-14 weeks) before termination occurs. The usual termination is rupture. It is associated with massive intraperitoneal hemorrhage due to its combined vascularization by the uterine and ovarian arteries. On rare occasion, abortion occurs through the uterine cavity Hysterectomy is commonly done. MANAGEMENT OF CORNUAL ECTOPIC PREGNANCY Pregnancy occurring in rudimentary horn of a bicornuate uterus, is called cornual pregnancy. Surgery includes removal of the rudimentary horn. If the pedicle is short and the attachment is wide, hysterectomy may have to be done

8. MANAGEMENT OF CAESAREAN SCAR ECTOPIC PREGNANCY Surgical management involves excision as an open or laparoscopic procedure followed by repair of the scar. Medical management involves Intra Muscular injection or local injection of Methotrexate in to the gestational sac under ultrasound guidance. Monitoring about vital signs Emotional therapy Diversional activities Frequent monitoring of complications.