ECTOPIC PREGNANCY PPT for BSc Nursing 4th Year.pptx

Ectopic Pregnancy

1. Presented by: Ms.G.Usha rani , MSc (N), Dept. of OBG, Asst. Professor, kkc college of nursing

2. ECTOPIC PREGNANCY

3. Definition The ectopic pregnancy in which the fertilized ovum is implanted and developed outside of the normal uterine cavity. According to “DC. Dutta ”

4. Sites of implantation Sites of Implantation Extra uterine Intra uterine Tubal Ovarian Abdominal Cervical Cornual (97%) (5%) (1%) (0.4%) (<1%) Ampulla (55%) Isthmus (25%) Infundibulum (18%) Interstitial (2%)

5. Sites of implantation:

6. Etiology: Previous history of ectopic pregnancy Previous tubal pregnancies Previous history of abdominal or tubal surgeries with resulting scar and adhesions in the tube Previous induced abortions Advanced maternal age Endometriosis of the tubal wall and lumen Salphingitis Congenital and developmental anomalies of the fallopian tube

7. Signs and symptoms: The first warning sign of an ectopic pregnancy is light vaginal bleeding and pelvic pain If blood leaks from the fallopian tube they may feel shoulder pain or an urge to have bowel movement Severe lower abdominal pain especially on one side Vaginal bleeding or spotting Shoulder pain Feeling very weak and dizzy Fainting Stomach upset and vomiting

8. Clinical features: The clinical features are varied from the morbid pathological changes in the tube and depends on the site of implantation clinical features Acute Un ruptured Chronic

9. Acute clinical features Abdominal pain History of amenorrhea Radiating shoulder pain Pallor Decreased pulse rate Vaginal bleeding Nausea Vomiting Fainting

10. Abdominal examination: The lower abdomen is tense, tumid, and tender. No mass is usually felt and dullness present. Bowels may be distended. Pelvic examination: vaginal mucosa – blanched white Uterus seems normal in size or slightly bulky Extreme tenderness on fornix palpation or an movement of the cervix No mass is usually felt through the fornix

11. Unruptured clinical features Presence of delayed periods Uneasiness on one side of the flank which is continuously colicky in nature Bimanual examination: Based on the examination the features are: Uterus is slightly smaller than the period of amenorrhea A pulsatile small well circumscribed tender mass may be felt through one fornix separated from the uterus.

12. Chronic features: Lower abdominal pain colicky in nature Amenorrhea Dark coloured vaginal bleeding and continuous in nature Dysuria Urine retention Increased pulse rate Shock Increased temperature due to infectious or due to absorption of the products of degenerative accumulated blood in the abdomen

13. Based in bimanual examination: Vaginal mucosa – pale Uterus seems normal in size and bulky Extreme tenderness on movement of the cervix Abdominal examination: Tenderness on the lower abdomen specially on the affected side A mass in the lower abdomen felt irregular and tender Cullen’s sign: dark bluish discoloration around the umbilicus.

14. Diagnostic tests: Complete blood picture Estimation of hcg levels Culdocentesis Sonography Colour doppler Laproscopy Dilatation and curettage Serum progesterone

15. Diagnostic tests: Complete blood picture – should be done routine because the varying degrees of leucocyte count and raised ESR. ABO and Rh typing Estimation of Hcg levels – A single estimation of β Hcg levels either in the serum or in urine to confirm the pregnancy but cannot determines its location. Culdocentesis – It is safe and simple and alternative to the laproscopy , unfortunately a negative culdocentesis does not rule out an ectopic pregnancy neither a positive result is very specific.

16. Sonography – Transvaginal sonography is more informative. Fluid in the pouch of douglas and adnexal mass clearly seperated from the ovary and rarely cardiac motion may be seen. Colour doppler - Can identify the placental shape,and enhance the blood flow pattern to the outside of the uterine cavity. laproscopy – It is benefit in cases of confusion with other pelvic lesions.it should be done when the patient is hemo -dynamically stable.

17. Dilatation and curettage – Identification of decidua without villi structures is very much suggestive Serum progesterone – The level greater than 25ng/ml is suggestive of viable intra uterine pregnancy where as level less than 5ng/ml suggests an ectopic or abnormal intra uterine pregnancy.

18. MANAGEMENT Medical management: An early ectopic pregnancy without unstable bleeding is more often treated with a medication called as Inj.Methotrexate which stops cell growth and dissolves existing cells. Inj.methotrexate Potassium chloride

19. Surgical management: Solpingostomy - The ectopic pregnancy is removed and the tube left to heal on its own is called salphingostomy Salpingectomy – The ectopic pregnancy and the tubes are both will removed.