Ectopic Pregnancy PPT Notes, Summaries of General Surgery

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ECTOPIC PREGNANCY

NAME : GAURAV PATEL

GROUP .NO: 507

Ectopic pregnancy

Definition :

An ectopic pregnancy is one in which the

fertilised ovum becomes implanted in a site other than the

normal uterine cavity.

• (^) Extrauterine pregnancy -but rudimentary horn of a

bicornuate uterus.

• (^) It is the consequence of an abnormal implantation of the

blastocyst.

Sites of ectopic pregnancy According to frequency

• Fallopian tubes 95 - 98% (At fimbriated end 17%, Ampulla- 55%,Isthmus 25% interstitial 3%)
• Uterine cornu 2 - 2.5%
• Ovary, Cervix & abdominal cavity <1%
• (^) Right side is more common than left.

Risk factors

• PID (pelvic inflammatory diseases — 6 fold increases risk
• Use of IUCD —3-5% increased risks
• Smoking 2.5% increased risks
• ART 3 - 5% increased risks
• Tubal damage
• Tubal surgery 5.8%
• Salpingitis isthmica nodes 3.5% increased risks
• (^) Prior ectopic pregnancy cont.

Aetiology

• Tubal damage or altered motility results improper transport of blastocyst
• Most common cause is acute salpingitis 50%
• In 40% no risk factors apparent
• Salpingitis causes peritubal adhesion , lumen occlusion , intratubal adhesion diverticula & disturbed tubal function.
• PID due to infections eg Chlamydia, gonococcal, tuberculosis, postabortal, puerperal, pelvic peritonitis also appendicitis
• Altered tubo- ovarian relationship in endometriosis.

Sites of ectopic pregnanc y

Clinical features Symptom & signs

• Normal symptom & signs of pregnancy ( amenorrhoea and uterine softening )
• Acute abdominal pain(dull, cramps or colicky )
• Evidence of haemodynamically instability (hypotension, collapse, S/S of shock)
• Adnexal mass (with or without tenderness)
• Vaginal bleeding
• Signs of peritoneal irritation
• Absence of G. Sac in uterine cavity on USG with a beta HCG > 2500 mlU/ml

Classical triad

• A pt. with amenorrhoea, pain, vaginal bleeding should always be suspected to have an ectopic pregnancy.
• The dictum to early diagnosis & successful management is to “Think Ectopic” but also not to “Over Think Ectopic”.

Diagno sis Classical triad of pelvic pain, vaginal spotting and amenorrhoea 5 - 9weeks Others Adnexal mass or tenderness, S/S pregnancy, dizziness, passage of clot or tissue. In case of rupture - shoulder pain due to diaphragmatic irritation S/Sign of shock

Tests and aid to diagnosis

• Urine for PT - 5 0% case positive
• Serum beta HCG- is less as compared to normal pregnancy. (TVS detect sac when beta HCG >2400mIU/ml. ✤ (^) Serial beta HCG in 48 hours not double
• Serum Progesterone >25 ng/dl is associated with an intrauterine preg in 97.5%
• Ultrasound.

Ultrasoun d Extrauterine

• (^) No findings
• (^) Live tubal pregnancy
• Adnexal ring sign
• Complex adnexal mass
• (^) Free fluid in pouch of Douglas. ✤ (^) Colour dopplar will classically identify “ ring of fire ” around the ectopic on the same side of corpus luteum.

Other placental marker

• Serum creatine kinase (CK)
• Pregnancy specific beta(1)-glycoprotein(sp1)
• Human placental lactogen(HPL)
• Pregnancy associated plasma proteins A (PAPP-A)
• Vascular endothelial growth factors, progesterone and PAPP - triple marker test
• Cancer antigen 125 (CA125)
• Serum IL- 8 ,IL 6 ,and TNF-𝛼increases in ectopic.

Manangement & Treatment Options

• Hospitalisation
• Shock must be treated before she is moved.
• Options depends on ◆ Condition of patient like acute chronic ,ruptured , enraptured , ectopic other than fallopian tube eg uterine scar, ovarian, cervical, abdominal.

Options

• Expectant management
• Medical
• Surgical