Ectopic Pregnancy
•
5 likes•352 views
ECTOPIC PREGNANCY WITH MEDICAL MANAGEMENT UPDATED UPON ACOG 2018
Recommended
Recommended
More Related Content
What's hot
What's hot (20)
Similar to Ectopic Pregnancy
Similar to Ectopic Pregnancy (20)
Recently uploaded
Recently uploaded (20)
Ectopic Pregnancy
- 1. Assistant Lecturer OB/GYN Department Benha Faculty of Medicine 2019
- 2. Ectopic pregnancy is a high-risk condition where in a fertilized ovum gets implanted outside the uterine cavity. This condition poses a significant threat to women of reproductive age and is a leading cause of maternaldeathduringthe first trimester. Introduction
- 3. Ectopic pregnancy still contributes significantly to the cause of maternalmortalityand morbidity. While there has been about fourfold increase in incidence over the couple of decades, but the mortalityhasbeenslasheddownby 80%. Recognition of high-risk cases , early diagnosis (even before rupture) with the use of TVS, serum Beta- hCG and laparoscopy have significantly improved the managementof ectopicpregnancy. Incidence
- 4. Safety First
- 5. Incidence is increasing ( From 1 % to 2.5 % ) Increasingly detected Detected early Current Scenario 95 – 98 % of all ectopic are tubal
- 6. Common Sites
- 7. P I D Most important factor( 50 % ) Prior Tubal Surgery Infertility,Reversal, Sterilization Past H/O ectopic 15 % & linearly increasing Infertility ART / Ovulation induction Progesteroneonly contraceptives,Em.Contraceptives IUCD Congenitalfactors,Old age, smoking Risk Factors No risk factor found in many cases
- 8. Course Of Ectopic Pregnancy Spontaneous resolution Tubal abortion (Ampullary, fimbrial ( Resolution Pelvic hematocele Hematosalpinx Tubal rupture (Isthmic,interstitial- at 12-16 wks ( Acute Chronic Secondary abdominal
- 9. Classicaltriad found in only 1/3rd cases Pain 90 % cases Amenorrhoea 80 % cases Bleeding 70 % cases Symptomsof shockin acute rupture Faintingattack typical but rare It can be asymptomaticalso Clinical Presentation (Symptoms) Ectopic pregnancy is a great deceiver
- 10. Adenexalmass Adenexaltenderness Cervical movementstenderness! Features of acute abdomen Cullen’ssign !! (Superficialedema and bruisingin the subcutaneousfatty tissue aroundthe umbilicus) Clinical Presentation (Signs)
- 11. Different Presentations Emergency presentation Suddenly, without warning a woman is very unwell, collapses and is taken to hospital in stage of haemoperitoneum and hemorrhagic shock. Subacute presentation The most common presentation is with a missed period, positive pregnancy test, some abdominal pain, and irregular vaginal bleeding High Risk Pregnancy Group After previous ectopic, tubal surgery or assisted conception (IVF) → detection rate is high → women are primary observed.
- 12. The discriminatory zone is based upon the correlation between visibility of the gestational sac andthehCGconcentration. It is defined as the serum hCG level above which a gestational sac should be visualized by ultrasound examinationif an intrauterinepregnancyis present. In most institutions, this serum hCG level is 1500 or 2000 IU/LwithTVS “ Thelevelishigher[6500 IU/L]withTAS. Discriminatory Zone
- 13. Serum hCG greater than 1500 IU/L without visualization of intrauterine or extrauterine pathology may represent a multiple gestation repeat the TVS examination and hCG concentration two dayslater. An ectopic pregnancy can be diagnosed if the serum hCG concentration is increasing or plateaued. Treatment can be instituted. A falling hCG concentration is most consistent with a failed pregnancy (eg, arrested pregnancy, blighted ovum, tubal abortion, spontaneously resolving ectopicpregnancy). B-HCG Above The Discriminatory Zone
- 14. Pregnancy of unkown location
- 15. Management
- 18. Contraindications Precuations Single dose Protocol Two dose Protocol Multiple dose Protocol Methotrxate therapy in Ectopic ( ACOG, 2018)
- 20. Precuations
- 28. Ovarian Ectopic
- 29. Cervical Ectopic
- 31. ACOG 2018 level A
- 32. ACOG 2018 level B
- 33. ACOG 2018 level C