Ectopic Pregnancy

Definition 

1. Ectopic pregnancy is a life threatening condition where a fertilized egg implants and grows outside the uterus.

2. An Ectopic pregnancy occurs when a fertilized ovum implants outside of the endometrial lining of the uterine cavity.

Implantation Site

• Fallopian Tube (95-98%)

          ° Ampullary (70%)

          ° Isthmic (12%)

          ° Fimbrial (11%)

          ° Interstitial (2-4%)

• Ovarian (3%)
• Abdominal (1%)
• Cervical (<1% )
• Cesarean Scar (<1% )

Incidence Rate:-  it's occur in approximately 1-2% of all pregnancy 

Mortality Rate :-  3-4% of pregnancy

Etiology 

•  Anatomical anomalies of the fallopian tubes
• Tubal Malformation
• Previous surgeries leading to scarring 
• Pelvic Inflammatory disease 
• Previous Ectopic pregnancy 
• Tubal Surgery
• In Vitro Fertilization (IVF) 
• Smoking
• Endometriosis
• Uterine and Tubal Adhesions
• Maternal age Previous abdominal or pelvic's surgery
• Multiple Sexual partners
• Douching 
• Congenital Tubal Abnormalities
• Genetic Factor
• Infertility treatment

Causes

• PID (Pelvic Inflametory disease)
• Failure of IUD 
• Tubal Trauma
• Tubal ashesion
• ART (assistent reproductive technique) 
• Advanced age 
• Vaginits 

Stages

1. Un ruptured Ectopic Pregnancy :- The Embryo continues to grow in the abnormal location. 
2. Threatened Ectopic Pregnancy :- Symptoms suggest potential rupture or complication. 
3. Ruptured Ectopic Pregnency :- The structure containing the embryo bursts, causing internal bleeding and acute symptoms. 

Clinical Features

• Severe abdominal Pain
• Shoulder pain 
• Dizziness
• Amenorrhea 
• Vaginal bleeding No growth fundal hight 
• Decrease oestrogen & Progesteron level 
• Cullein's Sign ( Bluish discoloration in periumbias area) 
• Sign of shock 
• Hypotension 
• Pain radiate toward shoulder

DIAGNOSIS

• History collection 
• Physical examination 
• HCG level
• Harmonal diagnosis 
• Laproscopy 
• Laprotomy
• USG

MANAGEMENT 

  Medical Management 
                                    If the viable product size is < 4cm then performe medical management. 

    Methotraxute :- 

        Route:-     Inj- IM - 

         Function:-  To stop cell division 

          Dose :-  50 mg/m2

                        1,3,5,7th day

Surgical Management 

                                If the viable product size is > 4 cm than perform Surgery. 

I) Conservative surgery:- 

    A) Salphingostomy :- Salpingostomy is a surgical procedure to make an incision in a fallopian tube, to treat conditions ectopic pregnancy. Use laser to stop bleeding and no sutering Performe 

    B) Salphingotomy :- Salpingotomy is a surgical procedure to make an incision in a fallopian tube, to treat conditions ectopic pregnancy.

II) Non- Conservative surgery 

    A) Salphingectomy :- Salpingectomy: how and why are the Fallopian tubes extracted?A salpingectomy is a surgical procedure for the removal of one or both fallopian tubes. 

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