Bansal MBBS,MS,MICOG,FICOG Professor OBGY ExPrincipal & Controller Jhalawar Medical College & HospitalMahatma Gandhi
Medical College, Jaipur.
11. Prev Previous induced abortion Age 35-45 yrs Other Risk factors
Fundal Fibroid Genital Tuberculosis Salpingitis Isthmica Nodosa Infertility
DES Exposure in Utero Cigarette smoking ious pelvic surgeries &
Transperitoneal migration of ovum Adenomyosis of tube
12. Iffy hypothesis Theory of reflux menstural fluid throw the fertilised
ovum into the tubeFactors facilitating nidation of ovum in tube: - Premature
degeneration of zona pellucida - Increased decidual reaction - Tubal
endometriosis
13. Tubal pregnancies rapidly invade the mucosa, feeding from the tubal
vessels, which become enlarged and engorged. The segment of the affected tube
is distended as the pregnancy grows. Possible outcomes of such abnormal
gestations are as follows:Evolution
15. In rare instances, a tubal pregnancy will be expelled from the tube and
seed onto sites in the abdominal cavity (e.g. the omentum, the small or large
bowel, or the parietal peritoneum), and gives rise to a viable abdominal
pregnancy.
19. P/V:- uterus may be bulky, deviated to opposite side, fornix is tender,
excitation pain on movement of cervix. POD may be full, uterus floats as if in
water. P/S:- minimal bleeding may be present P/A:- abdomen tense, tender
mostly in lower abdomen,shifting dullness, rigidity may be present. O/E:- patient
is restless in agony, looks blanched, pale, sweating with cold clammy skin.
Features of shock, tachycardia, hypotension.
20. She may have amenorrhoea, vaginal bleeding with dull pain in
abdomen,and with bladder and bowel complaints like dysuria,frequency or
retention of urine, rectal tenesmus. Patient had previous attack of acute pain from
which she has recovered. It can be diagnosed by high clinical
suspicion.CHRONIC ECTOPIC PREGNANCY
21. P/V:- Vaginal mucosa pale, uterus may be normal in size or bulky, ill
defined boggy tender mass may be felt in one of the forni P/A:- Tenderness and
muscle guard on the lower abdomen. A mass may be felt, irregular and tender.
O/E:- patient look ill, varying degree of pallor, slightly raised temperature. Features
of shock are absent.x.
24. Now the rate of tubal rupture is as low as 20%. This has resulted in
early diagnosis and effective treatment. This is due to the widespread
introduction of diagnostic tests and an increased awareness of the serious nature
of this disease. In recent years, inspite of an increase in the incidence of ectopic
pregnancy there has been a fall in the case fatality rate.DIAGNOSIS
hCG and can be detected on 24th day after LMP. Blood should be drawn for Hb
gm%, blood grouping and cross matching, DC and TWBC, BT, CT. Patient with
acute ectopic can be diagnosed clinically.DIAGNOSIS
Potassium chloride -Salpingotomy - Prostagladin(PGF2) - Hypersmolar glucose Segmental - Actinomycin D resection - Mifepristone -Milking or fimbrial expression
43. Warning: - Tubal pregnancies have been known to rupture even when
Serum HCG levels are low. The percentage fall in serum HCG by day 7 is a
better indicator than the percentage fall by day 2. In spontaneous resolution, it
may take 4-67 days (mean 20 days) for the serum HCG to return to non pregnant
level. Spontaneous resolution occurs in 72%,while 28% will need laparoscopic
salpingostomyEXPECTANT MANAGEMENT
51. VARIOUS CONSERVATIVE SURGERIES1.Linear Salpingostomy: Indicated in unruptured ectopic <2cm in ampullary region. - Linear incision given
on antimesentric border over the site and product removed by fingers, scalpel
handle or gentle suction and irrigation. - Incision line kept open (heals by
60. OVARIAN ECTOPIC PREGNANCYIncidence: 1:40,000Risk factor: IUCD - Endometriosis on surface of ovaryCourse:C/F are same as tubal
pregnancy ruptures within 2-3 wksDiagnosis: On LaparotomySpiegelbergs Criteria
1. Ipsilateral tube is intact and separate from sac 2. Sac occupies the position of
the ovary 3. Connected to uterus by ovarian ligament 4. Ovarian tissue found on
its wall on HP study Ruptured M/M Unruptured Laparotomy Ovarian wedge
resection Ovarian Cystectomy Oophorectomy
71. USG slows on empty uterine cavity and gestational sac attached low to
the lower segment caesarean scar.C/F : similar to threatened or inevitable
abortionDiagnosis : Doppler imaging confirmsT/t : Methotrexate injection
Hysterectomy in a multiparous women. In young pt resection Recently
reportedCAESAREAN SCAR ECTOPIC PREGNANCY & suturing of scar may be
done (high risk of rupture).