Wednesday, March 9, 2011

Signs of ectopic pregnancy

Definition of ectopic pregnancy: Implantation of a conceptus outside the uterine cavity.
Occurs approximately 1 in 1000 pregnancy. 95% of which is tubal ectopic.

Risk factors for ectopic pregnancy
  • History of infertility of assisted conception
  • History of pelvic inflmmatory disease
  • Endometriosis
  • Prev pelvic surgery
  • Previous ectopic pregnancy
  • IUCD
  • Smoking
  • Higher maternal age

Symptoms of ectopic prenancy
  • Mostly asymptomatic
  • Abdominal pain
  • Dark PV bleed
  • Shoulder tip pain (ruptured ectopic with intra-abdominal blood irritating diaphragm)
Signs of ectopic pregnancy
  • Abdominal tenderness
  • Adnexum tenderness
  • Cervical excitation

Investigations of ectopic pregnanacy
  • Serum HCG >1500 or 66% rise in 48 hr suggestive of intra-uterine pregnancy
  • Trans vaginal Ultrasound
  • Laproscopy is gold standard
Treatment of ectopic pregnancy
  • Expectant: under strict criteria
  • Medical: Methotrexate -use contraception for 3 months as teratogenic
  • Surgical: Laproscopy vs Laprotomy. Salpingectomy or Salpingostomy
  • Anti-D in rhesus negative patients

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