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    Ectopic Pregnancy Y3

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    Nguyen
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    Ectopic Pregnancy Y3

    Uploaded by

    Nguyen
    1 views35 pages
    Ectopic Pregnancy Y3

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    © © All Rights Reserved

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    Ectopic Pregnancy Y3

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    1 views35 pages

    Ectopic Pregnancy Y3

    Uploaded by

    Nguyen
    Ectopic Pregnancy Y3

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 35

    ECTOPIC PREGNANCY

    Dr. Le Trung Quoc Thanh. MSc


    Objective
    • Remember definition and locations of ectopic pregnancy.
    • Know risk factors of ectopic pregnancy.
    • Know to use clinical information, laboratory and ultrasound to
    approach and diagnosis ectopic pregnancy.
    Definition
    • Ectopic pregnancy is defined as a pregnancy that occurs outside of the
    uterine cavity.
    • ectopic pregnancy accounts for 2% of all reported pregnancies.
    • Ruptured ectopic pregnancy is a significant cause of pregnancy-
    related mortality and morbidity. (accounted for 2.7% of all pregnancy-
    related deaths).
    LOCATION

    Cunningham, 2010

    heterotopic pregnancy: ectopic pregnancy co-occur with an intrauterine


    pregnancy
    Etiology
    • Fallopian tube problems result from conditions that block or damage
    the tube
    • Anatomy: scar, narrow, obstruction
    ectopic pregnancy diagnosis
    • Function: decline the movement of villus

    unknown risk factor have risk factor


    Risk factor
    • pelvic infections
    • Sexually transmitted disease:
    Chlamydia…
    • Tuberculosis
    Risk factor
    • Prior pelvic or fallopian tube surgery
    Risk factor
    • Endometriosis
    Risk factor
    • infertility and assisted reproductive technology
    Risk factor
    • history of ectopic pregnancy
    Risk factor
    • intrauterine device (IUD)
    Risk factor
    • Smoking more than 20 cigarettes a day
    • Age > 35
    Progress of a tubal ectopic
    pregnancy
    • Rupturedinternal bleedingdeath
    • Resolution
    • Discharge to abdominal
    DIAGNOSIS
    • Hard to diagnosis.
    • Wide spectrum of clinical presentations
    • Until the location of the pregnancy is confirmed, the diagnosis
    remains a pregnancy of unknown location.

    history

    physical
    Ultrasound
    examination

    laboratory
    HISTORY
    • Patient’s age, PARA
    • Menstrual history
    • current contraceptive status
    • Identify risk factor of ectopic pregnancy
    • classic symptom triad:
    • Abdominal pain (99%)
    • Amenorrhea (75-90%)
    • Vaginal bleeding (56%)
    • QS at home
    Physical Examination
    • Vital signs
    • Full – body examination, notice abdomen and pelvis
    • Speculum examination
    • Bimanual examination
    Unruptured ectopic pregnancy
    • vital signs: normal
    • Abdomen: nontender or mildly
    tender, with or without rebound
    • Uterus: slightly enlarged
    • Vagina: bleeding from cervix
    • Cervical motion tenderness: ±
    • Palpaple adnexal mass: consistency,
    soft and tenderness
    • recto-uterine pouch: soft, no
    tender
    Ruptured ectopic pregnancy

    • Vital signs: tachycardia, hypotension


    • Palm skin
    • Bowel sounds are decreased or absent
    • Abdomen: tenderness and rebound
    tenderness
    • Cervical motion tenderness : +
    • recto-uterine pouch: tenderness
    Quantitative β-human chorionic
    gonadotropin (β-hCG)
    • Urine pregnancy tests detect β- hCG at ≥20 mIU/mL
    • Serum pregnancy tests detect levels >5 mIU/mL
    • hCG levels peak at 10 weeks gestation and the average peak level is
    100,000 UI/ml
    • hCG levels cannot predict gestational age
    Single Human Chorionic
    Gonadotropin Level
    • negative to exclude the diagnosis of ectopic pregnancy
    • a-hCG level greater than the ultrasound discriminatory zone indicates
    a possible extrauterine pregnancy
    • Discriminatory zone: hCG value above which the landmarks of a nor-
    mal intrauterine gestation should be visible on ultra- sonography.
    • Old Value: 1000-2000 mIU/ml
    • New update: can up to 3500 mIU/ml in patient hopes to continue (ACOG
    2018)
    Serial Human Chorionic
    Gonadotropin Level
    • required when results of the initial ultrasonography examination are
    indeterminate.
    • Follow up to 48 hours:
    • normal intrauterine >< ectopic pregnancy
    • Intrauterine failure >< resolution of ectopic pregnancy
    • normal pregnancy: traditionally rise at least 66% (85% confidence interval)
    • updated: rise at least 53% (99% confidence interval)
    • expected rise depends upon starting β-hCG level: 1,500, 1,500 - 3,000, ≥ 3,000 mIU/mL ≈
    49%, 40%, 33%
    • at least three serial values is helpful, especially if the starting β-hCG level is low
    • spontaneous abortions: decrease 21% - 35% 2 days after presentation
    • 85% drop within 4 days or a 95% drop in 7 days: risk of ectopic pregnancy = 0
    Ultrasonography

    Pseudosac: decidual reaction

    Real intruterine pregnancy: double – decidual sign


    Ultrasonography
    Intrauterine pregnancy Pseudosac

    Endometrial hyperplasia ++++ +

    Location in endometrial eccentric center


    cavity

    double – decidual sign + -


    Ultrasonography
    • Tubal ectopic pregnancy: diagnostic on ultrasound
    • Gestational sac located outside uterine with yolk-sac, embryo ± heart rate
    • Mass located beside uterine with adnexal rings (fluid sacs with thick
    echogenic rings) (Bagel sign).
    • Heterogenous echogenic adnexal mass out of the ovary (Blod sign)

    Bagel sign Blod sign


    Ring of fire
    • Signs suggest ectopic pregnancy on ultrasound:
    • Empty Uterus/ Pseudosac
    • Adnexal mass
    • Free fluid
    • The presence of intra-abdominal free fluid should raise concern
    about tubal rupture.
    • Paracolic gutter: 200 ml
    • Morrison space: 500 ml
    Dilation and Curettage
    • performed when the pregnancy is
    confirmed to be nonviable
    • It is essential to confirm the presence of
    trophoblastic tissue
    • After tissue is obtained by curettage, add it
    to saline:
    • Decidual tissue does not float.
    • Chorionic villi are usually identified by their
    characteristic lacy frond appearance
    • Intrauterine pregnancy: after evacuation, the
    β-hCG level decreases by greater than 15%
    within 12 to 24 hours
    Diagnosis
    DIFERENTIAL DIAGNOSIS
    • Intrauterine pregnancy with adnexal tumor
    • Appendicitis
    • https://pollev.com/thanhle972

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