ECTOPIC PREGNANCY

ECTOPIC PREGNANCY

Ectopic pregnancy is an implantation of a fertilized ovum in a site other than the endometrial lining of the uterus

הריון חוץ רחמי בחצרוצה

RISK FACTORS • Tubal damage caused by PID; surgery • Endometriosis • Previous ectopic pregnancy • Presence of an IUD • Congenital anomalies of the tube • IVF • Advanced maternal age

CLINICAL SIGNS • One-sided lower abdominal pain • Slight vaginal bleeding These are the signs of an ectopic that has NOT ruptured

CLINICAL THERAPY • Assessment of menstrual history; especially the last menstrual period • Blood test– BetaHCG; CBC; Blood type-cross match • US • HL • D/D for appendicitis; ovarian cyst; torsion of ovary; UTI; spontaneous abortion

MEDICAL MANAGEMENT • Methotrexate (MTX) IM with follow-up of BetaHCG till the beta is down The woman is instructed to return to the hospital immediately if she experiences heavy bleeding, severe pain and dizziness.

Severe one-sided lower abdominal pain Fainting and\or dizziness Right shoulder pain Signs of hypovolemic shock CLINICAL SIGNS OF ECTOPIC THAT HAS RUPTURED

CLINICAL THERAPY • NPO • US • IV • Blood type and cross-match • CBC; PTT;PT; Biochemistry • 2 PC Blood • Immediate surgery—laparoscopic salpingectomy or abdominal salpingectomy

CLINICAL MANAGEMENT • Assessment of the vaginal bleeding • Assessment of the hemovac (if there is one) • Vital signs • Urine output (catheter) • Pain management • I & O • Emotional support; grieving

אפשרויות הטיפול בהריון חוץ רחמי • מעקב והסתכלות תרופתי כירורגי • MethotrexateLaparatomy Laparascopy expectant management כריתת חתך חליבה חצוצרה בחצוצרה Milking Salpingostomy Salpingectomy

DISCHARGE COUNSELING • Prevent infection • Symptoms to report (pain, bleeding and fever) • Follow-up visit • Emotional support

ECTOPIC PREGNANCY