1 / 34

Lecture 8 ECTOPIC PREGNANCY. ABORTION

Lecture 8 ECTOPIC PREGNANCY. ABORTION. Prof. Vlad TICA, MD, PhD. ECTOPIC PREGNANCY. DEFINITION Implantation outside of the uterine cavity

rance
Download Presentation

Lecture 8 ECTOPIC PREGNANCY. ABORTION

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Lecture 8ECTOPIC PREGNANCY. ABORTION Prof. Vlad TICA, MD, PhD

  2. ECTOPIC PREGNANCY DEFINITION • Implantation outside of the uterine cavity • It is a condition that significantly jeopardizes the mother → catastrophic bleeding may occur when the implanting pregnancy erodes blood vessels / ruptures of the tubal wall

  3. IMPLANT LOCATIONS • Tubal: 95% (80% ampullary portion) • Ovarian: < 1% • Abdominal: 1-2% • Cervical: 0.15% • Cornual: 2%

  4. ETIOLOGY • Salpingitis - 6x increase the risk of ectopic pregnancy • Operation of fallopian tubes • IUD (intrauterine device) • Dysfunction of fallopian tubes • Other: endometriosis

  5. OUTCOMES OF ECTOPIC PREGNANCY • Tubal abortion • 8-12 weeks ampullary portion • Rupture of tubal pregnancy • 5 weeks isthmic portion • Tubal abortion with subsequent implantation • on an intraperitoneal structure, for example liver pregnancy

  6. CLINICAL MANIFESTATIONS • Amenorrhea - 70-80% (6-8 weeks) • Abdominal and pelvic pain - the most common symptom, which is present in nealy all patients • Pain is a result of distented of fallopian tube and irritation of peritoneum by blood • Irregular vaginal bleeding - results from the sloughing of the decidua • Shock - result from amount of blood loss • Abdominal mass

  7. PHYSICAL FINDINGS IN TUBAL PREGNANCY • Anemic / pale face • Pulse ↑↓ • BP ↓ • T < 38 ºC

  8. ABDOMINAL EXAMINATION • Distention and tenderness with or without rebound • Decreased bowel sound • Shifting dullness positive • Mass

  9. PELVIC EXAMINATION • Slightly open cervix with bleeding • Cervical motion tenderness • Adnexal tenderness • Adnexal mass • The uterus size may be normal / enlarged

  10. DIAGNOSTIC PROCEDURES • Typical cases can be determined easy • Early ectopic pregnancy / unruptured type - difficult • It is necessary to need assistant examination

  11. DIAGNOSTIC PROCEDURES • Typical cases can be determined easy • Early ectopic pregnancy / unruptured type - difficult • It is necessary to need assistant examination

  12. DIAGNOSTIC PROCEDURES A. hCG TEST • 80-100% positive • Urinary hCG level • Blood hCG level • If hCG negative, ectopic pregnancy does not be rule out B. TYPE B ULTRASOUND

  13. DIAGNOSTIC PROCEDURES C. CULDOCENTESIS • Aid in the identification of peritoneum bleeding • Positive (noncloting blood) • Ectopic pregnancy may be confirmed • Negative ectopic pregnancy does not be depletion

  14. DIAGNOSTIC PROCEDURES D. LAPAROSCOPY • It is a direct visualization and accurate method to diagnosis ectopic pregnancy • Even laparoscopy - 2-5% misdiagnosis rate • an extremely early tubal pregnancy gestation may not be identified

  15. PATHOLOGY OF ENDOMETRIUM • Curettage of the uterine cavity can also help rule out ectopic pregnancy • Identification of chorionic villi in curetting may identify an intrauterine pregnancy

  16. DIFFERENTIAL DIAGNOSIS • Abortion • Acute salpingitis • Acute appendicitis • Rupture of corpus luteum • Torsion of ovarian cyst

  17. TREATMENT SURGICAL TREATMENT • Salpingectomy • Conservative operation • Salpingostomy • Segmental resection and tubal reanastomosis

  18. TREATMENT CHEMICAL THERAPY • Drug: MTX • Indications: • The diameter of the mass < 3cm • Unrupture • Not significantly bleeding • hCG level < 2000 UI/L

  19. ABORTION DEFINITION • The termination of a pregnancy before 26 weeks from the first day of the last menstrual period

  20. CLASSIFICATION • Early abortion: < 12 wks • Late abortion: 12-28 wks • Spontaneous abortion • Artificial abortion

  21. ETIOLOGY • Genetic factors • Maternal factors • Infection • Systemic factors, heart disease, sever anemia, endocrine • Reproductive tract abnormality • Immunologic factors • Enviromental factors - Toxin, Radiation, smoking, alcohol

  22. PATHOLOGY • Haemorrhage occurs in the decidua basalis leading to local necrosis and inflammation

  23. PATHOLOGY • The ovum, partly or wholly detached, acts as a foreign body and irritates uterine contractions. The cervix begins to dilate.

  24. PATHOLOGY • Expulsion complete. The decidua is shed during the next few days in the lochial flow

  25. CLINICAL MANIFESTATIONS • Haemorrhage • usually the first sign • may be significantly if placental separation is incomplete • Pain • usually intermittent, ‘like a small labrur’ • it ceases when the abortion is complete

  26. THREATENED ABORTION • Low abdominal pain • Vaginal bleeding • Cervix is closed • Unruptured membranes • Embryo survive

  27. INEVITABLE ABORTION • Bleeding increased • Pain development • Rupture of membranes • Cervix dilation • Embryo tissue incarcerated in the cervix

  28. COMPLETE ABORTION • Uterine contractions are felt, the cervix dilates and blood loss continues • The fetus and placenta are expelled complete, the uterus contracts and bleeding stops • No further treatment is needed

  29. INCOMPLETE ABORTION • In spite of uterine contractions and cervical dilatation, only the fetus and some membranes are expelled • The placenta remains partly attached and bleeding continues • This abortion must be completed by surgical methods

  30. MISSED ABORTION • Is the retention of a failed intrauterine pregnancy for a extended period, usually defined as > 2 menstrual cycles RECURRENT ABORTION • The patient has had two / more consecutive spontaneous abortions SEPTIC ABORTION

  31. TREATMENT INCOMPLETE ABORTION • Remove the embryo and placenta as soon as possible • Negative pressure suction • Embryulcia MISSED ABORTION • Notice blood clot function prevent DIC SEPTIC ABORTION • Broad-spectrum antibiotics

  32. REMOVAL OF PLACENTAL TISSUE WITH OVUM FORCEPS

  33. REMOVAL OF PLACENTAL TISSUE WITH CURETTE

  34. THANK YOU !

More Related