Ectopic Pregnancy
Introduction
Ectopic pregnancy occur when fertilized ovum implant at some other place then that of uterus.
It come under high risk of pregnancy.
Special maternal and obsteptic care should be given to pregnant mother during gestational weeks.
Definition
Ectopic pregnancy is one in which the fertilized over is implanted and develop outside the normal utrine cavity that can be cervix, cornua, abdomen and fallopian tube.
Which leads to high risk pregnancy and complicated pregnancies.
Types of ectopic pregnancy..
1) Fimbrail pregnancy (11%)
2) Ampullary Pregnancy (70%)
3) Isthmic pregnancy (12%)
4) Interstitial pregnancy (2-3%)
5) Abdominal pregnancy (1%)
6) Cervical Pregnancy (1%)
7) Ovarian pregnancy (3%)
Etiology
1) Mechanical factors
That retarded passage of fertilized ovum into the uterine cavity.
2) Salpingitis
Agglutination of folds of tubal mucosa with narrowing of lumen and formation of blind pocket.
3) Intrauterine contraceptive uses
4) elective abortions and medical termination of pregnancy
5) infertility
6)Tubel surgery
7) Assistant reproductive techniques
8) Information and scoring of fallopian tube
9)Hormonal factors
10) Genetical abnormalities
11) Medical condition
12) Other ediopatic causes
Risk factors
1) Maternal age of 35 years or older
Maternal age more than 35 years can also be the cause of actopic pregnancy due to fluctuation in hormones and changes in reproductive health.
2) History of pelvic surgery abdominal surgery multiple abortion
Any previous pelvic surgery or abdomen surgery can also results in ectopic pregnancy because surgery changes the anatomical structure of the body.
3) History of pelvic inflammatory disease
History of any infection in perineal area, vaginaitis and other can also lead to actopic pregnancy
4) History of endometriosis
5) Smoking
If mother has history of smoking and alcoholism that can also lead to ectopic pregnancy as it leads to changes in amount of hormones.
6) Sexually transmit diseases history
Any sexually transmit disease HIV AIDS can also lead to actopic pregnancy.
Signs And Symptoms
1) Nausea and vomiting
In this the nozia and vomiting are worsen than that of normal pregnancy.
2) Breast soreness
3) Breast tenderness
4) Sharp waves of pain in abdomen, pelvis, shoulder and neck
The pain is more severe than that of abdomen pain in normal pregnancy pain radiates from from back to abdomen.
5) Severe pain that occurs one side of the abdomen
6) Light aur heavy vaginal bleeding
Vaginal bleeding before pregnancy.
7) Rectal pressure
8) Dizziness or fainting
Mother will feel tiredness and dizziness.
Investigation
1) Blood examination
Blood examination complete blood count, HCG level and hemocritis.
2) Culdocentesis
3) Beta HCG level
In ectopic pregnancy HCG is lower as compared to normal pregnancy.
4) Sonography
Management
Acute Ectopic
Resuscitation + laparotomy
With dextrose 5% drip and immediately arrange blood for transfusion.
Laprotomy
Abdomen is open as quickly as possible by vertical midline incision uterus is grasped under vision tubes and ovaries of both sides and inspected to find out offending sides are inspected to find out offending site than Salphingectomy is done.
Medical management
Various chemotherapeutic agents have been used.
Common used drugs are
Potassium chloride
Methotrexate
Prostaglandins