Ectopic pregnancy

                                                        ECTOPIC PREGNANCY
Ectopic pregnancy is the implantation of pregnancy outside of uterine  cavity. The common areas where ectopic pregnancy occur include fallopian tube,uterine interstitium, cervix, ovary, abdominal cavity, pelvic cavity etc. The most common site of ectopic pregnancy implantation is fallopian tube followed by uterine interstitium.
Epidemiology
- incidence is 2/100 of diagnosed pregnancies and its increase with maternal age.
- recurrence risk is about 10 to 25% from the first ectopic pregnancy.
- 5% of ectopic pregnancies occur when intrauterine device (IUD) is in place.

Risk factors
- higher maternal age
- pelvic inflammatory disease (P.I.D)
- post tubal surgery
- past history of ectopic pregnancy
- cigarette smoking
- history abortion
- assisted reproductive techniques

Symptoms and signs
-pelvic pain-common presentation
-vaginal bleeding
-severe pain followed by syncope/shock is sign of rupture ectopic pregnancy.
-small uterus compared to dates
-cervical motion tenderness may be present.

Diagnosis
- clinically is diagnosed in any reproduction age women with history of amenorrhea, pelvic, vaginal bleeding, unexplained syncope or hemorrhagic shock.
- physical examination like per abdomen examination may support the diagnosis.
- definitive diagnosis include urine test for

•  beta human chorionic gonadotropin -sensitive for 99% of pregnancy test include ectopic. If beta-hCG is < 5 mIU/ml, ectopic pregnancy is excluded. Absences of gestation sac with beta-hCG, are strongly suggest ectopic pregnancy.
• ultrasonography -ultrasound detect uterine gestation sac, ectopic pregnancy is unlikely when uterine gestation sac is seen, but care should be taken in case of abdominal ectopic pregnancy, because it may look the same in ultrasound. absence of uterine gestation are likely to be ectopic pregnancy. mixed masses (contain cyst and solids)  may be seen.

Treatment

•   surgical treatment- laparascopic (for hemodynamically stable) or open surgical resection (especially for unstable patient).
• medical treatment- 50mg/meter square single dose of methotrexate is given IM , in case of unruptured ectopic pregnancy, with not fetus heart rate, and with < 5000 mIU/ml of beta-hCG level. beta-hCG test are repeated after 4 and 7 days and when it doesn't fall, a second dose of methotrexate or surgery is needed.

Prognosis
- untreated ectopic pregnancy is fatal and maternal death is rare if treatment occur before rupture
- results in 10% of pregnancy maternal related death.
- 50% of fetuses are alive during surgery but only few reported to survive.

Complications
- ruptured into peritoneal cavity
- intra peritoneal abscess
- bleeding
-shock
-lithopedion/stone baby
-maternal death

    

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                             by MWANDA MD.