From Medicineworld.org: Ectopic pregnancy
when the women with intrauterine contraceptive device become pregnant.
What are the features of ectopic pregnancy?
The clinical feature depends on whether the ectopic pregnancy has ruptured or not.
In an unruptured tubal pregnancy:
The patient usually presents with a short period of amenorrhea (usually 6-8 weeks) with features suggestive of pregnancy. There is pain on one side of the lower abdomen which is continuous or sometimes colicky. The physician must have high degree of suspicion to diagnose unruptured ectopic pregnancy. Transvaginal ultrasound is more useful.
In a case of acute ectopic pregnancy (tubal rupture)
The patient presents with sudden onset of symptoms. After a short period of amenorrhea, the patient has sudden onset of abdominal pain, which is present in the lower abdomen which later spreads to the whole abdomen. There may be pain in the shoulder tip. Vaginal bleeding is slight and dark colored blood comes which is continuous. There will be nausea, vomiting and fainting attacks. If there is massive bleeding due to rupture, the patient will have features of shock like cold and clammy extremities, rapid pulse and low blood pressure. The abdomen is tense and pain will be there on examination.
In cases of Chronic or old ectopic:
This is the commonest type of presentation of ectopic pregnancy. Here there is pelvic haematocele a result of tubal leak following tubal pregnancy.
How do you diagnose ectopic pregnancy?
The classic history of acute abdominal pain in pregnant woman with fainting attack and collapse with features of bleeding inside the abdomen points to the diagnosis of ectopic pregnancy. The conditions which mimic acute ectopic pregnancy are acute appendicitis, perforated peptic ulcer, twisted ovarian tumour, ruptured endometrial cyst
Chronic ectopic pregnancy causes confusion to the treating physician. The following conditions present like chronic ectopic pregnancy: Incomplete abortion in a retroverted uterus, salphingitis, appendicitis, twisted ovarian tumour. Basic blood examination like Hemoglobin, Blood grouping are done. In a woman, when pregnancy test is positive and the ultrasound examination shows empty uterus, the diagnosis of ectopic pregnancy is made. Transvaginal sonography is useful in diagnosing ectopic pregnancy. Laproscopy is helpful if other conditions cause confusion in diagnosing an ectopic pregnancy
What is the treatment of ectopic pregnancy?
In patient with acute ectopic pregnancy presenting with shock, intravenous fluids should be started and morphine should be given for pain. Surgical treatment is needed for ruptured ectopic pregnancy (Emergency laprotomy or laproscopic surgery) Blood transfusion is given to replace the lost blood.
In case of non ruptured ectopic pregnancy medical treatment with methotrexate, potassium chloride, prostaglandins or mifepristone is indicated.
What is the prognosis of ectopic pregnancy?
Because of the immediate recognition of the condition and treatment, maternal mortality is reduced to 0.05%. An ectopic mother has got a chance of recurrence of 10% in future pregnancy.
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Medicineworld.org: Ectopic pregnancy
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