Professional Documents
Culture Documents
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INCREASES WITHIN
3 MONTHS
FOLLOWING TERM
BIRTH
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BLIGHTED OVUM-when the gestational sac is open,
fluid id commonly found surrounding a small
macerated fetus or alternately no fetus is visible
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THREATENED ABORTION INEVITABLE ABORTION
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INCOMPLETE ABORTION MISSED ABORTION
• Part of the placenta • Embryonal demise
or portions of the • No expulsion
products of
conception are
• Retained > 8 weeks
expelled • Closed cervix
• Cervix is open • Minimal or absent
• Vaginal bleeding vaginal bleeding
• Curettage with
• Uterus incompatible
evacuation is the with age
treatment • No signs & symptoms
of pregnancy
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Presence of
anticardiolipin
antibodies and
lupus
anticoagulant
wherein one or
the other is
present in 5-
15% of women
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UTERINE CERVICAL UTERINE SIZE
OTHER
CATEGORY CONTRA BLEEDING DILATATIO VS BOW FINDINGS
MANAGEMENT
CTION N GESTATION
Watchful
INEVITABLE COMPATIB expectancy
+++ + + + +/- FHT
ABORTION LE Oxytocin
Curettage
Not Absent
COMPLETE INCOMPATIB
_ +/- - apprec signs of Observation
ABORTION LE
iated pregnancy
Not
MISSED INCOMPATIB Prostaglandins
_ Spotting/- - apprec -FHT
ABORTION LE
iated
D and C
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The blastocyst normally implants in the
endometrial lining of the uterine cavity.
Implantation anywhere else is an ectopic
pregnancy.
With earlier diagnosis, however, both
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Tubal pregnancy
Abdominal pregnancy
Broad ligament pregnancy
Interstitial pregnancy
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The fertilized ovum may lodge in any portion
of the oviduct, giving rise to ampullary,
isthmic, and interstitial tubal pregnancies
The ampulla is the most frequent site,
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. Abortion is common in ampullary tubal
pregnancy,
whereas rupture is the usual outcome with
isthmic pregnancy.
The immediate consequence of hemorrhage
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If the fimbriated extremity is occluded, the
fallopian tube may gradually become
distended by blood, forming a hematosalpinx
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The invading, expanding products of
conception may rupture the oviduct at any of
several sites.
whenever there is tubal rupture in the first
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Occasionally, if larger, they may remain in the
cul-de-sac for years as an encapsulated
mass, or even become calcified to form a
lithopedion
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When the greater portion of the placenta
retains its tubal attachment the fetus may
then survive for some time, giving rise to an
abdominal pregnancy.
Typically in such cases, a portion of the
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When original zygote implantation is toward
the mesosalpinx, rupture may occur at the
portion of the tube not immediately covered
by peritoneum.
The gestational contents may be extruded
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Implantation within the tubal segment that
penetrates the uterine wall results in an
interstitial or cornual pregnancy).
Because the implantation site is located
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Twin tubal pregnancy has been reported with
both embryos in the same tube, as well as
with one in each tube
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Pain
Abnormal mesturation
Abdominal and pelvic tenderness
Uterine Changes
Blood Pressure and Pulse (slight rise in blood
pressure, or a vasovagal response with
bradycardia and hypotension )
Pelvic Mass
Culdocentesis
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Appendicitis
PID
Threatened abortion
Twisted or ruptured ovarian new growth
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In contemporary practice, symptoms and
signs of ectopic pregnancy are often subtle or
even absent.
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vaginal bleeding, or "spotting."
Severe abdominal pain.
Vasomotor disturbances
The posterior vaginal fornix may bulge
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SIGNS & SYMPTOMS LABORATORY TESTS
pregnancy
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CULDOCENTESIS
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CULDOCENTESIS
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ULTRASOUND
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ULTRASOUND
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LAPAROSCOPY
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Systemic Methotrexate-This antineoplastic
drug acts as a folic acid antagonist and is
highly effective against rapidly proliferating
trophoblast
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Candidates for methotrexate therapy must be
hemodynamically stable.
Medical therapy fails in at least 5 to 10
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If the woman is treated as an outpatient, rapid
transportation must be reliably available.
Signs and symptoms of tubal rupture such as
vaginal bleeding, abdominal and pleuritic pain,
weakness, dizziness, or syncope must be
reported promptly.
Until the ectopic pregnancy is resolved, sexual
intercourse is prohibited, alcohol avoided, and
folic acid supplements—including prenatal
vitamins—should not be taken.
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LAPAROTOMY
LAPAROSCOPY
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Open abdominal surgery is preferred when
the woman is hemodynamically unstable, or
when laparoscopy is not feasible.
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Laparoscopy is more cost-effective, and there
is a shorter postoperative recovery
laparoscopy is not without risks or cost. It is
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DIRECT VISUALIZATION OF THE PELVIC
ORGANS REMAINS THE GOLD STANDARD
IN THE DIAGNOSIS AND MANAGEMENT
OF
ECTOPIC PREGNANCY
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CONSERVATIVE SURGERY
Desires future fertility
Hemodynamically stable
Procedures
o Salpingostomy
o Salpingotomy
o Segmental resection with or without reanastomosis
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SALPINGOSTOMY
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RADICAL SURGERY
Involved oviduct is damaged beyond salvage
Hemodynamically unstable
Procedures
o Salpingectomy
o Hysterectomy
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Salpingostomy- This procedure is used to
remove a small pregnancy that is usually <
2 cm in length and located in the distal
third of the fallopian tube.
Salpingotomy - Seldom performed today
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Resection of the ectopic mass and tubal
reanastomosis is sometimes used for an
unruptured isthmic pregnancy because
salpingostomy may cause scarring and
subsequent narrowing of the small isthmic
lumen
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Hemogram
Chorionic Gonadotropin Assays
Serum Progesterone Levels
Ultrasound Imaging
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Abdominal Vaginal Sonography
Sonography
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◦ Vaginal sonography.
◦ Serum -hCG—both the initial level and the
pattern of subsequent rise or decline.
◦ Serum progesterone.
◦ Uterine curettage.
◦ Laparoscopy and, less frequently, laparotomy.
The choice of diagnostic algorithm applies
only to hemodynamically stable women;
those with presumed rupture should
undergo prompt surgical therapy
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Ectopic pregnancy implanted in the ovary is
rare. Traditional risk factors for ovarian
ectopic pregnancy are similar to those for
tubal pregnancy
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Four criteria for differentiating ovarian froother
ectopic pregnancies:
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An abdominal pregnancy is a form of an
ectopic pregnancy where the pregnancy is
implanted within the peritoneal cavity outside
the fallopian tube or ovary and not located in
the broad ligament. While rare, abdominal
pregnancies have a higher mortality rate than
ectopic pregnancies in general but, on
occasion, can lead to a delivery of a viable
infant.
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Normal bilateral fallopian tubes and ovaries
Absence of the utero-peritoneal fistula .
Presence of a pregnancy related to the
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