An ectopic pregnancy occurs when a fertilized egg grows outside of the uterus. It is the leading cause of 1st trimester death and causes 0. There are 3 ways of treatingmanaging an ectopic pregnancy. Information for you this leaflet has been updated uptodate information is available on the rcog website. Surgical treatment may either be an open laparotomy or laparoscopic depending on the surgeons skill, equipment availability and condition of the patient 8. The diagnosis and management of ectopic pregnancy hse. Diagnosis and management of ectopic pregnancy 2016. The current incidence of ectopic pregnancy is difficult to estimate from available data because inpatient hospital treatment of ectopic pregnancy has decreased and multiple health care visits for a single ectopic pregnancy have increased. Only 10% to 15% of ectopic pregnancies occur in women who have never been pregnant before. A history of genital infections or infertility and cur. When a pregnant patient presents with firsttrimester bleeding or.
There is a paucity of evidence regarding the risk of alloimmunisation associated with medical and expectant management of ectopic pregnancy. Signs and symptoms it is important for both the pregnant woman and the health care provider to identify any signs and symptoms of an ectopic pregnancy before rupture. Ectopic pregnancy ep is reported in about 1%2% of pregnant females and is associated with mortality and morbidity. If pregnancy tissue is seen, an ectopic pregnancy is very unlikely, although very rarely a double pregnancy, one in the uterus and the other in the fallopian tube called a heterotopic pregnancy can occur. The later the structure ruptures, the worse the blood loss, and the higher the risk of death.
Ectopic pregnancy is the second major cause of maternal mortality in the united states and a leading cause of maternal morbidity and mortality in the world. Results there were 47 ectopic pregnancies in the 10,685 women. The incidence of ectopic pregnancy has remained static in recent years 11. If you have an ectopic pregnancy you may also have spotting small amounts of bleeding from your vagina or feel.
Some examples of the different types of ectopic pregnancy are described below. The majority of ectopic pregnancies occur in the fallopian tube 96 percent, but other possible sites include. Women of reproductive age presenting acutely with gastrointestinal symptoms, particularly diarrhoea, as well as those presenting with abdominal pain andor vaginal bleeding should have a urinary hcg test. Protocol for management of ectopic pregnancy page 5 4 ectopic mass 3. Alopecia is a rare side effect with the doses used to treat ectopic pregnancy. In a normal pregnancy, the fertilized egg moves from the fallopian tube into the uterus, where the pregnancy develops. Diagnosis of ectopic pregnancy has been greatly improved by the advent of rapid serum beta human chorionic gonadotropin. Several genetic and environmental factors might modulate occurrence of ep. This guideline will cover the following ectopic pregnancies. Apr 20, 2015 4570% of pul resolve spontaneously with expectant management ectopic pregnancy was subsequently diagnosed in 1428% of pul interventionlaparoscopic salpingostomy has been shown to be required in 2329% of cases 40. An ectopic pregnancy is classified according to where exactly the fertilized egg implants.
Ectopic pregnancy is defined as implantation of a fertilized egg outside the uterine cavity. Surgical management of ectopic pregnancy natural progress of t ubal ectopic pregnancy. Ultrasound of failed first trimester pregnancies and ectopic pregnancies duration. An appraisal of the management of ectopic pregnancy in a nigerian. Expectant management of ectopic pregnancy if you have been diagnosed with an ectopic pregnancy we understand this may be a very distressing time and we are sorry for your loss. If there is no evidence of pregnancy tissue, the presence of and early diagnosis of an ectopic pregnancy must be considered. Women who underwent ectopic pregnancy are advised to avoid getting pregnant for a year after the incident because there is a 10% to 20% chance of a subsequent ectopic pregnancy. This book contains the practical methods to early diagnosis of various forms of ectopic pregnancies and their modern management. Suspect ectopic pregnancy in a client whose history includes a missed menstrual period, spotting, or bleeding pelvic or shoulder pain, use of intrauterine device, pelvic infections, tubal surgery, or previous ectopic pregnancy.
Six of the 11 deaths were associated with substandard care. Ectopic pregnancy overview pathophysiology, signs and. An ectopic pregnancy is a serious medical condition that can actually threaten a womans life. Ectopic pregnancy affects 1% to 2% of all pregnancies and is responsible for 9% of pregnancy related deaths in the united states. If you have an ectopic pregnancy, the fertilized egg grows in an abnormal place, outside the uterus, usually in the fallopian tubes. Nov 19, 2016 ectopic pregnancy overview pathophysiology, signs and symptoms, treatment, investigations. Expectant management of pregnancy of ectopic pregnancy criteria for selection asymptomatic women with an ultrasound diagnosis of ectopic pregnancy. The most common ectopic implantation site is the fallopian tube, though 10 % of ectopic pregnancies implant in the cervix, ovary, myometrium, interstitial portion of the fallopian tube, abdominal cavity or within a cesarean section scar. Considerations for management of interstitial ectopic. The most common symptoms of an ectopic pregnancy are abnormal bleeding andor pelvic pain in the first trimester.
Be aware of grief and lost manifestations in the client and family. It is not unusual for women treated with methotrexate to experience abdominal pain 23 days after administration, presumably from the cytotoxic effect of the drug on the trophoblast tissue, causing tubal abortion. Purpose and scope there were maternal deaths resulting from ectopic pregnancy in the uk during the period 199799. Diagnosis involves a combination of clinical symptoms. Methotrexate is a drug normally used in cancer treatment but the amount used is very small. Dec 29, 2015 diagnosis of ectopic pregnancy has been greatly improved by the advent of rapid serum beta human chorionic gonadotropin. Medical management of an ectopic pregnancy or a pregnancy of. University of wisconsin medical schoolmadison, madison, wisconsin e ctopic pregnancy is any. In most ectopic pregnancies, the egg grows in a fallopian tube. An ectopic pregnancy results when an early pregnancy becomes implanted anywhere outside the cavity of the uterus. Expectant management of ectopic pregnancy and trophoblast of unknown site 9. Ectopic pregnancy affects 1% to 2% of all pregnancies and is responsible for 9% of pregnancyrelated deaths in the united states. Foster, dphil, md, am amanda dennis, mbe fiona smith, mph acknowledgements this research was conducted by ibis reproductive health for the national womens law center.
Ectopic pregnancy modern diagnosis and management is a comprehensive book which guides the reader through. Ectopic pregnancy overview pathophysiology, signs and symptoms, treatment, investigations. Pregnancy in patient with prior tubal ligation or iud in place is ectopic until proven otherwise 2550% are ectopic even if an iup is visualized, there is a small risk of heterotopic ectopic pregnancy. It is a potentially serious condition affecting about 1 in 100 pregnancies. The management of tubal pregnancy this guideline replaces the management of tubal pregnancies,produced in october 1999. Diagnosis and management of ectopic pregnancy ncbi. Clinical management of ectopic pregnancy 2 citation. Common reasons for failing to diagnose an ectopic pregnancy are.
In vitro fertilisation and fertility treatments sexually transmitted infections e. Ectopic pregnancy is a potentially lifethreatening condition occurring in 12 % of all pregnancies. Your doctor has suggested that it may be appropriate to manage your ectopic pregnancy expectantly. Incidence, diagnosis and management of tubal and nontubal. Ectopic pregnancy can be very difficult to diagnose. This estimate is conservative, as the analysis did not include patients whose condition. Clinical practice guideline the diagnosis and management of ectopic pregnancy 3 key recommendations 1. Diagnosis and management of ectopic pregnancy american. Management of ectopic pregnancy linkedin slideshare. Risk factors risk factors most strongly associated with ectopic pregnancy include previous ectopic pregnancy, tubal surgery, and in utero diethylstilbestrol des exposure. Sometimes the egg grows in an ovary or another place in the belly.
This booklet is designed to provide information on the diagnosis and treatment of ectopic pregnancy. Ectopic pregnancy accounted for 11 deaths out of the 15 in early pregnancy in the 20002002 report. Medical management of ectopic pregnancy a case history. Women who undergo surgical management of ectopic pregnancy may be at higher risk of sensitisation due to mixing of fetal and maternal blood. An ectopic pregnancy can be life threatening because as the pregnancy gets bigger it runs out of space to grow and can potentially rupture burst causing severe pain and internal bleeding. Ectopic pregnancy is a considerable cause of maternal morbidity, causing acute symptoms such as pelvic pain and vaginal bleeding and long.
If in shock for resuscitation and laparotomy surgical treatment. Most ectopic pregnancies develop in the fallopian tubes but some occur in the cervix, caesarean section scar, ovary or even the abdominal cavity. You have been diagnosed with an ectopic pregnancy or a pregnancy of unknown location for more information on ectopic pregnancy please refer to the patient information leaflet entitled ectopic pregnancy in certain circumstances, an ectopic pregnancy, or pregnancy of unknown location pul, may be treated by medication drug. Ectopic pregnancy 7 medical management of ectopic pregnancy medical treatment of ectopic pregnancy is also used commonly and may avoid the need for surgery. Definition ectopic pregnancies account for 1% to 2% of all conceptions. The diagnosis and management of pregnancy of unknown location will not be covered. Surgical management of ectopic pregnancy anesthesia key. In a normal pregnancy, the fertilized egg grows inside the uterus. Ectopic pregnancy diagnosis and management in gynaecology. Ectopic pregnancy patient information brochures mater group. Diagnosis and management of ectopic pregnancy greentop.
The use of methotrexate to treat ectopic pregnancy was first cited in 1982. Ectopic pregnancy is the result of a flaw in human reproductive physiology that allows the conceptus to implant and mature outside the endometrial cavity see the image below, which ultimately ends in the death of the fetus. The etiology of ep concentrated mainly on factor causes delayed transport of the fertilized ovum through the fallopian tube favors implantation in tubal mucosa, thus giving rise to ep. The majority of ectopic pregnancies occur in the fallopian tube 96 percent, but other possible sites include the cervix, interstitial portion of the fallopian tube also referred to as cornual. Diagnosis and management of ectopic pregnancy annemarie lozeau, m. Nowadays it represents less than 1% of all ectopic pregnancies, with a reported incidence varying from 1. A decrease in beta hcg by more than 15% between day 4 and day 7 after treatment shows successful medical treatment.
It is important for both the pregnant woman and the health care provider to identify any signs and symptoms of an ectopic pregnancy before rupture. Ectopic pregnancy modern diagnosis and management intechopen. To determine the incidence and associated risk factors, for ectopic pregnancy. It works because it kills the rapidly growing cells of an ectopic. At first, an ectopic pregnancy may feel like a normal pregnancy with the usual pregnancy symptoms. Guidelines provided by the royal college of obstetricians and gynaecologists 6 stated that tubal pregnancy can be managed by.
Different pattern of presentation of ectopic pregnancy and. Pdf medical management of ectopic pregnancy a case history. Pdf expectant management of ectopic pregnancy juha. An ectopic pregnancy ep falls within the area of the gynecological emergency andor reproductive management of women, which is the implantation of fertilized ovum outside the endometrial cavity. Nowadays it represents less than 1% of all ectopic pregnancies, with a reported incidence varying from. Ectopic pregnancies represent approximately 2% of all pregnancies 1,2. In a small percentage of pregnancies, however, the embryo implants in. Without timely diagnosis and treatment, ectopic pregnancy can become a lifethreatening situation. When an ectopic pregnancy ruptures, bleeding may be severe and even threaten the life of the woman. Ectopic pregnancy can be a medical emergency if it ruptures. Each department should develop protocols for the surgical and medical management of ectopic pregnancy. A healthy 29yearold woman who has been trying to conceive presents with vaginal spotting for the past 5 days and intermittent crampy abdominal pain in her left lower quadrant for the past 3 days.
Cronicon gynaecology open access case report clinical. Ectopic pregnancy occurs in up to 2% of pregnancies. Medical management of ectopic pregnancy clinical practice. Cervical ectopic pregnancy is a rare form of ectopic pregnancy and can be defined as the implantation of the blastocyst in the endocervix, below the internal os 14. Ectopic pregnancy occurs in about 1 in 100 pregnancies. It is the place where a baby grows when a woman is pregnant. Jun 25, 2017 ectopic pregnancy is the leading cause of maternal death in early pregnancy. The purpose of this guideline is to improve the management of women who may have. It is not unusual for women treated with methotrexate to experience abdominal pain 23 days after administration, presumably from the cytotoxic effect of the drug on.
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