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ECTOPIC PREGNANCY

Notes

Definition gestation that implants outside of the endometrial cavity

Incidence 1/100 clinically recognized pregnancies fourth leading cause of maternal mortality increase in incidence over the last 3 decades

Etiology obstruction or dysfunction of tubal transport mechanisms intrinsic abnormality of the fertilized ovum conception late in cycle transmigration of fertilized ovum to contralateral tube

Figure 5. Sites of Implantation Printed with permission from Obstetrics and Gynecology. 2nd ed. Beckmann, Charles et. al. Williams and Wilkins, 1995

Risk Factors history of PID past or present IUD use previous lower abdominal surgery previous ectopic pregnancy endometriosis uterine or adnexal mass assisted reproductive techniques

Symptoms vaginal bleeding or spotting (most common) • due to low ßhCG production by the ectopic trophoblast • heavy vaginal bleeding rare amenorrhea, other symptoms of pregnancy lower abdominal pain (usually unilateral) • abdominal distension adnexal fullness if ectopic pregnancy ruptures • acute abdomen • abdominal distension symptoms of shock

Physical Examination firm diagnosis is usually possible in 50% on clinical features alone hypovolemia/shock guarding and rebound tenderness bimanual examination • cervical motion tenderness • adnexal tenderness (unilateral vs bilateral in PID) • palpable adnexal mass (< 30%) • uterine enlargement • rarely increases beyond equivalent of 6-8 weeks gestation other signs of pregnancy, i.e. Chadwick sign, Hegar sign

Gynecology 22

MCCQE 2000 Review Notes and Lecture Series

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