- Ectopic pregnancy
- Ectopic pregnancy: A 5-step plan for medical management
- Uterine prolapse
- The Diagnosis and Treatment of Ectopic Pregnancy
- How to Write a SOAP Note With Obstetric Examples
Ectopic pregnancyChang K. Published July 5, Updated December 22, Accessed April 10, By kachangmd. Os is closed. Ectopic Missed Abortion"] [text] Anticipatory guidance, supportive measures and return indications discussed with patient. See DCI. DCI: Bed rest. Pelvic Rest. Drink plenty of fluids. There are 8 form elements. This patient in the first trimester of pregnancy presented to the emergency department with complaints of vaginal bleeding and abdominal pain. A pelvic ultrasound demonstrated normal intrauterine gestation with normal FHT. Rh was positive. UA was positive negative for infection. Ectopic Missed Abortion Anticipatory guidance, supportive measures and return indications discussed with patient. Copy to Clipboard. Comment Name Email Website. Users outside the medical profession are welcome to use this website, but no content on the site should be interpreted as medical advice.
Ectopic pregnancy: A 5-step plan for medical management
John E. Two experts describe a multidose methotrexate regimen, the first choice for unruptured, uncomplicated ectopics. As a result, medical therapy with systemic methotrexate has become the first-line treatment, with surgery reserved for hemorrhage, medical failures, neglected cases, and circumstances in which medical therapy is contraindicated. Early diagnosis not only makes medical therapy possible, it also is cheaper, since it avoids rupture, blood loss, and surgery; preserves fertility; and minimizes lost productivity. Despite this progress, serious challenges remain. Medical management is not for everyone. Success is inversely related to initial serum human chorionic gonadotropin hCG levels 3 and diminishes substantially when embryonic cardiac activity is observed during ultrasound imaging. In addition, because medical therapy has made outpatient treatment the norm in most cases, it has become virtually impossible to chart the prevalence of ectopic pregnancy. In past years, when hospital records were used, ectopic pregnancy rates were increasing relentlessly, from 4. This article describes a 5-step approach to diagnosis and medical management with multiple-dose methotrexate, as well as fine points of treatment and basic surgical technique. It includes a protocol for multiple-dose methotrexate, a table summarizing treatment outcomes, and several case histories. If women present with a positive pregnancy test and pain and bleeding, approximately 60 will have a normal pregnancy, 30 are experiencing spontaneous abortion, and 9 have an ectopic pregnancy. The first step in early diagnosis is being vigilant for risk factors and symptoms associated with ectopic pregnancy, most of which are well known 9 :. Tubal disease carries a 3. In addition, women with a previous ectopic pregnancy are 6 to 8 times more likely to experience another, while a history of tubal surgery raises that likelihood to A history of pelvic infection, including gonorrhea, serologically confirmed chlamydia, and pelvic inflammatory disease, increases the risk of ectopic pregnancy 2 to 4 times. Rather, when a woman with an IUD becomes pregnant, an ectopic gestation should be high on the list of possibilities. A similar relationship exists between ectopic pregnancy and tubal ligation, which carries an OR of 9. Diethylstilbestrol exposure in utero alters fallopian tube morphology and can lead to absent or minimal fimbrial tissue, a small tubal os, and decreased length and caliber of the tube. In vitro fertilization. When blocked tubes are treated, the embryos can migrate retrograde into the oviduct, implant, and eventually rupture. The OR for ectopic pregnancy with assisted reproduction is 4. Ultrasound imaging reveals no intrauterine pregnancy. Should you presume the diagnosis is ectopic pregnancy and start methotrexate therapy? Or should you play it safe and perform curettage? Some practitioners argue that proceeding with methotrexate therapy under these circumstances causes no harm. However, presumptive treatment unnecessarily exposes women to the side effects of chemotherapy and artificially inflates methotrexate success rates. Presumptive treatment does not decrease overall side effects or save money. It also falsely labels a woman as having an ectopic pregnancy, which directly affects future diagnosis and prognosis. A pregnant patient complaining of moderate pain has a 4-cm adnexal mass identified at ultrasound, with no evidence of an intrauterine gestational sac.
The Diagnosis and Treatment of Ectopic Pregnancy
Aka: Ectopic PregnancyTubal Pregnancy. These images are a random sampling from a Bing search on the term "Ectopic Pregnancy. Search Bing for all related images. The uterus, or womb, is an important female reproductive organ. It is the place where a baby grows when a woman is pregnant. If you have an ectopic pregnancy, the fertilized egg grows in an abnormal place, outside the uterus, usually in the fallopian tubes. The result is usually a miscarriage. Get medical care right away if you have these signs. Doctors use drugs or surgery to remove the ectopic tissue so it doesn't damage your organs. Many women who have had ectopic pregnancies go on to have healthy pregnancies later. Started inthis collection now contains interlinked topic pages divided into a tree of 31 specialty books and chapters. Content is updated monthly with systematic literature reviews and conferences. Although access to this website is not restricted, the information found here is intended for use by medical providers. Patients should address specific medical concerns with their physicians. Toggle navigation. Antepartum Disorders Chapter. From Related Chapters. Page Contents Definition Implantation of fertilized ovum outside of the Uterus. Symptoms Pregnancy Symptoms e. Images: Related links to external sites from Bing. Related Studies. Trip Database TrendMD. Ontology: Ectopic Pregnancy C