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Ectopic Pregnancy, Diagnosis and Management

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Introduction:

The incidence of ectopic pregnancy is increasing due to various reasons like Pelvic infections, previous tubal surgery and assisted conception technology. Appropriate diagnosis and timely intervention is key management of better maternal outcome. Nearly 32,000 ectopic pregnancies are diagnosed in the UK within a three year period from 1997 to 1999.

Tubal pregnancy can be managed by laparotomy, operative laparoscopy, medically and occasionally by conservative management. Management must be tailored to the clinical condition and future fertility requirements of the woman.

Every institution at accident and emergency, should have a written protocol and a simple algorithm to diagnose and manage ectopic pregnancy.

Clinical Preseantation: Mostly atypical!

Detailed history is obtained if the patient is in stable condition. History of amenorrhoea, onset of pain, Vaginal bleeding , associated symptoms like giddiness, vomiting, dysurea, dyspareunia and past history of sexually transmitted disease, pelvic infection, assisted conceptions, contraception is essential and helps in diagnosis.

Clinical examination for pulse, blood pressure, general condition and pallor is undertaken. Abdominal examination for suprapubic tenderness, rigidity and guarding is mandatory. Vaginal examination for adnexial mass, cervical excitation pain, uterine size and tender uterine movements should be done.

Investigations:

  1. Sensitive Urine Pregnancy Test
  2. Serum Beta HCG
  3. Trans vaginal Scan.
  4. Complete Blood count, Blood group and Rh , Cross match.
  5. Random Blood Sugar, Sickling test.

A simple but sensitive pregnancy test is basic at an A & E. Negative pregnancy test does not rule out ectopic pregnancy !

Simple algorithm can be followed as stated below.

(attached to this lecture as an attachment of algorithm for diagnosis and management of ectopic pregnancy).



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