topik list dr. pim - ectopic pregnancy

7/23/2019 Topik List Dr. PIM - Ectopic Pregnancy

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Ectopic Pregnancy

Supervisor : dr. Pim Gonta,

Sp.OG



Defnition

•Pregnancy withfertilized egg thatdoes not attach toendometrial wallof uterine cavity



Followingfertilization

Fallopian tubetransit

Implant inendometri

al

EctopicImplantation

1-2% in !

"iagnosisby rine#β-h$#

&ransvaginal

!onography



Tubal Pregnancy

• ' m p u l a r i s ( ) ) % * • I s t h m i c ( 2 ) % * • F i m b r i a l ( 1 + % * • I n t e r s t i t i a l ( 2 % *

$lassi,cation

• ' b n o r m a l f a l l o p i a n t u b e a n a t o m y • ! u r g e r i e s f o r a p r i o r t u b a l p r e g n a n c y # f o r f e r t i l i t y r e s t o r a t i o n #

f o r s t e r i l i z a t i o n c o n f e r • P r e v i o u s e c t o p i c p r e g n a n c y • P r i o r s e - u a l l y t r a n s m i t t e d d i s e a s e o r o t h e r t u b a l i n f e c t i o n • ! o m e c o n t r a c e p t i v e m e t h o d f a i l u r e s

.is/

• E m b r y o o r f e t u s i s o f t e n a b s e n t o r s t u n t e d

• & u b a l r u p t u r e # t u b a l a b o r t i o n # p r e g n a n c y f a i l u r e

• & u b a l a b o r t i o n • 0 e m o r r h a g e

Evolutionand Potential

utcomes



Tubal Pregnancy

$linicala

nifestation

• &riad (delayedmenstruation#pain# andvaginalbleeding*

• !evere lowerabdominal pain

• Pelvic pain• &enderness

ulmodali

ty"iagnosis

• &ransvaginalsonography(&3!*

• !erum 4-h$level

• "iagnosticsurgery



Medical Management

Methotrexate is a folic acid antagonist m

ethotrexate is highly effective against rapidl

y proliferating tissue such as trophoblast,



Surgical management

Laparoscopy is the preferred surgical treatment for ectopic pregnancy unless a woman is hemodynamically unstableSalphingostomy: typically used to remove asmall unruptured pregnancy that is usually< 2 cm in length and located in thedistal thi

rd of the fallopian tubeSalpingectomy: used for both ruptured andunruptured ectopic pregnancies



Serum β-h! levels are used to monitor res

ponse to both medical and surgical therapy"#fter linear salpingostomy$ serum β-h! levels decline rapidly over days and then mor

e gradually$ with a mean resolution time ofapproximately 2% days"



Abdominal Pregnancy

# form of an ectopic pregnancy where the pregnancy is implanted within the peritonealcavity"&ave higher mortality$ but can lead to a delivery of a viable infant"

< '( in the )S or about '*'%"%%% pregnancies"



Abdominal Pregnancyrimary

+regnancy that implanted directly in the

abdominal cavity , its organsS condary

+regnancy that originated from a tubal p

regnancy tubal abortion." /f an early conceptus is expelled essentially undamaged intothe peritoneal cavity$ its placental attachme

nt may persist"Most small conceptuses are resorbed. Occa

sionally, they may remain as an encapsulat

ed mass or even become calcified to form a

lithopedion .



Interstitial Pregnancy

# form of an ectopic pregnancy where the pregnancy is implanted within the part of the

fallopian tube that penetrates the muscularlayer of the uterus"2-0( of all tubal gestations"

1upture would not occur usually until ' to'3 wee4s$ often with severe hemorrhage"



Ovarian Pregnancy

1are

5our clinical crit ria : '" the ipsilateral tube is intact and distinct from the ovary 2" the ectopic pregnancy occupies the ovary 0" the ectopic pregnancy is connected by the uteroovarian li

gament to the uterus

" ovarian tissue can be demonstrated histologically amid the placental tissuelinical manif station: mirror tubal ectopic pregnancy6rans vaginal )S use in diagnosis of unruptured ovarian pregnan

cies" an internal anechoic area surrounded by a wide echogenic rin , which in turn is surrounded b ovarian cortex.



Management for ovarian pregnancies has been surgical"Small lesions have been managed by ovaria

n wedge resection or cystectomy$Larger lesions re7uire oophorectomy"Systemic or locally in8ected methotrexate h

as been used successfully to treat small unruptured ovarian pregnancies"β-h! levels should be monitored to exclude remnant trophoblast"



Cervical Pregnancy

cervical glands opposite the placental attachment site"part or all of the placenta found below theuterine vessels or below the peritoneal on uterus"/ncidence ' in 93%% pregnancies$ but the in

cidence is increasing as a result of #16Management: medically or surgically

5irst line methotrexate

topik list dr. pim - ectopic pregnancy

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