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2.1
Bleeding from an Ectopic Pregnancy
Ectopic Pregnancy Hemorrhage (subsequent Episode)

Presentation

For severe pain you should always present to the Emergency Department of your nearest hospital if you cannot contact your doctor. [alanahealthcare.com.au]

Consider ectopic when a patient presents with syncope and has a positive BhCG. [emergencymedicinecases.com]

Abdominal examination: Cullen’s sign: a periumbilical bluish discoloration may be present due to absorption of the blood in the peritoneal cavity by lymphatics. It is a late sign. [gfmer.ch]

Patients frequently present with benign examination findings, and adnexal masses are rarely found. [emedicine.medscape.com]

Tissue present in the open cervical os must always be removed and should be sent for histopathological examination to confirm retained POC. [racgp.org.au]

Entire Body System

  • Pallor

    Signs General examination: Rapidly developed shock, with pallor, sweating, air hunger, rapid thready pulse and hypotension. [gfmer.ch]

Gastrointestinal

  • Abdominal Pain

    In addition to signs of pregnancy, symptoms include abdominal pain and vaginal bleeding. [amboss.com]

    The most common symptoms are the combination of a missed period and abdominal pain. [familydoctor.co.nz]

    If the bleeding continues or if you have any other concerning symptoms, such as fever or abdominal pain, you should seek emergency medical attention. [zocdoc.com]

    Abdominal pain and abnormal bleeding may be symptoms of an ectopic pregnancy. [everydayhealth.com]

    The abdominal pain can be sharp and severe, or in some cases there may be no pain. The pain often increases on movement and straining, and is often localized to one side of the abdomen. [wikihow.com]

  • Cullen's Sign

    Abdominal examination: Cullen’s sign: a periumbilical bluish discoloration may be present due to absorption of the blood in the peritoneal cavity by lymphatics. It is a late sign. [gfmer.ch]

  • Acute Abdomen

    Tubal rupture Acute course with sudden and severe lower abdominal pain ( acute abdomen ) Signs of hemorrhagic shock : e.g., tachycardia, hypotension, syncope More common in interstitial pregnancy References: [10] [11] [12] Diagnostics Positive pregnancy [amboss.com]

Cardiovascular

  • Tachycardia

    Tubal rupture Acute course with sudden and severe lower abdominal pain ( acute abdomen ) Signs of hemorrhagic shock : e.g., tachycardia, hypotension, syncope More common in interstitial pregnancy References: [10] [11] [12] Diagnostics Positive pregnancy [amboss.com]

    […] however, may show some of these findings: Pelvic mass (either from the enlarged ectopic, or from the corpus luteum cyst that accompanies many early pregnancies of all types) Pelvic tenderness, localized or geeralized Abdominal distension Hypotension, tachycardia [brooksidepress.org]

    Unilateral or bilateral abdominal or pelvic tenderness - Usually much worse on the affected side Abdominal rigidity, involuntary guarding, and severe tenderness, as well as evidence of hypovolemic shock, such as orthostatic blood pressure changes and tachycardia [emedicine.medscape.com]

Urogenital

  • Adnexal Mass

    Patients frequently present with benign examination findings, and adnexal masses are rarely found. [emedicine.medscape.com]

    These women should be haemodynamically stable, be able to comply with treatment and follow-up, ideally have an hCG 7,15 and an adnexal mass 2 ), with 14% of women requiring a further dose. [racgp.org.au]

    […] cyst: 10% chance of an ectopic complex extra-adnexal cyst/mass: 95% chance of a tubal ectopic (if no IUP) an intra-adnexal cyst/mass is more likely to be a corpus luteum solid hyperechoic mass is possible but non-specific tubal ring sign 95% chance of [radiopaedia.org]

    Physical examination findings in ectopic pregnancy (5): Abdominal tenderness (80-90%) Adnexal tenderness (75-90%) Adnexal mass (50%) Uterine enlargement (25%) Orthostasis (10%) Pelvic exams can be completely normal. [emergencymedicinecases.com]

    Unfortunately, this 'adnexal mass' is an unreliable sign: doctors may miss them and sometimes feel them on the opposite side to the ectopic pregnancy! [familydoctor.co.nz]

Workup

Patients need a full workup for ectopic rupture: hematocrit, BhCG, and ultrasound to look for bleeding. If there are any signs of rupture, urgent OB consult is needed. [emergencymedicinecases.com]

A workup will generally be ordered, including beta hCG levels and ultrasound examinations to determine the location and viability of the pregnancy. [wehavekids.com]

Treatment

What are the treatments for ectopic pregnancy? There are three possible types of treatment for ectopic pregnancy: 1. Conservative treatments (observation) 2. Medical treatments (medications such as methotrexate) 3. [alanahealthcare.com.au]

Ectopic pregnancy treatment An ectopic pregnancy must be treated in order to stop its growth and prevent complications. Treatment is broadly divided into medical treatment and surgical treatment. 1. [philipthomas.com.au]

Medical treatment of Ectopic Pregnancy The success rate of medical treatment is 80-90%. [layyous.com]

The current gold standard for surgical treatment of an ectopic pregnancy is to perform the procedure laparoscopically. Preservation of fertility is a main objective in the modern treatment of an ectopic pregnancy. [ivf1.com]

Treatments for ectopic pregnancy Treatments are available even though ectopic pregnancy seems impossible to cure. However, most of which require surgery as it is the only way to end ectopic pregnancy. [webmedicinecenter.com]

Prognosis

Ectopic pregnancy: etiology, pathology, diagnosis, management, fertility prognosis. In: Lobo RA, Gershenson DM, Lentz GM, Valea FA, eds. Comprehensive Gynecology. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 17. Nelson AL, Gambone JC. [medlineplus.gov]

General complications for a typical (tubal) ectopic pregnancy include: tubal rupture : 15-20% Treatment and prognosis Management depends on the location of the ectopic pregnancy and the patient's hemodynamic status. [radiopaedia.org]

This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. [wehavekids.com]

Etiology

Ectopic pregnancy: etiology, pathology, diagnosis, management, fertility prognosis. In: Lobo RA, Gershenson DM, Lentz GM, Valea FA, eds. Comprehensive Gynecology. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 17. Nelson AL, Gambone JC. [medlineplus.gov]

Etiology Localization Fallopian tube (96% of cases): ampulla >> isthmus > fimbriae > interstitial pregnancy : e.g., cornual pregnancy Ovary (3% of cases) Abdomen (1% of cases) Cervix (very rare) Risk factors Anatomic alteration of the fallopian tubes [amboss.com]

Ectopic pregnancy after hysterectomy: a review and insight into etiology and prevention. Fertil Steril. 2010 Jul. 94(2):431-5. [Medline]. Peterson HB, Xia Z, Hughes JM, Wilcox LS, Tylor LR, Trussell J. [emedicine.medscape.com]

Pathophysiology

This bleeding will be both vaginal and internal and has two discrete pathophysiologic mechanisms. External bleeding is due to the falling progesterone levels. Internal bleeding is due to hemorrhage from the affected tube. [knowhen.com]

Prevention

Ectopic Pregnancy Prevention Many ectopic pregnancies cannot be prevented, but some of those caused by PID may be preventable. [everydayhealth.com]

Prevention There's no way to prevent an ectopic pregnancy, but here are some ways to decrease your risk: Limit your number of sexual partners. [mayoclinic.org]

Not all ectopic pregnancies can be prevented, but reporting any suspicious symptoms right away to your provider can help prevent serious problems. Developed by RelayHealth. Published by RelayHealth. [summitmedicalgroup.com]

Ectopic pregnancy cannot be prevented. [babyhopes.com]

Prevention of Ectopic Pregnancy Ectopic pregnancy cannot be prevented but there are important points that should be considered to decrease the incidence of (PID) which as previously mentioned increases the incidence of ectopic pregnancy. 1. [layyous.com]

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