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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]
Easy Bruising
  • ., anticoagulants, oral contraceptives, intrauterine devices ) Anticoagulants : easy bruising, bleeding tendency References: [20] [21] [22] [23] [24] [25] [26] [27] [28] The differential diagnoses listed here are not exhaustive.[amboss.com]
Pallor
  • Signs General examination: Rapidly developed shock, with pallor, sweating, air hunger, rapid thready pulse and hypotension.[gfmer.ch]
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]
  • I'm suffering abdominal pain – is this an ectopic pregnancy? Munira said: "Abdominal pain during early pregnancy can be due to many things but it can be a common symptom of an ectopic pregnancy.[closeronline.co.uk]
Morning Sickness
  • Because morning sickness is common during early pregnancy, this symptom may be hard to distinguish from normal pregnancy symptoms. 10.[justmommies.com]
  • A missed period may be one of the first pregnancy symptoms you experience – along with a bit of morning sickness or a positive pregnancy test.[early-pregnancy-tests.com]
  • Possible symptoms of an ectopic pregnancy are: Missed period or abnormal bleeding Pain in the lower belly or pelvis Symptoms of pregnancy, such as breast tenderness or morning sickness The ectopic pregnancy can damage your pelvic organs.[summitmedicalgroup.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]
Food Poisoning
  • In fact, I thought I was sick from food poisoning. Turns out it was far from that. First off, what is an ectopic pregnancy aka a tubal pregnancy? It’s a pregnancy that develops anywhere except where it should be, in the uterus.[chaimommas.com]
Tachycardia
  • ., tachycardia, hypotension, syncope More common in interstitial pregnancy References: [10] [11] [12] Diagnostics Positive pregnancy test : β-hCG Serum test: β-hCG verifiable from the 8 th day after ovulation Follow-up measurements are required to monitor[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]
Weak Pulse
  • If you have any symptoms of shock, such as cold clammy skin, anxiety, dizziness, sweating, feeling weak, fainting, or having a rapid but weak pulse, you should call 911 immediately.[justmommies.com]
Cold, Clammy Skin
  • If you have any symptoms of shock, such as cold clammy skin, anxiety, dizziness, sweating, feeling weak, fainting, or having a rapid but weak pulse, you should call 911 immediately.[justmommies.com]
Hirsutism
  • ., foreign body, sexual abuse) Pelvic pain Bruising, hematoma, possible accompanying injuries Painless vaginal bleeding Differential diagnosis Findings PCOS Amenorrhea, oligomenorrhea, as well as breakthrough bleeding and hypermenorrhea Hirsutism, obesity[amboss.com]
Acne Vulgaris
  • vulgaris, infertility Ultrasound shows enlarged ovaries with numerous anechoic cysts.[amboss.com]
Grieving
  • Stillbirth: How to be there for someone who has lost a baby READ: 10 beautiful stillbirth & miscarriage poems to help grieving mothers Mother’s Day after miscarriage or stillbirth: Advice on how to cope and grieve If you or a loved one need any comfort[closeronline.co.uk]
  • Give yourself time to grieve. Remember that many women go on to have healthy pregnancies and babies. When you’re ready, talk to your doctor about ways you can ensure that your future pregnancy is a healthy one.[healthline.com]
Withdrawn
  • BiggerBoatNeeded Wed 01-Feb-17 22:57:10 Message withdrawn at poster's request. user1485706893 Thu 02-Feb-17 07:57:44 God I'm so worried.[mumsnet.com]
Convulsions
  • Although the journey took less than 15 minutes, she became unconscious and was having convulsions.[ectopicireland.ie]
Difficulty Concentrating
  • Physical symptoms of grief and bereavement include: fatigue (tiredness) loss of appetite difficulties concentrating sleeping problems Emotional symptoms of grief and bereavement include: guilt shock and numbness anger (sometimes at a partner, or at friends[your.md]
Stroke
  • Stopping smokingif you smoke will also lower your risk of ectopic pregnancy as well as many other serious health conditions such as lung cancer, stroke and heart disease.[your.md]
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]
  • Other common diagnoses in this setting include: ruptured corpus luteum exophytic corpus luteum of pregnancy intrauterine pregnancy incidental adnexal mass appendicitis (negative beta-hCG) The scenario of clinically suspected ectopic pregnancy that is[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]
Oligomenorrhea
  • ., foreign body, sexual abuse) Pelvic pain Bruising, hematoma, possible accompanying injuries Painless vaginal bleeding Differential diagnosis Findings PCOS Amenorrhea, oligomenorrhea, as well as breakthrough bleeding and hypermenorrhea Hirsutism, obesity[amboss.com]
Adnexal Tenderness
  • 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]
Incontinence
  • When she finally awoke, she had become a total hemiplegic, unable to talk and doubly incontinent.[today.mims.com]

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]
  • You do not need this injection though if you receive medical treatment. The above is a brief description of treatment options. A gynaecologist will advise on the pros and cons of each treatment with you.[patient.info]
  • Support is also provided throughout the treatment period and after treatment.[newkidscenter.com]
  • Medical treatment of Ectopic Pregnancy The success rate of medical treatment is 80-90%.[layyous.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 is the[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]
  • 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]
  • 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]
  • 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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