METHODS: This was a prospective cohort study enrolling all patients in the first trimester of pregnancy presenting to the ED with abdominal pain and/or vaginal bleeding. [ncbi.nlm.nih.gov]

A 33-year-old woman, para 2, presented to the emergency department with a report of vaginal bleeding and abdominal pain of several days' duration. She had no history of pelvic inflammatory disease. [nejm.org]

• Pain

  It was determined that a ruptured ectopic pregnancy was the etiology of her abdominal pain. The rare phenomenon of combined intrauterine and extrauterine pregnancy is discussed. [ncbi.nlm.nih.gov]

  Symptoms include: a missed period, a positive pregnancy test spotting right or left lower-abdominal pain Lower abdomen pain Vaginal spotting Lower stomach cramping Inflammation of the lower abdomen Painful urination Mild vaginal bleeding Pain during bowel [babymed.com]

  Sudden, sharp abdominal and pelvic pains – pains that can have you on your knees and doubled over 3. A baseline and constant abdominal pain and another pain that comes and goes 4. Tender to the touch abdomen 5. Distended abdomen 6. [chaimommas.com]

  She rates her pain as 8 on a 0–10 pain intensity rating scale. During your physical assessment, you note abdominal tenderness and guarding. What's your assessment? Based on Mrs. [journals.lww.com]

• Infertility

  No statistically significant associations were found concerning past history of pelvic infection, use of IUCD and operations for infertility treatment-tubal surgery. [ncbi.nlm.nih.gov]

  (whether treated or not): women using assisted reproduction have 2x risk of ectopic pregnancy, although this is mostly due to the underlying infertility (related associations are fertility drugs and treatments, such as in vitro fertilization) History [pathologyoutlines.com]

  A history of infertility will be the biggest influence on your odds of getting pregnant again -- and, unfortunately, it might also raise the chances of another ectopic pregnancy. [webmd.com]

• Internal Bleeding

  The tubes can only stretch but so much and once the pressure of the growing pregnancy splits the tube, it causes heavy internal bleeding. A ruptured ectopic pregnancy is a true medical emergency and nothing to be messed around with. [chaimommas.com]

  Weakness, dizziness or lightheadedness, and a sense of passing out upon standing can represent serious internal bleeding, requiring immediate medical attention. [medicinenet.com]

  internal bleeding is occurring, the life of the mother is in jeopardy. [babymed.com]

  This can cause internal bleeding, infection, and in some cases lead to death. Am I at risk for an ectopic pregnancy? We don’t always know the cause of ectopic pregnancy. [plannedparenthood.org]

  The growing fetus can damage or rupture the tissue around the reproductive organs, causing internal bleeding and severe pain. If the pregnancy tissue grows too large, it may damage the walls of the fallopian tube. [medbroadcast.com]

• Severe Pain

  Clinical Practice Pearls: Suspect PCD clinically in patients with characteristic findings of severe swelling, blue discoloration, severe pain, and paresthesias in the lower extremity. Males are affected more than females 1.5:1. [ebmedicine.net]

  Full Text A 50 year old man, with a prior history of stage IV rectal cancer in palliative treatment, came to the Emergency Department with sudden severe pain of 12h duration in the left lower extremity. [elsevier.es]

  It is characterized by sudden severe pain, swelling, cyanosis and edema. Origin Latin, literally "painful blue edema". English Wiktionary. Available under CC-BY-SA license. [yourdictionary.com]

  […] cause severe pain while you are having a bowel movement, especially if you are straining. [summitmedicalgroup.com]

  Severe pain, rapid swelling, and bluish-skin coloring affect the area below the blocked vein. Continued clotting can lead to increased swelling. The swelling can interfere with blood flow. This complication is called phlegmasia alba dolens. [medlineplus.gov]

• Fatigue

  We ask about general symptoms (anxious mood, depressed mood, fatigue, pain, and stress) regardless of condition. Last updated: May 14, 2019 [patientslikeme.com]

  A history of jaw discomfort or fatigue upon awakening in the morning along with a finding of excessive tooth wear or enlarged jaw muscles is very suggestive of sleep bruxism. [aaom.com]

  Although the causes of bruxism are unknown, one study links it with such factors as anxiety, stress, alcohol consumption, cigarette smoking, caffeine, sleep apnea, snoring and fatigue. [sleepfoundation.org]

  You will face hormonal changes that can intensify your emotions, as well as contribute to fatigue, difficulty sleeping, and trouble concentrating. Reach out to your family and friends for emotional support. [verywell.com]

  Symptoms associated with pregnancy include: breast tenderness food cravings feeling sick when thinking about certain foods missing a period nausea, especially in the morning unexplained fatigue urinating more frequently If you think you may be pregnant [healthline.com]

• Nausea

  She denied fever, nausea, and vomiting. She stated that she was five weeks pregnant by last menstrual period. She had an ultrasound a few weeks before that showed no intrauterine pregnancy, but she had not followed up for additional testing. [jetem.org]

  Painful nausea and vomiting Nausea and vomiting is more painful when suffering from ectopic pregnancy. This is due to the abdominal and pelvic pain. Near-syncope It is the feeling of passing out upon standing, whether prolonged standing or not. [webmedicinecenter.com]

  Severe nausea – the kind that makes you wonder about what you last ate and if you’ve been food poisoned 9. Vomiting and/or diarrhea 10. Pressure in the butt or rectum area and constant urge to go to the bathroom 11. Inability to walk 12. [chaimommas.com]

  Symptoms like nausea and abdominal cramps, which simulate food poisoning may be a warning of impeding emergency. Our patient complained of something wrong but could not localize it and was restless. [nature.com]

• Acute Abdomen

  The acute abdomen in spinal cord injury individuals. Paraplegia 1995; 33 : 704–706. 4. Neumayer LA, Bull DA, Mohr JD, Putnam CW. The acutely affected abdomen in paraplegic spinal cord injury patients. Ann Surg 1990; 212 : 561–566. 5. [nature.com]

  This is generally reserved for women presenting with signs of an acute abdomen and hypovolemic shock. [4] Often if a tubal abortion or tubal rupture has occurred, it is difficult to find the pregnancy tissue. [en.wikipedia.org]

• Loss of Appetite

  Loss of appetite usually is the first indication that something is wrong. Symptoms like nausea and abdominal cramps, which simulate food poisoning may be a warning of impeding emergency. [nature.com]

  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]

• Rectal Pain

  Referred pain Diaphragmatic irritation from free blood in the peritoneal space may present as shoulder pain Referred neck or rectal pain are reported Vagal stimulation from intra-peritoneal blood can present as hypotension and bradycardia Selected Differential [coreem.net]

• Chest Pain

  But, about 6 months later, I started having a lot of chest pain and trouble breathing. I went to my PCP and they thought I had a blood clot in my lung and rushed me to the ER again for a chest CT. It was terrifying. They determined I was fine. [myptsd.com]

  During admission, he had acute dyspnea with desaturation but no chest pain at ten days after admission. [ncbi.nlm.nih.gov]

• Palpitations

  She gave a history of palpitation and having symptoms of ‘food poisoning’ for about 1 week. She was seen in a walk-in centre for these symptoms and was treated for urinary tract infection. She had had an early miscarriage 3 years earlier. [nature.com]

• Shoulder Pain

  George, Utah ACCOMPANIED BY HER HUSBAND, Tiffany Blackmore, 31, arrives at your ED complaining of severe lower abdominal and right shoulder pain. [journals.lww.com]

  ( referred shoulder pain may b e present) irregular bleeding amenorrhoea temperture > 38 C is unusual (look for infectious cause) Physical exam cervical motion tenderness adnexal mass A ruptured ectopic pregnancy may present with hypotension signs of [medbullets.com]

  Cigarette Smoking Ectopic pregnancy gets neglected in the early stage because of its common problems like pain in abdomen, amenorrhea and shoulder pain. But after sometime, the pregnancy may rupture, leading to hemorrhage. [onlymyhealth.com]

  Signs of ectopic pregnancy include Abdominal pain Shoulder pain Vaginal bleeding Feeling dizzy or faint 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. [fpnotebook.com]

• Back Pain

  Lower back pain 7. Intense shoulder tip pain – can be both or just on one side; due to heavy internal bleeding causing pressure on the diaphragm 8. [chaimommas.com]

  Any of the following warrant an immediate visit to the emergency room: Sudden, severe abdominal or pelvic pain Dizziness or fainting Pain in the lower back Pain in the shoulders (due to leakage of blood into the abdomen affecting the diaphragm) When to [verywell.com]

  Symptoms Usually the most common complaints of women with an ectopic pregnancy are vaginal bleeding and/or pain in the abdomen or pelvis, especially on one side of the body, Kickham said. Some women may have shoulder pain or lower back pain. [livescience.com]

• Fear

  If the issue is more complicated, such as moving to a new town, discuss your child's concerns and try to ease any fears. If you're concerned, talk to your doctor. In rare cases, basic stress relievers aren't enough to stop bruxism. [kidshealth.org]

  I can't talk myself down from the fear I feel. I have been 100% convinced that I was having a stroke/heart attack/had cancer, etc... I don't trust my doctors to care or listen to me. [myptsd.com]

  I couldn’t intake any folic acid out of fear it would support the baby that had to be terminated before it terminated me. Two days later I was at a California Pizza Kitchen and felt a sharp pain in my abdomen which soon had me doubled over. [modernloss.com]

  I could see the fear on my husband’s face but he held my hand and kept telling me it’s going to be alright and that he loved me. When we arrived to the second hospital I couldn’t make out what anyone was saying around me. [whattoexpect.com]

  I briefly felt fear as they put me on the operating table, and everyone had masks. The anesthesiologist told me he was giving me the medicine. I was afraid to go asleep because I wasn’t sure I would wake up. [thelewisnote.com]

• Cesarean Section

  Aside from the fallopian tube, an ectopic pregnancy can also occur in other locations such as… Pregnancy week by week Abdominal cavity Cornua (horn) of the uterus Cervix Ovaries Cesarean section scar Image source : Wikipedia by Takatakatakumi shared under [webmedicinecenter.com]

  Case reports indicate that viable abdominal ectopic pregnancies may be discovered at cesarean section, albeit rarely. 13 Diagnostic Evaluation Between 40 and 50 percent of ectopic pregnancies are misdiagnosed at the initial visit to an emergency department [aafp.org]

The most critical step in beginning the workup is to have a high clinical suspicion for ectopic pregnancy (eg, in any woman of childbearing age). [emedicine.medscape.com]

• Chlamydia

  Tests for gonorrhea and chlamydia were negative. The final pathological findings were consistent with a ruptured first-trimester ectopic pregnancy secondary to chronic follicular salpingitis. [nejm.org]

  Chlamydia What is Chlamydia? Chlamydia is a hidden bacterial infection which affects the neck of the womb (cervix), womb lining, fallopian tubes and pelvis in women. [ectopic.org.uk]

  Prevention of STIs, especially Chlamydia, may reduce incidence of ectopic pregnancy. return to top Resources and References Murray H et al. 2005. Diagnosis and treatment of ectopic pregnancy. CMAJ. 173(8). ACOG Practice Bulletin. 2008. [sharinginhealth.com]

  Avoid gonorrhea, chlamydia, and other sexually transmitted diseases If you plan to get pregnant soon and you are using an intrauterine device (IUD) for contraception, discuss this with your health-care professional. [emedicinehealth.com]

  Chlamydia often exhibits no noticeable symptoms, so women may be unaware they are infected. But the bacteria can cause inflammation of the fallopian tubes, which is known as salpingitis. [your.md]

The success was due to a correct diagnosis accompanied with prompt treatment and quick recognition of the etiology. [ncbi.nlm.nih.gov]

Almost all ectopic pregnancies will require treatment. [verywell.com]

Clinical diagnosis and treatment of ectopic pregnancy. Obstet Gynecol Surv 2013;68(8):571-81. [jetem.org]

Prognosis The prognosis for an ectopic pregnancy is excellent if treated before rupture. Long-term prognosis depends most on any associated complications. Copyright © 2017, 2013 Decision Support in Medicine, LLC. All rights reserved. [clinicaladvisor.com]

Treatment and prognosis IV heparin angioplasty +/- stenting catheter-directed thrombolysis surgical thrombectomy Complications significant risk of massive pulmonary embolism, even with anticoagulation 40-60% develop gangrene of the periphery 3 due to [radiopaedia.org]

The prognosis (outlook) for future pregnancies depends on the extent of the surgery. If the Fallopian tube has been spared, the chance of a successful pregnancy is usually better than 50%. [medicinenet.com]

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]

[…] recent series, 10-20% of patients undergoing thrombolysis with possible stenting for extensive DVT presented with phlegmasia. [7, 8, 9] The prevalence is thought to be slightly higher in men than in women, with a male-to-female ratio of 1.5:1. [10] Prognosis [emedicine.medscape.com]

We report 2 episodes of hemoperitoneum in a PD patient occurring more than 1.5 years apart, with different underlying etiologies. [ncbi.nlm.nih.gov]

Codes with this note are Etiology codes and must be followed by a Manifestation code or codes. [icd.codes]

Definition / general Implantation of fertilized egg within fallopian tube Epidemiology Estimated prevalence of 1 in 40 pregnancies (25 cases per 1000 pregnancies); US incidence ~2% Approximately 85 - 90% occur in multigravid women Rates are nearly twice [pathologyoutlines.com]

Epidemiology DVT affects as many as 2 million Americans every year. The majority of patients are treated medically, with anticoagulation being the mainstay of therapy to promote thrombus resolution and prevent propagation and embolization. [emedicine.medscape.com]

This was an epidemiological study and the diagnosis of bruxism was based on self-report questionnaires, representing the lower (‘possible’) grade of bruxism diagnosis (1, 2). [frontiersin.org]

Epidemiology The number of ectopic pregnancies has increased dramatically in the past few decades. [aafp.org]

[…] surgery. [44] In comparison, the cumulative pregnancy rate of women under 40 years of age in the general population over two years is over 90%. [45] In case of ovarian ectopic pregnancy, the risk of subsequent ectopic pregnancy or infertility is low. [46] Epidemiology [en.wikipedia.org]

The pathophysiological changes caused by the SCI must be kept in mind while evaluating the patient. [nature.com]

[…] women ( MMWR Surveill Summ 2003;52:1 ) Any woman with functioning ovaries (menache to menopause) can potentially have an ectopic pregnancy; women > 40 years have adjusted odds ratio of 2.9 Sites Ampulla (~80%), isthmus (12%), fimbriae (5%), cornu (2%) Pathophysiology [pathologyoutlines.com]

Objectives • Describe the anatomy & physiology of female reproductive system • Discuss the etiology & pathophysiology of REP • Discuss the anaesthetic consideration of patient undergoing surgery due to REP • Discuss the anesthetic management of patient [slideshare.net]

[…] are not as helpful. return to top Differential Diagnosis Other possible conditions include: normal pregnancy appendicitis urinary tract infection ovarian torsion ovarian cyst salpingitis ruptured corpus luteum cyst threatened abortion return to top Pathophysiology [sharinginhealth.com]

Pathophysiology In PAD, the thrombosis involves only major deep venous channels of the extremity, thus sparing collateral veins. The venous drainage is decreased but still present; the lack of cyanosis differentiates this entity from PCD. [emedicine.medscape.com]

This will prevent a possible ectopic pregnancy from advancing to the complication of tubal rupture. [tubal-reversal.net]

Some are designed to prevent damage to your teeth. Others prevent the upper and lower teeth from touching to eliminate grinding. Your doctor will help find the right kind of mouth guard for you. [familydoctor.org]

Early prenatal care is critical to diagnose an ectopic pregnancy and prevent it from rupturing. Current as of: September 5, 2018 Author: Healthwise Staff Medical Review: Sarah A. [myhealth.alberta.ca]

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]

Early prenatal care is critical to diagnose an ectopic pregnancy and prevent it from rupturing. Current as of: November 21, 2017 Author: Healthwise Staff Medical Review: Sarah A. [metrohealth.net]