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Ruptured Ectopic Pregnancy


Presentation

  • 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]
Wound Infection
  • There were no significant differences in the incidence of postoperative fever (RR, 0.95; 95% CI, 0.43-2.01), postoperative wound infection (RR, 0.73; 95% CI, 0.17-3.19) or duration of hospital stay longer than 7 days (RR, 1.3; 95% CI, 0.44-4.31).[ncbi.nlm.nih.gov]
Rectal Pain
  • pain are reported Vagal stimulation from intra-peritoneal blood can present as hypotension and bradycardia Selected Differential Considerations: OB/GYN conditions: Spontaneous abortion (of normal IUP), septic abortion, early normal IUP, ovarian cyst,[coreem.net]

Workup

  • 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]

Treatment

  • Our case shows that non-operative treatment of a ruptured ectopic pregnancy may be a possible non-invasive treatment option in highly selected patients.[ncbi.nlm.nih.gov]
  • Clinical diagnosis and treatment of ectopic pregnancy. Obstet Gynecol Surv 2013;68(8):571-81.[jetem.org]

Prognosis

  • 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]
  • 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]
  • 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]
  • Prognosis Ectopic pregnancy is fatal to the fetus, but if treatment occurs before rupture, maternal death is very rare. In the US, ectopic pregnancy probably accounts for 9% of pregnancy-related maternal deaths.[merckmanuals.com]

Etiology

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

Epidemiology

  • 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]
  • The American Journal of Epidemiology. Retrieved from: J Coste, N JobSpira, and H Fernandez. Increased risk of ectopic pregnancy with maternal cigarette smoking. American Journal of Public Health.[natural-fertility-info.com]
  • 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]
Sex distribution
Age distribution

Pathophysiology

  • 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]
  • The pathophysiology involves antiphospholipid antibodies binding to β 2 -glycoprotein I, which then bind to glycoprotein Iba on platelets, monocytes, and endothelial cells.[apicareonline.com]
  • 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]
  • […] 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]

Prevention

  • 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]
  • 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]
  • Cyclizine • Dexamethasone administration also prevents POVN 39.[slideshare.net]
  • Hypothermia was prevented using IV fluid warmer and active convective warming of the patient. The emergence, extubation and recovery were uneventful. The vital signs after extubation were HR 87/min, BP 116/54 mmHg, RR 13/min, SpO2 98% on FiO2 0.35.[apicareonline.com]
  • Scarring in the tube prevents the normal passage of the fertilized egg through the tube and into the uterus where a healthy pregnancy takes place.[verywell.com]

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