hello in this video we're going to talk
about ectopic pregnancies this is an
overview and introduction ectopic
pregnancy means abnormal placement or
position ectopic pregnancy is what the
word suggests which is a pregnancy in
which the fetus develops in an abnormal
place outside the uterus typically in
the fallopian tube the clinical
presentation of an ectopic pregnancy is
usually a woman of reproductive age
let's just say 25 years old presenting
with acute abdominal pain with or
without / vaginal bleeding in any
presentation that is similar to this an
ectopic pregnancy must be ruled out why
because ectopic pregnancies are
life-threatening comparing an ectopic
pregnancy to normal the female genital
tract comprises of the vagina cervix the
uterus the ovary were ovulation of the
female egg occurs and then the fallopian
tube here which has many parts including
the fimbriae and the ampulla and this
joins with the uterus when the ovary
ovulates and releases the egg the female
egg travels through the fallopian tube
and becomes fertilized by sperm if lucky
and this is fertilization and the
fertilized egg then typically implants
in the endometrium of the uterus and
this is the beginning of a normal
pregnancy in an ectopic pregnancy the
fertilized egg implants somewhere
outside the uterine endometrium most
commonly in the fallopian tube and more
than 95% of cases of ectopic pregnancy
occurs within the fallopian tube which
is also known as the
you try to other less-common sites
include the ovaries the abdominal cavity
and the cervix the clinical presentation
of an ectopic pregnancy will be during
the first trimester of pregnancy so
before 13 weeks gestation let's just say
the clinical presentation of the ectopic
pregnancy will depend on a few things
number one it will depend on where the
ectopic pregnancy is located number two
it will depend if the ectopic pregnancy
is symptomatic or asymptomatic and three
if the ectopic pregnancy has ruptured or
not the clinical presentation of most
patients is often that they are
asymptomatic but symptomatic ectopic
pregnancies may include abdominal pain
and this because and this can be very
severe with vaginal bleeding there can
be no Ziya the feeling of faint with
shoulder tip pain which indicates a
ruptured ectopic pregnancy because of
the irritation of the diaphragm which
will then refer the pain onto the
shoulder finally the other symptoms is
amenorrhea which makes sense because a
woman who is pregnant will not men
straight the physical examination will
also depend if the woman is symptomatic
or not and whether the ectopic pregnancy
is a ruptured ectopic or not in a
ruptured ectopic pregnancy as you can
imagine there is tachycardia a fast
heart rate hypotension low blood
pressure and there can be signs of shock
and signs of peritonitis which will
indicate irritant irritation of the
peritoneum but how does an ectopic
pregnancy develop well there are risk
factors which increase the risk of
ectopic pregnancy which increases the
risks of implantation along the
fallopian tube and this and these risk
factors include a previous ectopic
pregnancy the use of intrauterine
devices chronic salpingitis which is
inflammation of the fallopian tube
having Shoebill surgery also increases
the risk but 50% of patients actually
have no identifiable risk
but some other less common risk factors
include pelvic inflammatory disease as
well as smoking the main differential
diagnosis of abdominal pain and P V
bleeding in the first trimester of
pregnancy can be divided into being a
non viable pregnancy or a viable
pregnancy a non viable pregnancy include
a miscarriage also known as a
spontaneous abortion another non viable
pregnancy differential is a molar
pregnancy a viable pregnancy includes
implantation bleed as well as a sub
chorionic hemorrhage and there are other
differential diagnoses including
infections of the genital tract or even
trauma investigations for a woman of
reproductive age presenting with per
vaginal bleeding and abdominal plain
pain include a full blood count to check
for anemia or infection electrolyte urea
creatinine to check for differentials
such as kidney stones check liver
function tests to check for any biliary
colic involvement but the most important
is serum beta HCG as well as urinalysis
checking for positive pregnancy test
beta HCG beta HCG is the hormone of
pregnancy and is used to see if a woman
is pregnant or not and to monitor
pregnancy in the early stages in this
scenario it is important to take serial
beta HCG for example every 48 hours the
reason for serial beta HCG measurement
can be shown by looking at a graph with
the length of pregnancy on the x-axis
first trimester pregnancies second
trimester pregnancy and third trimester
pregnancy and the y-axis is the beta HCG
concentration here on the y-axis
this is the normal trend of beta-hcg
during pregnancy as you can see EDA HCG
rapidly increases during the first
trimester of pregnancy it Peaks around 7
weeks 7 to week 10 gestation before it
will taper off down during this rapid
increase of beta HCG in the first
trimester beta HCG should double roughly
every two days every 48 hours if the
pregnancy is viable further
investigations that can be done must
include an abdominal ultrasound and or
transvaginal ultrasound to check for any
complications in the pregnancy the
management of ectopic pregnancy will
again depend on the woman if they are
symptomatic or asymptomatic and whether
the ectopic pregnancy has ruptured or
not the medical treatment can include
watchful waiting if the patient is
asymptomatic and if the ectopic
pregnancy is detected early the ectopic
pregnancy might miss cat miscarry
spontaneously
however symptomatic ectopic pregnancy or
even those who are asymptomatic can take
methotrexate methotrexate is a type of
chemotherapy agent but it essentially
works by inhibiting rapidly dividing
cells which makes sense because the
fertilized egg comprises of rapidly
dividing cells and thus by taking
methotrexate the ectopic pregnancy can
be stopped so the proliferation can be
stopped surgical treatment of an ectopic
pregnancy is usually an emergency
because the patient is hemodynamically
unstable this is always done in cases of
a ruptured ectopic pregnancy
surgical treatment can be either a
laparoscopic or open laparotomy
procedure laparoscopic is preferred and
then following this if the pregnancy is
within the fallopian tube which majority
of ectopic pregnancies are a self
injecting me or self in gosta me can be
performed a self injecting me is where
the whole fallopian tube is removed a
self in gosta me is where only part of
the fallopian tube is removed surgical
treatment of an ectopic pregnancy is
also done when there is a retained
product of conception still within the
female genital tract complications of
ectopic pregnancy include a ruptured
ectopic which will lead to shock and
even possibly death another complication
includes a recurrent ectopic pregnancy
as well as methotrexate side effects
including nausea vomiting and also
surgical complications including
infection
you