Ectopic pregnancy....how to diagnose & treat? एक्टोपिक प्रेग्नंसी... कैसे पता करें & इलाज कैसे करें скачать в хорошем качестве

Ectopic pregnancy....how to diagnose & treat? एक्टोपिक प्रेग्नंसी... कैसे पता करें & इलाज कैसे करें

An ectopic pregnancy occurs when a fertilized egg implants outside the uterine cavity, most commonly in a fallopian tube. Here’s an overview of its diagnosis and management: Diagnosis 1. *Clinical Symptoms:* Abdominal or pelvic pain Vaginal bleeding Shoulder pain due to diaphragmatic irritation from internal bleeding Dizziness or syncope if there is significant bleeding 2. *Physical Examination:* Tenderness in the abdomen Adnexal mass or tenderness on pelvic examination Hypotension or tachycardia signs of shock if there is significant hemorrhage 3. *Laboratory Tests:* *Serum hCG human chorionic gonadotropin* Levels typically rise slower in ectopic pregnancies compared to normal intrauterine pregnancies. *Complete blood count :* To check for anemia or signs of infection. 4. *Imaging:* *Transvaginal ultrasound* The primary diagnostic tool. It may show an empty uterine cavity, an adnexal mass, or free fluid in the pelvis indicating possible bleeding. Management Medical Management 1. *Methotrexate:* Indicated for hemodynamically stable patients with no contraindications to the drug. Criteria include no fetal cardiac activity, ectopic mass less than 4 cm, and reliable follow-up. Methotrexate works by inhibiting cell division in the rapidly dividing trophoblastic tissue. Surgical Management 1. *Laparoscopy:* The preferred surgical approach if the patient is hemodynamically stable. Procedures include salpingostomy removal of the ectopic pregnancy while preserving the fallopian tube or salpingectomy removal of the affected fallopian tube 2. *Laparotomy:* Performed in hemodynamically unstable patients or when laparoscopy is not feasible. Expectant Management In very select cases where the ectopic pregnancy is resolving spontaneously declining hCG levels and the patient is asymptomatic, close monitoring may be an option. Follow-up Regular monitoring of serum hCG levels until they return to less than 5 mIU/mL to ensure complete resolution. Rh immunoglobulin should be given to Rh-negative women to prevent Rh sensitization. Prevention and Counseling Discuss risk factors such as previous ectopic pregnancy, tubal surgery, pelvic inflammatory disease, and certain fertility treatments. Counseling on future fertility and the risk of recurrence is essential.