ectopic - ADVANCES IN THE ADVANCES IN THE MANAGEMENT OF...

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Unformatted text preview: ADVANCES IN THE ADVANCES IN THE MANAGEMENT OF ECTOPIC MANAGEMENT OF ECTOPIC PREGNANCY PREGNANCY Prof. Surendra Nath Panda, M.S. Department of Obst.Gynaec M.K.C.G.Medical College Berhampur-760010, Orissa, India 24/12/11 Ectopic Pregnancy 2 ECTOPIC PREGNANCY DEFINITION Any pregnancy where the fertilised ovum gets implanted & develops in a site other than normal uterine cavity. 24/12/11 Ectopic Pregnancy 3 INCIDENCE >1 in 100 pregnancies. Recent evidence indicates that the incidence of ectopic pregnancy has been rising in many countries. USA-5 fold UK-2 fold France 15/1000 pregnancies India-1in100 deliveries Recurrence rate - 15% after 1 st , 25% after 2 ectopics 24/12/11 Ectopic Pregnancy 4 HISTORY Ectopic pregnancy was first described in 963 Ad by Albucasis. 1884 -- Robert Lawson Tait of Birmingham prformed the first successful Salpingectomy operation 1953 -- Stromme Conservative surgery of Salpingostomy 1973 -- Shapiro & Adller Laparoscopic Salpingectomy 1991 -- Young et al Laparoscopic Salpingotomy 24/12/11 Ectopic Pregnancy 5 AETIOLOGY Any factor that causes delayed transport of the fertilised ovum through the. Fallopian tube favours implantation in the tubal mucosa itself thus giving rise to a tubal ectopic pregnancy. These factors may be Congenital or Acquired. 24/12/11 Ectopic Pregnancy 6 AETIOLOGY CONGENITAL - Tubal Hypoplasia , Tortuosity , Congenital diverticuli , Accessory ostia , Partial stenosis ACQUIRED - Inflammatory: PID, Septic Abortion, Puerperal Sepsis, MTP (lntraluminal adhesion) Surgical: Tubal reconstructive surgery, Recanalisation of tubes Neoplastic: Broad ligament myoma, Ovarian tumour Miscellaneous Causes: IUCD , Endometriosis, ART (IVF & & GIFT), Previous ectopic 24/12/11 Ectopic Pregnancy 7 SITES OF ECTOPIC PREGNANCY 1)Fimbrial 2)Ampullary 3)Isthemic 4)Interstitial 5)Ovarian 6)Cervical 7)Cornual-Rudimentary horn 8)Secondary abdominal 9)Broad ligament 10)Primary abdominal Ampulla (>85%) Isthmus (8%) Cornual (< 2%) Ovary (< 2%) Abdomen (< 2%) Cervix (< 2%) 24/12/11 Ectopic Pregnancy 8 CLINICAL PRESENTATION Ectopic Pregnancy remains asymptotic until it ruptures when it can present in two variations - Acute &. Chronic SYMPTOMS- Amenorrhea Abdominal Pain Syncope Vaginal Bleeding Pelvic Mass 24/12/11 Ectopic Pregnancy 9 DIAGNOSIS Pregnancy in the fallopian tube is a black cat on a dark night. It may make its presence felt in subtle ways and leap at you or it may slip past unobserved. Although it is difficult to distinguish from cats of other colours in darkness, illumination clearly identifies it. --Mc. Fadyen - 1981 24/12/11 Ectopic Pregnancy 10 DIAGNOSIS In recent years, inspite of an increase in the incidence of ectopic pregnancy there has been a fall in the case fatality rate....
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This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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ectopic - ADVANCES IN THE ADVANCES IN THE MANAGEMENT OF...

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