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Early Pregnancy Complications…

Early Pregnancy Complications…. Miscarriage Ectopic IUCD in situ Use of Aspirin. Differential Diagnosis: First Trimester Vaginal Bleeding. Ectopic pregnancy Spontaneous miscarriage Idiopathic bleeding in a viable pregnancy Molar pregnancy Subchorionic hemorrhage

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Early Pregnancy Complications…

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  1. Early Pregnancy Complications… Miscarriage Ectopic IUCD in situ Use of Aspirin

  2. Differential Diagnosis:First Trimester Vaginal Bleeding Ectopic pregnancy Spontaneous miscarriage Idiopathic bleeding in a viable pregnancy Molar pregnancy Subchorionic hemorrhage Infection of the vagina or cervix Cervical abnormalities Malignancy, polyps, trauma Vaginal trauma

  3. Ectopic Pregnancy Any pregnancy that occurs outside of the uterine cavity Tubal Ampulla (55%) Isthmus (25%) Fimbria (17%) Cervical Ovarian Abdominal 97% 3%

  4. Ectopic Pregnancy Risk FactorsBouyer J, Coste J, Shojaei T, et al. Am J Epidemiol 2003; 157:185

  5. Ectopic Pregnancy - Pathophysiology • Conditions that impair tubal transport • Chronic salpingitis • Salpingitisisthmicanodosa Kutluay L, et al. Tubal histopathology in ectopic pregnancies. Eur J ObstetGynecolReprod Biol. 1994 • Conditions that cause premature implantation Attar E. Endocrinology of ectopic pregnancies. ObstetGynecolClin NA. 2004

  6. Ectopic Pregnancy History/Exam Findings Pelvic/Abdominal pain (90-100%) Vaginal bleeding (50-85%) Palpable adnexal mass (40%) Normal size uterus

  7. Ectopic Pregnancy Suspect Rupture… Significant abdominal tenderness *Especially if accompanied by: Hypotension Abdominal guarding Rebound tenderness

  8. Ectopic Pregnancy Diagnostic Tests βHCG Does not increase appropriately Ultrasound- what type and when do we do it? No intrauterine gestational sac Possible adnexal mass

  9. Ectopic Pregnancy Treatment Expectant management Monitor progress with βHCG levels Medical treatment Methotrexate – folic acid antagonist Disrupts rapidly dividing trophoblastic cells Surgery Laparoscopy with salpingostomy or salpingectomy Laparotomy – patient unstable

  10. Case 1 33 yo G3P2 with prior history of chlamydia, LMP 5/52 ago and + UPT. Seen by GP with vague lower abdominal pain. βHCG - 352 IU/l TV USS – 8.5mm intrauterine sac compatible with 5/52 pregnancy. No adnexal masses seen.

  11. Case 2 24 yo G2P1 LMP 7/52 ago and + UPT. Seen by GP with vaginal spotting. βHCG - 5230 IU/l TV USS – No intrauterine pregnancy, 3 cm R adnexal mass.

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