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Ruptured ectopic pregnancy Dr. Megha Jain University College of Medical Sciences & GTB Hospital, Delhi email:

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Ruptured Ectopic Pregnancy

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Ruptured Ectopic Pregnancy PowerPoint Presentation

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Description : Ruptured ectopic pregnancy Dr. Megha Jain University College of Medical Sciences & GTB Hospital, Del... Read More

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Published on : Nov 13, 2014
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Slide 1 - Dr. Megha Jain Ruptured ectopic pregnancy University College of Medical Sciences & GTB Hospital, Delhi email:
Slide 2 - Ectopic Pregnancy Definition: fertilized ovum is implanted and developes outside the normal uterine cavity. Incidence: 20 in 1000 pregnancies Responsible for 7% of all pregnancy related maternal deaths. Most common cause of death: hemorrhage(92%) Infection(3%) Embolism(3%) Anesthetic complication(1%) > 30% patients with ectopic suffer from infertility and 5-20% develop recurrent ectopic.
Slide 3 - Etiology Factors preventing or delaying migration of fertilized ovum: - PID - Contraceptive failure - Tubal reconstructive surgery - ART(ovulation induction drugs) - Previous ectopic - Prior induced abortion - Developmental defects of the tube
Slide 4 - Types of Ectopic Implantation site Extrauterine Uterine - tubal - cervical - ovarian - angular - abdominal - cornual
Slide 5 - Tubal Ectopic 1. Ampulla(64%) 2. Isthmus(25%) 3. Infudibulum(9%) 4. Interstitial(2%)
Slide 6 - Clinical Presentation Depends on gestational age, site of implantation and occurrence of hemorrhage Classical features of ruptured ectopic: - Short period of amenorrhea - Acute abdominal pain - Vaginal bleeding O/E - severe pallor - features of shock - tense and tender abdomen - uterus smaller than expected for dates - tender adnexal mass.
Slide 7 - How to diagnose? Positive pregnancy test with absence of intrauterine gestational sac on USG Serum progesterone <5 ng/ml Serial beta HCG - ↓, plateau, show a subnormal rise Culdocentesis- aspiration of non clotting bloody fluid
Slide 8 - Differential Diagnosis Threatened, inevitable or incomplete abortion Acute appendicitis Perforated peptic ulcer Ruptured ovarian cyst Ovarian torsion Ruptured endometrial cyst
Slide 9 - Management Laproscopy Resuscitation and laprotomy Unruptured tubal ectopic Ruptured ectopic Expectant Medical/ Surgical mgmt Salpingectomy Pt. hemodynamically stable Patient in shock
Slide 10 - Anesthetic management of ruptured ectopic Two large gauge i/v cannula with RL Arrange blood and blood products Routine noninvasive monitoring, consideration of invasive hemodynamic monitoring(arterial line,CV line) Foleys catheterisation General anesthesia RSI with cricoid pressure
Slide 11 - GA (contd….) Ketamine for induction(thiopentone or propofol if intravascular volume is restored) Succinylcholine for endotracheal intubation Maintenance with O2, N2O, volatile halogenated agent as tolerate Reversal of muscle relaxant and extubation when the patient is awake and responds to verbal commands.
Slide 12 - References Obstetric Anesthesia- Principles and practice David H. Chestnut 3rd edition Anesthesia for Obstetrics- Shnider and Levinson’s 4th edition Miller’s Anesthesia- Ronald D. Miller 6th edition Textbook of obstetric anesthesia- Colli’s 5th edition Principles and practice of critical care in obstetrics – A.Bhattacharya,S.Ahuja,A.K.Saxena. International anesthesiology clinics-2005,vol.43,no.4. Textbook of obstetrics- D.C.Dutta 6th edition
Slide 13 - Thank You