MedLecturesMadeEasy's video: Ectopic pregnancy

This is a brief video on ectopic pregnancies, or a pregnancy occurring outside the uterus. I created this presentation with Google Slides. Images were created or taken from Wikimedia Commons I created this video with the YouTube Video Editor. ADDITIONAL TAGS: Ectopic pregnancy Ectopic pregnancy in open Fallopian tube, ~7 weeks gestational age By Ed Uthman, MD (Flickr, Wikipedia) - (2014). "Tubal pregnancy with embryo". WikiJournal of Medicine 1 (2): 7. DOI:10.15347/wjm/2014.007., Public Domain,https://commons.wikimedia.org/w/index.php?curid=840032 Pregnancy outside of the uterus Definition: embryo attaches outside the uterus Most commonly occur in the ampulla of fallopian tube, but can occur in other parts of tube, ovary, cervix, myometrium or within the abdomen Ectopic embryos can grow and create pressure or invade surrounding tissues Overview Overview Presentation Causes Diagnosis Management Symptoms: Classic symptoms: abdominal/pelvic pain, vaginal bleeding Pain can be sharp, dull, and/or crampy, often mimicking appendicitis Bleeding 6 weeks after last menstrual period Tender cervix, adnexal mass, or adnexal tenderness Symptoms of pregnancy: nausea, vomiting, urination, fatigue, breast tenderness Destruction / rupture of fallopian tubes: Rupture: abdominal distention, generalized tenderness, peritonitis, and hypovolemic shock (low BP, high HR, feeling cold) Presentation Overview Presentation Causes Diagnosis Management Damage to Fallopian tubes and/or hair-like cilia in internal surface of tubes Pelvic inflammatory disease / salpingitis resulting in scarring (most common) Infertility IUD use Exposure to DES Tubal surgery (ligation) Intrauterine surgery (D&C) Smoking Previous ectopic pregnany Endometriosis Causes / risk factors Overview Presentation Causes Diagnosis Management Overview Presentation Causes Diagnosis Management By Mikael Häggström, from original by BruceBlaus - File:Blausen 0602 Laparoscopy 02.png, CC BY 3.0, https://commons.wikimedia.org/w/index.php?curid=32779153 Overview Presentation Causes Diagnosis Management A "blob sign", which consists of the ectopic pregnancy. The ovary is distinguished from it by having follicles, whereof one is visible in the field. This patient had an intrauterine device (IUD) with progestogen, whose cross-section is visible in the field, leaving an ultrasound shadow distally to it. By Mikael Häggström.When using this image in external works, it may be cited as:Häggström, Mikael (2014). "Medical gallery of Mikael Häggström 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.008. ISSN 2002-4436. Public Domain.orBy Mikael Häggström, used with permission. - Own work, CC0, https://commons.wikimedia.org/w/index.php?curid=32779152 Perform transabdominal/transvaginal ultrasound: ↪ If intrauterine gestational sac present in uterus → not ectopic pregnancy ↪ If gestational sac present elsewhere (ring of fire with color Doppler d/t increased vascular flow to adnexa) → ectopic pregnancy ↪ If no gestational sac seen, perform quantitative serum hCG: ↪ If serum hCG 1500-2000 → treat like ectopic pregnancy (should be able to see intrauterine pregnancy) ↪ If serum hCG 1500-2000 → too soon to tell → perform serial hCG: ↪ Repeat hCG in 48 hours: ↪ If hCG doubles → intrauterine pregnancy → routine care, evaluate other causes of symptoms ↪ If hCG fails to double → ectopic pregnancy Ruptured ectopic pregnancy: Stabilize with fluids, blood, pressors OR for salpingectomy (remove tube) Unruptured ectopic pregnancy: Stabilize, OR for salpingostomy (unblock tube) If hCG 3000, gestational size 3.5 cm, no fetal heart tones Medical management: methotrexate +/- leucovorin Management Overview Presentation Causes Diagnosis Management Uterus in blue arrows Bleeding ectopic pregnancy in red arrows By Mikael Häggström - File:Ectopic pregnancy1981.jpg by Urskalberer81, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=31193206 By Urskalberer81 - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=29204493 Salpingectomy