Results for "ectopic pregnancy"

Ultrasound in Contraception, Infertility, and Ectopic Pregnancy

Ectopic Pregnancy

abortion and ectopic pregnancy

Ectopic Pregnancy, Hydatidiform Mole, Abruption Placenta, Placenta Previa

Ectopic Pregnancy

Module 7: Ectopic Pregnancy & Postpartum Uterus

1. Hyperemesis Gravidarum/ Pernicious Vomiting Definition: Excessive nausea and vomiting during pregnancy, extending beyond week 12 or causing dehydration, ketonuria, and significant weight loss within the first 12 weeks. Incidence: 1 in 200-300 women Cause: Unknown, but may be associated with increased thyroid function and Helicobacter pylori infection. Signs and Symptoms: • Decreased urine output • Weight loss • Ketonuria • Dry mucous membranes • Poor skin turgor • Elevated hematocrit • Decreased sodium, potassium, and chloride levels • Polyneuritis (in some cases) Assessment: • Hemoglobin: Elevated hematocrit concentration (hemoconcentration) due to inability to retain fluids. • Electrolytes: Decreased sodium, potassium, and chloride levels due to low intake. • Acid-base Balance: Hypokalemic alkalosis (severe vomiting, prolonged period). • Neurological Examination: Polyneuritis due to B vitamin deficiency. Effects (if left untreated): • Intrauterine Growth Restriction (IUGR): Dehydration and inability to provide nutrients for fetal growth. • Preterm birth: Due to complications caused by the condition. • Prolonged hospitalization/home care: Resulting in social isolation. Therapeutic Management: • Fluid and Electrolyte Management: Monitor input and output, blood chemistry to prevent dehydration. • Nutritional Support: Withhold oral food and fluids (usually) and administer total parenteral nutrition (TPN). • Intravenous Fluid Replacement: 3000 ml Ringer's lactate with added vitamin B to increase hydration. • Antiemetic Medication: Metoclopramide (Reglan) to control vomiting. 2. Ectopic Pregnancy Definition: Implantation of a fertilized egg outside the uterine cavity (ovary, cervix, fallopian tube - most common). Incidence: Second most frequent cause of bleeding during the first trimester. Causes: • Obstruction of the fallopian tube: ◦ Adhesions (from previous infection like chronic salpingitis or pelvic inflammatory disease). ◦ Congenital malformations. ◦ Scars from tubal surgery. ◦ Uterine tumor pressing on the proximal end of the tube. ◦ Current use of an intrauterine device (IUD). Signs and Symptoms: • Missed period/amenorrhea. • Positive hCG test. • Sharp, stabbing pain in the lower abdominal quadrants and pelvic pain (at time of rupture). • Scant vaginal spotting/bleeding. • Rigid abdomen (from peritoneal irritation). • Leukocytosis (increased WBC count due to trauma). • Decreased blood pressure and increased pulse rate (signs of shock). • Cullen's sign (bluish tinge around the umbilicus). • Tender mass palpable in the cul-de-sac of Douglas (vaginal exam). • Falling hCG or serum progesterone level (suggesting the pregnancy has ended). • No gestational sac on ultrasound. Therapeutic Management: • Non-ruptured Ectopic Pregnancy: Oral administration of methotrexate followed by leucovorin. • Ruptured Ectopic Pregnancy (emergency): Laparoscopy to ligate bleeding vessels and remove or repair the damaged fallopian tube. 3. Hydatidiform Mole (H-mole)/ Gestational Trophoblastic Disease/ Molar Pregnancy Definition: A gestational anomaly of the placenta consisting of a bunch of clear vesicles resembling grapes. This neoplasm is formed from the swelling of the chorionic villi, resulting from a fertilized egg whose nucleus is lost, and the sperm nucleus duplicates, producing a diploid number 46XX. Incidence: Approximately 1 in every 1500 pregnancies. Risk Factors: • Low socioeconomic group (decreased protein intake). • Women under 18 or over 35 years old. • Women of Asian heritage. • Receiving clomiphene citrate (Clomid) for induced ovulation. Types of Molar Growth: • Complete/Classic H-mole: All trophoblastic villi swell and become cystic. No embryonic or fetal tissue present. High risk for malignancy. • Partial/Incomplete H-mole: Some of the villi form normally. Presence of fetal or embryonic tissue. Low risk for malignancy. Signs and Symptoms: • Uterus expands faster than normal. • No fetal heart sounds heard. • Serum or urine test for hCG strongly positive. • Early signs of preeclampsia. • Vaginal bleeding (dark-brown spotting or profuse fresh flow). • Discharge of fluid-filled vesicles. Diagnosis: • Ultrasound. • Chest x-ray (lung metastasis). • Amniocentesis (no fluid). • Hysteroscopy (via cervix). Management: • Evacuation of the mole: Dilation and curettage (D&C). • Blood transfusion. • Hysterectomy (in some cases). • Monitoring hCG levels: Every 2 weeks until normal. • Contraception: Reliable method for 12 months to prevent confusion with a new pregnancy. 4. Premature Cervical Dilatation/ Incompetent Cervix Definition: Premature dilation of the cervix, usually occurring around week 20, when the fetus is too immature to survive. Incidence: About 1% of pregnancies. Causes: • Increased maternal age. • Congenital structural defects. • Trauma to the cervix (cone biopsy, repeated D&C). Signs and Symptoms: • Painless dilation of the cervix. • Pink-stained vaginal discharge. • Increased pelvic pressure. • Rupture of membranes and discharge of amniotic fluid. Therapeutic Management: • Cervical cerclage: Surgical procedure to prevent loss of the child due to premature dilation. • Bed rest: After cerclage surgery, to decrease pressure on the sutures. 5. Abortion Definition: Termination of pregnancy before the fetus is viable (400-500 grams or 20-24 weeks gestation). Types of Abortion: • Spontaneous Abortion: Pregnancy interruption due to natural causes. ◦ Threatened: Mild cramping, vaginal spotting. ◦ Inevitable/Imminent: Profuse bleeding, uterine contractions, cervical dilation. ◦ Complete: All products of conception expelled spontaneously. ◦ Incomplete: Part of the conceptus expelled, some retained in the uterus. ◦ Missed: Fetus dies in utero but is not expelled. ◦ Habitual: 3 or more consecutive spontaneous abortions. • Induced Abortion: Deliberate termination of pregnancy in a controlled setting. Complications of Abortion: • Hemorrhage. • Infection (endometritis, parametritis, peritonitis, thrombophlebitis, septicemia). Management: • Bed rest. • Emotional support. • Sedation. • D&C: Surgical removal of retained products of conception. • Antibiotics. • Blood transfusion. 6. Placenta Previa Definition: The placenta is implanted in the lower uterine segment, covering the cervical os, obstructing the birth canal. Incidence: 5 per 1000 pregnancies. Signs and Symptoms: • Abrupt, painless vaginal bleeding (bright red). • Bleeding may stop or slow after the initial hemorrhage, but continue as spotting. Types: • Total: Placenta completely obstructs the cervical os. • Partial: Placenta partially obstructs the cervical os. • Marginal: Placenta edge approaches the cervical os. • Low-lying: Placenta implanted in the lower rather than the upper portion of the uterus. Therapeutic Management: • Immediate Care: Bed rest in a side-lying position. • Assessment: Monitor vital signs, bleeding, and fetal heart sounds. • Intravenous Therapy: Fluid replacement with large gauge catheter. • Delivery: Vaginal birth (safe for infant if previa is less than 30%). Cesarean section (safest for both mother and infant if previa is over 30%). 7. Abruptio Placenta/ Premature Separation of Placenta/ Accidental Hemorrhage/ Placental Abruption Definition: Separation of a normally implanted placenta after the 20th week of pregnancy, before birth of the fetus. Incidence: Most frequent cause of perinatal death. Causes: • Unknown. • Predisposing Factors: ◦ High parity. ◦ Advanced maternal age. ◦ Short umbilical cord. ◦ Chronic hypertensive disease. ◦ PIH. ◦ Trauma (automobile accident, intimate partner abuse). ◦ Cocaine or cigarette use. ◦ Thrombophilitic conditions (autoimmune antibodies). Classification: • Total/Complete: Concealed hemorrhage. • Partial: Concealed or apparent hemorrhage. Signs and Symptoms: • Sharp, stabbing pain in the uterine fundus. • Contractions accompanied by pain. • Uterine tenderness on palpation. • Heavy vaginal bleeding (may be concealed). • Signs of shock. • Tense, rigid uterus. • Disseminated Intravascular Coagulation (DIC). Therapeutic Management: • Fluid Replacement: IV fluids. • Oxygen: Limit fetal hypoxia. • Fetal Monitoring: External fetal heart rate monitoring. • Fibrinogen Determination: IV fibrinogen or cryoprecipitate. • Lateral Position: Prevent pressure on the vena cava. • Delivery: CS is the method of choice if birth is not imminent. 8. Premature Rupture of Membranes Definition: Rupture of the fetal membranes with loss of amniotic fluid during pregnancy before 37 weeks. Incidence: 5%-10% of pregnancies. Causes: • Unknown. • Associated with: Infection of the membranes (chorioamnionitis), vaginal infections (gonorrhea, streptococcus B, Chlamydia). Signs and Symptoms: • Sudden gush of clear fluid from the vagina with continued minimal leakage. • Nitrazine paper test: Amniotic fluid turns the paper blue (alkaline), urine remains yellow (acidic). • Microscopic examination: Amniotic fluid shows ferning, urine does not. • Ultrasound: Assess amniotic fluid index. • Signs of infection (increased WBC count, C-reactive protein, temperature, tenderness, odorous vaginal discharge). Therapeutic Management: • Bed Rest: To prevent further leakage and risk of infection. • Corticosteroids: To hasten fetal lung maturity. • Prophylactic Antibiotics: To reduce risk of infection. • Intravenous Penicillin/Ampicillin: If (+) for streptococcus B. • Induction of Labor: If fetus is mature and labor does not begin within 24 hours. 9. Pregnancy-Induced Hypertension (PIH)/ Toxemia Definition: Vasospasm occurring in both small and large arteries during pregnancy, causing elevated blood pressure, proteinuria, and edema. Incidence: Rarely occurs before 20 weeks of pregnancy. Risk Factors: • Multiple pregnancy. • Primiparas younger than 20 or older than 40. • Low socioeconomic background. • Five or more pregnancies. • Hydramnios. • Underlying diseases (heart disease, diabetes). • Rh incompatibility. • History of H-mole. Categories: • Gestational Hypertension: Blood pressure 140/90 or greater, without proteinuria or edema. • Preeclampsia: Blood pressure 140/90 or greater, with proteinuria and edema. • Eclampsia: Seizures or coma accompanied by preeclampsia. Therapeutic Management: • Preeclampsia: Bed rest, balanced diet, left lateral position. • Severe Preeclampsia: Hospitalization, diazepam, hydralazine, magnesium sulfate. • Eclampsia: Magnesium sulfate, diazepam, oxygen therapy, left lateral position

OBGYN : Abortion, Ectopic Pregnancy

Ectopic Pregnancy

Ectopic Pregnancy

ECTOPIC PREGNANCY

4- Ectopic Pregnancy

Ectopic pregnancy

Ectopic Pregnancy

Ectopic pregnancy

ECTOPIC PREGNANCY

Ectopic pregnancy

A Mastectomy Results In Physical And Emotional Truama. Pt Must Grapple The Cancer Diagnosis And The Impact Of The Physical Changes With S/O. Pelvic Examination, Which Involves Visualization And Palpation Of The Vulva, The Perineum, The Vagina, The Cervix. The Ovaries, And The Uterine Surfaces. Bimanual Pelvic Examination Progresses From The Visualization And Palpation Of The External Genital Organs For Edema And Irritations To An Inspection For Abnormalities Of The Internal Organs. To Visualize The Cervix And Vaginal Mucosa A Vaginal Speculum. (An Instrument Used To Enlarge The Vaginal Opening) Rectovaginal Examination To Evaluate Abnormalities Or Problems Colposcopy (Colpo, Vagina Or Vaginal; And Scopy, Observation) Provides Direct Visualization Of The Cervix And Vagina. Douching Or Having Intercourse Within 24 Hours Of The Examination Is Not Recommended. Mask Abnormal Cells And Reduce The Specimens Available For Collection. A Speculum Is Inserted Into The Vagina. The Vaginal Walls May Be Swabbed With An Iodine Or Vinegar Solution To Remove Surface Mucus To Improve Visualization Culdoscopy Culdoscopy (Cul-De-Sac; And Scopy, Observation) Is A Diagnostic Procedure That Provides Visualization Of The Uterus And Uterine Appendages (I.E., The Ovaries And Fallopian Tubes). Prepare The Patient For The Vaginal Operation With Preoperative In-Structions. Local, Spinal, Or General Anesthetic. After The Anesthetic Is Administered, The Patient Is Assisted To A Knee-Chest Position. Passed Through The Posterior Vaginal Wall. Examined For Tumors, Cysts, And Endometriosis. Conization (Removal Of Eroded Or Infected Tissue) May Be Done. Assess For Bleeding, Assess Vital Signs, And Monitor Voiding. Laparoscopy Laparoscopy (Examination Of The Abdominal Cavity With A Laparoscope, Inserted Through A Small Incision Made Beneath The Umbilicus) Provides Direct Visualization Of The Uterus And Its Appendages. Insertion Of A Foley Catheter To Maintain Bladder Decompression For An Open View. Carbon Dioxide May Be Introduced To Distend The Abdomen For Easier Visualization. Biopsy Is To Be Done Or Organs Are To Be Manipulated, A Second Incision May Be Made In The Lower Abdomen To Allow For Instrument Inser-Tion. Observed For Masses, Ectopic Pregnancy, Adhesions, And Pelvic Inflammatory Disease (Pid). Instruct The Patient Of The Probability Of Shoulder Pain Afterward Because Of Carbon Dioxide Introduced Into The Abdomen. Papanicolaou Test (Pap Test) Speculum Is Used To Widen The Vagina, Allowing Access To The Cervix. Exfoliative (I.E., Peeling) And Sloughed-Off Tissue Or Cells Are Collected From The Cervix, Stained, And Examined Specimens Must Be Labeled With The Date, Time Of The Last Menstrual Period, And Whether The Woman Is Taking Estrogen Or Birth Control Pills Instruct Not To Use A Douche, Tampon Or Vaginal Medication Or Have Sexual Intercourse For At Least 24 Hours Before Examination Between Ages 25 And 65 Years A "Pri-Mary Hpv Test Every 5 Years. Hpv Testing Is Not Available, Screening May Be Done With Either A Co-Test That Combines An Hpv Test With A Papanicolaou (Pap) Test Every 5 Years Or A Pap Test Alone Every 3 Years. Negative Findings Will Indicate The Woman Will Not Need Additional Testing Until The Time Defined By Her Age Category. Abnormal Findings Of Mild Dysplasia Will Be Monitored And Follow-Up Testing Completed. Bethesda System Is Preferred Because It Allows Better Communication Between The Cytologist And The Clinician. Evaluates The Adequacy Of The Sample Powder Fe, Whether Or Not It Is Satisfactory For Interpretation And Provides A General Classification Of Biopsy Biopsies Are Procedures In Which Samples Of Tissue Are Taken For Evaluation To Confirm Or Locate A Lesion. Tissue Is Aspirated By Special Needles Or Removed By Forceps Or Through An Incision. Breast Biopsy Is Performed To Differentiate Between Benign Or Mali Perfo Conditions Of The Breast Indicated For Patients With Palpable Masses; Suspicious Areas Appearing On Mammogra-Phy; And Righly Recommends Persistent, Encrusted, Purulent, Inflamed, Or Sanguineous Discharge From The Nipples Fine-Needle Aspiration: In Fna, Fluid Is Aspirated From A Palpable Breast Mass And Expelled Into A Specimen Bottle. Pressure Is Placed On The Site To Stop The Bleeding, And An Adhesive Bandage Is Ap-Plied. Fna May Or May Not Require A Local Anes-Thetic, And Typically Is Done In The Health Care Provider'S Office. • Stereotactic Or Ultrasound-Guided Core Needle Biopsy: Core Needle Biopsy Is A Reliable Diagnostic Technique To Obtain A Breast Biopsy If An Abnormal Mass Is Seen On The Mammogram. The Skin Is Anesthetized, And A Small Incision Is Made. Under The Guidance Of Ultrasound Or Stereotactic Imaging, A Biopsy Gun Is Used To Fire The Core Needle Into The Lesion To Remove A Sample Of The Mass. Compared With An Open Surgical Biopsy, This Procedure Produces Less Scarring, Requires Only Local Anesthesia, Is Less Expensive, And Is Done On An Outpatient Basis. Patients Must Be Advised To Stop Aspirin Or Blood Thinning Products 3 To 5 Days Prior To The Procedure And To Avoid Talcum Powder And Deodorant The Day Of The Procedure Open Surgical Biopsy: In An Open Surgical Biopsy, An Excisional Biopsy Usually Is Performed In A Portion Of The Breast To Expose The Lesion And Then Remove The Entire Mass. Specimens Of Selected Tissue May Be Frozen And Stained For Rapid Diagnosis. The Wound Is Sutured And A Bandage Applied. The Incision Site Is Monitored For Bleeding, Tenderness, And Erythema Johns Hopkins, N.D.A.). A Cervical Biopsy Is Done To Evaluate Cervical Lesions And To Diagnose Cervical Cancer. The Biopsy Generally Is Done Without Anesthesia. A Colposcope Is Inserted Through The Vaginal Speculum For Direct Visualization, The Cervical Site Is Selected And Cleansed, And Tissue Is Removed. The Area Then Is Packed With Gauze Or A Tampon To Check The Blood Flow. An Endometrial Biopsy Is Performed To Collect Tissue For Diagnosis Of Endometrial Cancer And Analysis Lor Infertility Studies. The Procedure Generally Is Performed At The Time Of Menstruation , When The Cervix Is Dilated And Cells Are Obtained More Easily. The Cervix Is Anesthetized Locally, A Curette (A Spoon-Shaped Instrument Used To Obtain Samples From The Wall Of A Cavity, Is Inserted, And Tissue Is Obtained From Selected Sites Of The Endometrium.

Ectopic Pregnancy

Obstetrics - Preterm Labor, Fetal Growth Disorders, Abortion, GTD and Ectopic Pregnancy