विवरण
Outside of the uterus, a fertilized egg cannot develop normally. It is necessary to remove the ectopic tissue to avoid potentially fatal consequences. This can be accomplished with medication, laparoscopic surgery, or abdominal surgery, depending on your symptoms and the time the ectopic pregnancy is found. Methotrexate, a drug that dissolves existing cells and slows cell growth, is most commonly used to treat an early ectopic pregnancy without unstable hemorrhage. The drug is administered intravenously. Prior to starting this treatment, it is crucial that the ectopic pregnancy diagnosis be confirmed.
सारांश
- Ectopic pregnancy occurs when a fertilized egg implants outside the uterus, most commonly in the fallopian tube. Tubal pregnancies are the most frequent type, with ampullary pregnancies being the most common within that category. Other rarer types include ovarian, abdominal, intramural, cervical, and cesarean scar ectopic pregnancies. Heterotopic pregnancy is the co-occurrence of both an intrauterine and extrauterine pregnancy. Early diagnosis is crucial as ectopic pregnancy can be life-threatening.
- Risk factors for ectopic pregnancy include previous tubal surgery, tubal infections or inflammation, infertility treatments, smoking, and a history of prior ectopic pregnancy. While contraception aims to inhibit implantation, failure of methods like tubal sterilization, IUDs, and progesterone-only pills can favor ectopic implantation.
- Unruptured ectopic pregnancies can present with vague and subtle symptoms, requiring a high index of suspicion. Common signs include missed periods, abdominal pain, and vaginal bleeding. In contrast, ruptured ectopic pregnancies can lead to significant hemorrhage and shock.
- Diagnosis involves urine pregnancy tests, transvaginal ultrasound to determine the location of the pregnancy, and quantitative beta-hCG levels. Serial beta-hCG measurements can help assess pregnancy viability. A discriminatory zone exists, where a beta-hCG level above 1500 should correlate with a visible gestational sac on ultrasound.
- Management options include expectant, medical, and surgical approaches. Expectant management requires a stable patient with low beta-hCG levels and good follow-up. Medical management, primarily using methotrexate, is suitable for asymptomatic patients with low beta-hCG levels, small ectopic size, and no fetal cardiac activity, with proper assessment of renal and hepatic function.
- Surgical management, via laparoscopy or laparotomy, is indicated when medical management fails or is contraindicated. Surgical options include salpingostomy, a conservative approach to preserve the fallopian tube, and salpingectomy, a radical procedure involving complete tube removal. Cesarean scar ectopic pregnancies are increasing and often require surgical intervention.
नमूना प्रमाण पत्र
वक्ताओं के बारे में
Dr. Alisha Singh
Assistant Professor, The Oxford Medical College, Hospital and Research Center, Bangalore, Karnataka
वित्तीय प्रकटीकरण
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