ECTOPIC PREGNANCY – When the blastocyst is implanted elsewhere than normal in the uterine cavity. All women of childbearing potential are pregnant until proven otherwise and it is always ectopic until it is proven to be an intrauterine pregnancy.
Symptoms: – It can be asymptomatic, it is not sure about the date of the last menstruation – Amenorrhea (6-8 weeks) – Pain (in the lower abdomen, moderate, usually unilateral) – Vaginal bleeding (small amount, often brown) – Diarrhea and vomiting – Dizziness – Shoulder pain (in diaphragmatic irritation – hematoperitoneum) – Collapse (if ruptured)
Signs: – Often there are no specific signs, the uterus is of normal size – Usually has cervical tenderness and adnexal pain – Peritoneal signs (due to intra-abdominal blood, if ectopic pregnancy is ruptured)
Differential diagnosis: Threatening abortion, complete abortion, bleeding corpus luteum, ruptured ovarian cyst, pelvic inflammation-adnexitis, Tubo ovarian abscess, degenerative fibroid, torsion of ovarian mass, and other acute surgical abdominal diseases.
Investigations: -TVUS (90% of ectopic pregnancies are identified) -serum progesterone – serum bHCG – Laparoscopy, the gold standard, when no diagnosis can be made
Treatment: Expectative, Drug, Surgical