The ectopic pregnancy is a pregnancy is developing outside the uterus. The vast majority of pregnancies are ectopic pregnancies in the fallopian tube or tubal pregnancies. The ectopic pregnancy is a surgical emergency as it ruptured.  Its diagnosis is increasingly early to avoid its rupture and the development and life-threatening to non-surgical treatment under certain strict conditions.

It is a surgical emergency that may compromise the prognosis of the mother or her future fertility. Among women without contraception, the two main risk factors are firstly the history of pelvic infection or tubal surgery and other tobacco. The hormone assays, the ultrasound and laparoscopy changed the management of the disease.

It is the leading cause of mortality in the first trimester of pregnancy in the United States It concerns a pregnancy on sixty.

Ectopic pregnancy organic

If there is a lesion of the tubal wall without obstruction of the fallopian tube, the increase of the egg is slowed by the disruption of peristalsis (contraction) tubal. The causes may be infectious (sequelae of pelvic inflammatory -cell more or less specific), surgical (flanges postoperative surgical sub-mesocolic, in case of appendicitis, for example, or surgery for tubal sterility).

The presence of an intrauterine device (IUD) can cause deciliation and inflammation. From a more practical, the IUD prevents implantation uterine implantation but not ectopic.

Ectopic Pregnancy functional

It is caused by a disruption of tubal peristalsis (contraction). The causes are multiple, the main one is smoking.The presence of a short luteal phase, intake of progestins micro-dosed, the morning after pill or fertility drugs increase the risk of ectopic pregnancy.

Diagnosis

There are different types of diagnosis available:

Clinic

The typical picture is that of a haematocele non-complicated type of colic pain, lateralized, accompanied by malaise, bleeding (bleeding genital) sepia or black after a period of amenorrhea. The complete review and examination history search gyneco-obstetric, surgical and medical. The examination shows the absence of shock or tachycardia. There is a pain caused by palpation of the abdomen, sometimes with a defense (in the form of contraction on palpation) below the navel.

The note touches pelvic uterus less fat than would be the gestational age and may charge a latero-uterine mass pain with a pain in the cul-de-sac (between rectum and vagina).

Biological

The NFS may show anemia, increased levels of leukocytes, nonspecific. Rising rates of β-HCG plasma can confirm pregnancy if it is greater than 10 IU / l. It may be lower than would be believed age of the pregnancy. The picture is completed by blood electrolytes, a hemostasis, and the blood group determination, referred to pre-operatively.

Imaging

The ultrasound probe is to visualize abdominal mass latero-uterine heterogeneous, consisting of the gestational sac outside the uterine cavity. The uterus is empty and its walls thickened. Effusion at the cul de sac can be demonstrated. The β-hCG above 4000 IU / l without viewing intrauterine ovular sac sign virtually ectopic pregnancy.

Ultrasound examination may be supplemented by the use of a transvaginal probe, allowing better visualization of the tubes, ovaries and uterine contents. The laparoscopic approach allows for the diagnosis. It should not be done too early because you may then ignore the ectopic pregnancy. She visualizes a blue olivary expansion of the tube, corresponding to a hématosalpynx (bleeding into the trunk) and can highlight the hemoperitoneum. She said the head of pregnancy.

Treatment

In 1863, Eugene Koeberle was the first to operate an ectopic pregnancy with living child.The first goal is to save the life of the patient, because it is of vital urgency. The second goal is to preserve the chances of a subsequent pregnancy trying to be as conservative as possible.

Hospitalization with a conditioning (clinical and biological) is essential.The medical options are the use of methotrexate systemically or preferably in situ after puncture of the gestational sac and U.S. guided injection. The repeated doses could increase the effectiveness of treatment. The monitoring is done to lower β-hCG to 2 IU / l. Drug treatment is at least as effective as surgery in uncomplicated forms, especially if the rate of β-hCG is low.

The no treatment can be discussed in case of ectopic pregnancy in β-HCG very low. In all cases, do not forget the prevention of rhesus iso-immunization to Rh-patients.

• Radical salpingectomy with total resection of the portion isthmus and oophorectomy in cases of ovarian lesion;
• With conservative Caesarean section and tubal digital expression of the egg from the pavilion after salpingotomy ;

They depend on the hemodynamic status, history of the patient, his desire for pregnancy, the condition of the contra-lateral trunk.

Complications

Early, they are common to all surgery: bleeding, thromboembolism, infectious…

The risk is that of a late infertility.

Prevention

Prevention of sexually transmitted infections (use condoms) is important.

Author: Nouman Umar

References:

Ectopic Pregnancy Analysis