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PowerPoint English Case KET

- A 34-year-old woman presented with acute abdominal pain and vaginal bleeding and was diagnosed with a ruptured ectopic pregnancy in her right fallopian tube. - She underwent an emergency laparotomy to address the ruptured ectopic pregnancy and excessive bleeding, which revealed a ruptured right fallopian tube. A right salpingectomy was performed to control the bleeding. - Ectopic pregnancies occur when implantation happens outside of the uterus, most commonly in the fallopian tubes. Risk factors include prior infections, ectopic pregnancies, contraceptive use, infertility treatments, and advanced maternal age. Surgical or medical treatments may be used depending on the
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0% found this document useful (0 votes)
74 views40 pages

PowerPoint English Case KET

- A 34-year-old woman presented with acute abdominal pain and vaginal bleeding and was diagnosed with a ruptured ectopic pregnancy in her right fallopian tube. - She underwent an emergency laparotomy to address the ruptured ectopic pregnancy and excessive bleeding, which revealed a ruptured right fallopian tube. A right salpingectomy was performed to control the bleeding. - Ectopic pregnancies occur when implantation happens outside of the uterus, most commonly in the fallopian tubes. Risk factors include prior infections, ectopic pregnancies, contraceptive use, infertility treatments, and advanced maternal age. Surgical or medical treatments may be used depending on the
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English Case

Ectopic Pregnancy
dr. Wahyuridistia M.

Consultant :
dr. Hj. Ermawati Sp.OG (K)
CHAPTER I
INTRODUCTION

• Ectopic pregnancy  abnormal implantation


• Major health problem
• Leading cause of pregnancy-related death
<20 weeks of pregnancy.
CHAPTER 2
CASE REPORT

IDENTITY
• Name : Miss. M
• Age : 34 years old
• MRNo : 00 72 03
• Date : May, 3rd 2017
• Adress : Dhamasraya
CHIEF COMPLAIN

A 34 years old patient was admitted to the


Delivery Room of Dhamasraya District Hospital on
May 3rd, 2017 at 10.30 am with chief complaint
acute abdominal pain since 3 hours ago.
PRESENT ILLNESS HISTORY

• Lower right abdominal pain a little bit since ± 1 days ago.


Worsening since 3 hours ago.
• This morning around 07.00 AM increasing pain during
activity and perceived continuously, no pain radiating to
the back.
• Blood staining from vagina since 1 day ago, staining a
piece of panty, blackish red colored but the patient didn’t
consult to anyone.
• Meat-like tissue out from the vagina was (-)
• Fish bubbles like tissue out from the vagina was (-)
• Amenorrhea since 2 month ago.
• First date of last menstrual period last March, patients
did not know she was pregnant
• This was the second pregnancy
• History of abnormal discharge vagina (-)
• No complaint in urinary and bowel system.
• History of fever (-)
• Menstrual History : menarche at 12 years old, no
regular cycle, every 28 days which last for about 4-5
days each cycle with the amount of 2-3 times pad
change/day without menstrual pain
PREVIOUS ILLNESS HISTORY
• There wasn’t previous history of heart, lung,
liver, kidney, DM, hypertension and allergic
history.

FAMILY ILLNESS HISTORY


• There wasn’t history of hereditary disease,
contagious and physicological illness in the
family.
Marriage history : once in 2010
History of pregnancy/abortion/delivery : 2/ 0 / 1
• 2012, male, 3000 gr, term pregnancy,
Spontaneous, midwife, alive
• Present
• History of family planning : contraception
injection every 3 mounth
• History of immunization : (-)
• History of education : senior high school
• History of occupation : house wife
• History of habitual : smoking, alcohol
and drug abuse were absent
Physical Examination :
• General Appearance : Moderate
• Consiousness : Composmentis cooperative
• Blood Pressure : 90/60 mmHg
• Pulse rate : 130 x/mnt
• Respiration rate : 26x/mnt
• Temperature : 37°C
• Body height : 156 cm
• Body weight before pregnancy : 51 kg
• Body weight : 52 kg
• Upper arm circumference: 25 cm
• BMI : 20,95 (normoweight)
• Eyes : Conjunctiva anemic, Sclera wasn’t icteric
• Neck : JVP 5-2 cmH2O
• Chest : H/L normal
• Abdoment : OR
• Genitalia : OR
• Extremity : Edema -/-, Physiological Reflex +/+,
Pathological Reflex -/-
Obstetric Record:

Abdoment
• Inspection : Abdomen didn’t seem enlarge, cicatrix (-)
• Palpation : Uterine fundal hard to palpate, abdominal
tenderness (+), defence muskular (-)
• Percution : Tympani
• Auscultation: Peristaltic sound was dicress
 Genitalia
Inspection : V/U normal, Bleeding pervaginam (+)
Inspeculo
Vagina : Tumor (-), laceration (-), fluxus (+) blackish red
blood seemed to accumulate in the posterior fornix
Portio : Multiparous, size equal to 1st digiti of plantar
pedis, tumor(-), laceration (-), fluxus (+) There was
black redish blood oozing from cervical canal, EUO
was closed
 VT bimanual
Vagina : tumour (-)
Portio : multiparous, size equal to 1st digiti of plantar
pedis, tumor(-), motion pain of the servix (+), EUO
was closed
CUT : hard to examine
AP : hard to examine
Douglas’ pouch: bulging
Laboratory Finding

No Parameter Result

12,00-14,00
1 Haemoglobin 8,3 gr/dl

37,0 % - 43,0 %
2 Haematocryte 30 %

3 Leucocyte 19.100/mm3 5000-10000

150000-400000
4 Trombocyte 182.000/mm3

5 PT 11,4 seconds

6 APTT 34,7 seconds


USG
Diagnose

Acute abdomen due to ruptured ectopic


pregnancy in G2P1A0L1 6-8 weeks of
pregnancy + moderate anemia
Advice :
• Control GA, VS
• Pre-operation room
• Consult to anasthesiologist and operative room
• Prepare blood for transfusion
• Informed consent

Plan :
• Emergency laparotomy
at 11.00 am
laparatomy was performed
• After opening the peritoneum in the blood and
blood clot looked ± 700 cc. Exploration was the
source of bleeding coming from the right tubal
rupture pars ampularis. Size 6x5x4,5 cm
• Impression: right fallopian tube rupture pars
ampularis.

Plan : Saphingectomy dextra


• Uterine shape and size larger than normal, the
left fallopian tube and ovary both shape and size
within normal limits
• Salphingectomy was performed

• D/ Post right salphingectomy on indication


rupture of right tube pars ampularis
CHAPTER 3
Ectopic Pregnancy

DEFINITIONS
• Abnormal implantation site
Risk Factor
• Infection
• Prior ectopic pregnancy
• Contraceptive Pill & IUD
• IVF
• Smoking
• Prior tubal surgery/obstruction
• Advanced maternal age
Sign and Symptoms

• Classic symptom : amenorrhea, irregular


bleeding and lower abdominal pain.
• Pain abdominal palpation
• Pain cervical motion
• Bulge cavum douglas
• Neck or shoulder pain
Multimodality Diagnosis

• USG
• Serum β-hCG level
• Laparoscopy
• Culdocentesis
Transvaginal sonography (TVS)
• Extrauterine GS
• Hemoperitoneum
• Trilaminar endometrial pattern
• Psudosac
• Heterotopic pregnancy
• Double decidual sac sign (decidua
capsularis and decidua parietalis)
Serum β-hCG level measurement

• Minimal hCG : USG visualize pregnancy


• 1.000-2.000 IU/L tranvaginal
• 5.000-6.000 IU/L transabdominal
Culdocentesis
• Hemoperitoneum
• 80% positive : ectopic pregnancy
Laparascopy

• Direct visualization
• Transition definitive operative
Treatment Options

• Medical & surgical


• Medical : antimetabolite methotrexate
• Surgical : salpingostomy or salpingectomy
Medical
• Success rates singledose methotrexate
93% with ectopic masses <3.5 cm
• Low success rate : Cardiac activity & size
>3.5 cm  relative contraindications
• Candidates : Hemodynamically stable, no
active bleeding or hemoperitoneum.
Medical

• Single-dose regimen : 50mg im


• β-hCG fall 15% in 7 days  2nd dosage
• Monitored of rupture
Surgical
• Preferred : laparoscopy, no if unstable.
• Hemodynamically unstable : stabilize &
exploratory laparotomy.
• Radical salpingectomy, salpingotomy &
salpingostomy
Preferred Salpingectomy

•Uncontrolled bleeding
•Extensive damage
•Recurrent ectopic pregnancy
•Sterilization
• Unruptured ectopic  linear salpingostomy
• No differences with or without suturing 
preferred salpingostomy
SUMMARY

• Diagnose : Ectopic pregnancy


• Risk factor : Contraceptive use
• Treatment : Unstable + excessive damage 
Emergency laparatomy  salphingectomy
THANK YOU

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