15. Ectopic Pregnancy

Duration = 4:32

00:00
APGO topic 15 ectopic
00:02
pregnancy ectopic pregnancies are
00:04
abnormal implantations outside of the
00:07
endometrial cavity they account for 1.5
00:10
percent of reported pregnancies in the
00:11
United States 98 percent of ectopic
00:14
pregnancies are in the fallopian tube 70
00:16
to 80 percent are located in the ampulla
00:18
a portion of the tube less common
00:21
locations include the ovary cervix and
00:24
abdomen ectopic pregnancy is a leading
00:26
cause of maternal morbidity and
00:27
mortality early diagnosis and management
00:30
may prevent serious adverse outcomes and
00:32
preserve future fertility the objectives
00:35
of this video are to one develop a
00:37
differential diagnosis for bleeding and
00:39
abdominal pain in the first trimester to
00:41
list risk factors for ectopic pregnancy
00:44
three described the diagnosis and
00:46
treatment for our topic pregnancy when a
00:49
patient presents with first trimester
00:50
vaginal bleeding and abdominal pain it
00:52
is essential to determine the location
00:54
of the pregnancy this could be a
00:56
non-viable intrauterine pregnancy that
00:58
could be either a spontaneous abortion
00:59
or a molar pregnancy or this could still
01:02
be a viable intrauterine pregnancy with
01:04
physiologic implantation bleeding or a
01:06
sub chorionic hemorrhage it is very
01:09
important to consider ectopic pregnancy
01:11
as a possible cause for missing an
01:13
ectopic pregnancy can lead to maternal
01:15
morbidity and mortality let’s discuss
01:17
ectopic pregnancy risk factors as we
01:20
discussed earlier
01:20
98% of ectopic pregnancies are located
01:23
in the fallopian tube here’s a nice and
01:25
normal fallopian tube what risk factors
01:27
would result in this fallopian tube
01:29
becoming scarred and damaged like this
01:31
illustration here having a history of an
01:34
ectopic pregnancy would be the highest
01:36
risk factor any other tubal surgery such
01:38
as a tubal ligation will also put her at
01:40
high risk chlamydial infection causes
01:43
tubal scarring via intraluminal
01:45
inflammation and subsequent fibrin
01:47
deposition if a patient has had three
01:49
episodes of pelvic inflammatory disease
01:51
her ratio of ectopic pregnancy and
01:53
intrauterine pregnancy is one to three
01:55
smoking is also a risk factor because it
01:58
slows the cilia and the fallopian tube
01:59
don’t forget however that 50% of
02:02
patients with atopic pregnancy will not
02:03
have any risk factors the diagnosis of
02:06
ectopic pregnancy involves a high index
02:08
of suspicion the classic symptoms
02:11
associated with ectopic pregnancy
02:12
or amenorrhea vaginal bleeding and
02:15
abdominal pain diagnostic testing
02:19
involves serum beta HCG measurements and
02:21
transvaginal ultrasound serial beta HCG
02:25
measurements are made at 48 hour
02:27
intervals to help determine if this is a
02:28
viable intrauterine pregnancy or a
02:31
non-viable uterine or ectopic pregnancy
02:33
the beta HCG should increase by at least
02:36
50 percent over a 48-hour interval when
02:40
the beta HCG is above approximately
02:42
1,500 to 2,000 and intrauterine
02:44
pregnancy should be seen on transvaginal
02:46
ultrasound treatment for an ectopic
02:49
pregnancy is either medical with
02:51
methotrexate or surgical with either a
02:53
sailfin joste me or a self injected me
02:55
usually performed laparoscopically
02:57
medical management with methotrexate can
02:59
be used if it is safe and there is a
03:01
high chance for success the absolute
03:03
contraindications to methotrexate
03:05
addressed the safety issue and these are
03:07
hemodynamic instability liver or kidney
03:10
abnormalities active lung disease
03:12
breastfeeding and inability to comply
03:14
with the required follow-up beta HCG
03:16
testing if the methotrexate therapy is
03:18
not going to be successful and she still
03:20
ultimately needs surgery then she is
03:22
likely not the best candidate so
03:24
relative contraindications include fetal
03:26
cardiac activity high beta HCG level and
03:29
a large ectopic pregnancy size greater
03:31
than 3.5 centimeters there are two main
03:34
options for surgical management of an
03:36
ectopic pregnancy
03:37
ASAP injected me involves removal of the
03:39
entire fallopian tube there is no need
03:42
for beta HCG follow-ups as the entire
03:44
pregnancy is removed with the fallopian
03:46
tube the other surgical option is a cell
03:48
pin joste me a small hole is made in the
03:51
fallopian tube and the pregnancy is
03:53
removed beta HCG levels have to be
03:56
followed after a South and jaws to me to
03:58
ensure that the entire ectopic pregnancy
04:00
has been removed this concludes the
04:03
aapko video on a topic pregnancy we have
04:05
discussed the differential diagnosis of
04:06
vaginal bleeding and abdominal pain in
04:08
the first trimester ectopic pregnancy
04:10
risk factors and diagnosis and treatment
04:12
remember to always have a high index of
04:15
suspicion in women presenting with
04:17
vaginal bleeding and abdominal pain in
04:18
the first trimester

Introductory Women's HealthCare