{"id":2613,"date":"2020-08-13T16:22:20","date_gmt":"2020-08-13T16:22:20","guid":{"rendered":"https:\/\/brooksidepress.org\/basic_obgyn\/?page_id=208"},"modified":"2021-05-09T20:37:33","modified_gmt":"2021-05-09T20:37:33","slug":"15-ectopic-pregnancy","status":"publish","type":"page","link":"https:\/\/brooksidepress.org\/pa_obgyn\/overview\/15-ectopic-pregnancy\/","title":{"rendered":"15. Ectopic Pregnancy"},"content":{"rendered":"<p><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/AQBfRFmYQeA\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>Duration = 4:32<\/p>\n<input type='hidden' bg_collapse_expand='69e9c9088cc4d3032468689' value='69e9c9088cc4d3032468689'><input type='hidden' id='bg-show-more-text-69e9c9088cc4d3032468689' value='Show Transcript'><input type='hidden' id='bg-show-less-text-69e9c9088cc4d3032468689' value='Hide Transcript'><button id='bg-showmore-action-69e9c9088cc4d3032468689' class='bg-showmore-plg-button bg-blue-button  '   style=\" color:#ffffff;\">Show Transcript<\/button><div id='bg-showmore-hidden-69e9c9088cc4d3032468689' ><\/p>\n<p>00:00<br \/>\nAPGO topic 15 ectopic<br \/>\n00:02<br \/>\npregnancy ectopic pregnancies are<br \/>\n00:04<br \/>\nabnormal implantations outside of the<br \/>\n00:07<br \/>\nendometrial cavity they account for 1.5<br \/>\n00:10<br \/>\npercent of reported pregnancies in the<br \/>\n00:11<br \/>\nUnited States 98 percent of ectopic<br \/>\n00:14<br \/>\npregnancies are in the fallopian tube 70<br \/>\n00:16<br \/>\nto 80 percent are located in the ampulla<br \/>\n00:18<br \/>\na portion of the tube less common<br \/>\n00:21<br \/>\nlocations include the ovary cervix and<br \/>\n00:24<br \/>\nabdomen ectopic pregnancy is a leading<br \/>\n00:26<br \/>\ncause of maternal morbidity and<br \/>\n00:27<br \/>\nmortality early diagnosis and management<br \/>\n00:30<br \/>\nmay prevent serious adverse outcomes and<br \/>\n00:32<br \/>\npreserve future fertility the objectives<br \/>\n00:35<br \/>\nof this video are to one develop a<br \/>\n00:37<br \/>\ndifferential diagnosis for bleeding and<br \/>\n00:39<br \/>\nabdominal pain in the first trimester to<br \/>\n00:41<br \/>\nlist risk factors for ectopic pregnancy<br \/>\n00:44<br \/>\nthree described the diagnosis and<br \/>\n00:46<br \/>\ntreatment for our topic pregnancy when a<br \/>\n00:49<br \/>\npatient presents with first trimester<br \/>\n00:50<br \/>\nvaginal bleeding and abdominal pain it<br \/>\n00:52<br \/>\nis essential to determine the location<br \/>\n00:54<br \/>\nof the pregnancy this could be a<br \/>\n00:56<br \/>\nnon-viable intrauterine pregnancy that<br \/>\n00:58<br \/>\ncould be either a spontaneous abortion<br \/>\n00:59<br \/>\nor a molar pregnancy or this could still<br \/>\n01:02<br \/>\nbe a viable intrauterine pregnancy with<br \/>\n01:04<br \/>\nphysiologic implantation bleeding or a<br \/>\n01:06<br \/>\nsub chorionic hemorrhage it is very<br \/>\n01:09<br \/>\nimportant to consider ectopic pregnancy<br \/>\n01:11<br \/>\nas a possible cause for missing an<br \/>\n01:13<br \/>\nectopic pregnancy can lead to maternal<br \/>\n01:15<br \/>\nmorbidity and mortality let&#8217;s discuss<br \/>\n01:17<br \/>\nectopic pregnancy risk factors as we<br \/>\n01:20<br \/>\ndiscussed earlier<br \/>\n01:20<br \/>\n98% of ectopic pregnancies are located<br \/>\n01:23<br \/>\nin the fallopian tube here&#8217;s a nice and<br \/>\n01:25<br \/>\nnormal fallopian tube what risk factors<br \/>\n01:27<br \/>\nwould result in this fallopian tube<br \/>\n01:29<br \/>\nbecoming scarred and damaged like this<br \/>\n01:31<br \/>\nillustration here having a history of an<br \/>\n01:34<br \/>\nectopic pregnancy would be the highest<br \/>\n01:36<br \/>\nrisk factor any other tubal surgery such<br \/>\n01:38<br \/>\nas a tubal ligation will also put her at<br \/>\n01:40<br \/>\nhigh risk chlamydial infection causes<br \/>\n01:43<br \/>\ntubal scarring via intraluminal<br \/>\n01:45<br \/>\ninflammation and subsequent fibrin<br \/>\n01:47<br \/>\ndeposition if a patient has had three<br \/>\n01:49<br \/>\nepisodes of pelvic inflammatory disease<br \/>\n01:51<br \/>\nher ratio of ectopic pregnancy and<br \/>\n01:53<br \/>\nintrauterine pregnancy is one to three<br \/>\n01:55<br \/>\nsmoking is also a risk factor because it<br \/>\n01:58<br \/>\nslows the cilia and the fallopian tube<br \/>\n01:59<br \/>\ndon&#8217;t forget however that 50% of<br \/>\n02:02<br \/>\npatients with atopic pregnancy will not<br \/>\n02:03<br \/>\nhave any risk factors the diagnosis of<br \/>\n02:06<br \/>\nectopic pregnancy involves a high index<br \/>\n02:08<br \/>\nof suspicion the classic symptoms<br \/>\n02:11<br \/>\nassociated with ectopic pregnancy<br \/>\n02:12<br \/>\nor amenorrhea vaginal bleeding and<br \/>\n02:15<br \/>\nabdominal pain diagnostic testing<br \/>\n02:19<br \/>\ninvolves serum beta HCG measurements and<br \/>\n02:21<br \/>\ntransvaginal ultrasound serial beta HCG<br \/>\n02:25<br \/>\nmeasurements are made at 48 hour<br \/>\n02:27<br \/>\nintervals to help determine if this is a<br \/>\n02:28<br \/>\nviable intrauterine pregnancy or a<br \/>\n02:31<br \/>\nnon-viable uterine or ectopic pregnancy<br \/>\n02:33<br \/>\nthe beta HCG should increase by at least<br \/>\n02:36<br \/>\n50 percent over a 48-hour interval when<br \/>\n02:40<br \/>\nthe beta HCG is above approximately<br \/>\n02:42<br \/>\n1,500 to 2,000 and intrauterine<br \/>\n02:44<br \/>\npregnancy should be seen on transvaginal<br \/>\n02:46<br \/>\nultrasound treatment for an ectopic<br \/>\n02:49<br \/>\npregnancy is either medical with<br \/>\n02:51<br \/>\nmethotrexate or surgical with either a<br \/>\n02:53<br \/>\nsailfin joste me or a self injected me<br \/>\n02:55<br \/>\nusually performed laparoscopically<br \/>\n02:57<br \/>\nmedical management with methotrexate can<br \/>\n02:59<br \/>\nbe used if it is safe and there is a<br \/>\n03:01<br \/>\nhigh chance for success the absolute<br \/>\n03:03<br \/>\ncontraindications to methotrexate<br \/>\n03:05<br \/>\naddressed the safety issue and these are<br \/>\n03:07<br \/>\nhemodynamic instability liver or kidney<br \/>\n03:10<br \/>\nabnormalities active lung disease<br \/>\n03:12<br \/>\nbreastfeeding and inability to comply<br \/>\n03:14<br \/>\nwith the required follow-up beta HCG<br \/>\n03:16<br \/>\ntesting if the methotrexate therapy is<br \/>\n03:18<br \/>\nnot going to be successful and she still<br \/>\n03:20<br \/>\nultimately needs surgery then she is<br \/>\n03:22<br \/>\nlikely not the best candidate so<br \/>\n03:24<br \/>\nrelative contraindications include fetal<br \/>\n03:26<br \/>\ncardiac activity high beta HCG level and<br \/>\n03:29<br \/>\na large ectopic pregnancy size greater<br \/>\n03:31<br \/>\nthan 3.5 centimeters there are two main<br \/>\n03:34<br \/>\noptions for surgical management of an<br \/>\n03:36<br \/>\nectopic pregnancy<br \/>\n03:37<br \/>\nASAP injected me involves removal of the<br \/>\n03:39<br \/>\nentire fallopian tube there is no need<br \/>\n03:42<br \/>\nfor beta HCG follow-ups as the entire<br \/>\n03:44<br \/>\npregnancy is removed with the fallopian<br \/>\n03:46<br \/>\ntube the other surgical option is a cell<br \/>\n03:48<br \/>\npin joste me a small hole is made in the<br \/>\n03:51<br \/>\nfallopian tube and the pregnancy is<br \/>\n03:53<br \/>\nremoved beta HCG levels have to be<br \/>\n03:56<br \/>\nfollowed after a South and jaws to me to<br \/>\n03:58<br \/>\nensure that the entire ectopic pregnancy<br \/>\n04:00<br \/>\nhas been removed this concludes the<br \/>\n04:03<br \/>\naapko video on a topic pregnancy we have<br \/>\n04:05<br \/>\ndiscussed the differential diagnosis of<br \/>\n04:06<br \/>\nvaginal bleeding and abdominal pain in<br \/>\n04:08<br \/>\nthe first trimester ectopic pregnancy<br \/>\n04:10<br \/>\nrisk factors and diagnosis and treatment<br \/>\n04:12<br \/>\nremember to always have a high index of<br \/>\n04:15<br \/>\nsuspicion in women presenting with<br \/>\n04:17<br \/>\nvaginal bleeding and abdominal pain in<br \/>\n04:18<br \/>\nthe first trimester<\/p>\n<p><\/div>\n","protected":false},"excerpt":{"rendered":"<p>Duration = 4:32<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":46,"menu_order":15,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-2613","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/2613","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/comments?post=2613"}],"version-history":[{"count":1,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/2613\/revisions"}],"predecessor-version":[{"id":2819,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/2613\/revisions\/2819"}],"up":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/46"}],"wp:attachment":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/media?parent=2613"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}