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Ectopic Pregnancy

by Carlo Raj, MD
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    00:01 Our topic here is ectopic pregnancy, a very common disorder.

    00:05 Make sure that you’re quite familiar with ectopic pregnancy.

    00:09 Abnormal implantation of a fertilized egg, instead of being in the uterus.

    00:15 And even with the uterus, remember, that implantation should be taking place in the proximal portion of the uterus.

    00:23 Keep that in mind because you can have implantation in other parts of the uterus uterus in which a diagnosis becomes complete different.

    00:31 Here, however, the implantation is not taking place anywhere near the uterus.

    00:37 We’re in the fallopian tubes -- 90% of the time, it will be in the fallopian tube.

    00:42 How is that possible? Well, I want you think about the fallopian and its behavior.

    00:48 In other words, it’s responsible for facilitating the journey of the fertilized egg from the ovary and then towards the uterus.

    00:59 But what may then happen is if you have a female and she unfortunately developed a sexually transmitted infection such as gonorrhea or chlamydia.

    01:09 And at some point in time, the organism starts causing infection to the fallopian tube.

    01:15 And so therefore, this type of salpingitis eventually, just like any type of injury to any organ, begins the process of repair.

    01:23 The repair to you should mean fibrosis, scarring.

    01:29 So now you have scarring in this fallopian tube that is relatively delicate and it’s responsible for contraction and such.

    01:37 So imagine now that fertilized egg comes -- it’s moving forward to the fallopian tube and it gets stuck in that area that’s scarred.

    01:46 This is ectopic pregnancy.

    01:48 So how is your patient going to then behave? Well, before we begin, anytime that you have a female in her reproductive age and she’s experiencing abdominal pain, your next step of management always is to do a pregnancy test.

    02:04 If the beta hCG comes back to be negative, and then you further explore, well, what’s going on with your patient? Comes back to you positive, and now, let’s talk about this abdominal pain that the ectopic pregnant woman is experiencing.

    02:19 Approximately six weeks after her last menstrual period is when she will start having abdominal pain, pelvic pain, there would be adnexal tenderness and maybe perhaps she’ll be spotting.

    02:34 All these should indicate that perhaps your patient might be suffering from the ectopic pregnancy.

    02:40 Comes back to be positive for beta hCG, you do an ultrasound and you find, my goodness, the egg is in the fallopian tube.

    02:50 Now, what are you worried about? If that egg keeps getting bigger, bigger, bigger and bigger as it would be, then the fallopian tube cannot handle obviously this type of growth.

    03:01 It is going to rupture, isn’t it, the fallopian tube? And your patient’s going to die.

    03:05 And we’re talking about spontaneous bleeding that’s going to take place within the peritoneum.

    03:09 This is no joke, ladies and gentlemen.

    03:11 You need to make sure that you’re quite aggressive and you’re using proper medical clinical acuity.

    03:19 Now the reason you need to bring this to your attention well, I need to bring this to your attention is because take a look, one in one fifty, that is really common.

    03:27 Anytime that you deal with ratio in medicine, figure out as to whether or not this is rare or common condition.

    03:34 And if the ratio is as, what you’re seeing here, frequent, then you’ll know that you definitely need to know everything about that particular condition.

    03:43 Once again, the pregnancy test should be investigated so that you can rule out pregnancy especially if you have a female in reproductive age who is experiencing abdominal pain.

    03:54 Also look for spotting, a little bit of blood that’s being released.

    03:57 It’s painful and there’s also adnexal tenderness, referring to what? Well, the fallopian tube, if that has been affected, there’s going to be – well, think about where the ovaries would be and there’d be pain in that region, adnexa.


    About the Lecture

    The lecture Ectopic Pregnancy by Carlo Raj, MD is from the course Pregnancy Complications.


    Included Quiz Questions

    1. 1:150
    2. 1:50
    3. 1:5000
    4. 1:3000
    5. 1:1500
    1. Pelvic inflammatory disease and endometriosis
    2. Nulliparity and Gonococcal sexually transmitted infection
    3. Endometriosis and late menarche
    4. Endometriosis and Polycystic ovarian disease
    5. Pelvic inflammatory disease and Turner syndrome
    1. Serum beta-hCG
    2. Abdominal ultrasound
    3. Blood culture
    4. Urinalysis
    5. Abdominal CT

    Author of lecture Ectopic Pregnancy

     Carlo Raj, MD

    Carlo Raj, MD


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