Ectopic pregnancy (EP)
Definition: This is the implementation and development of a pregnancy outside of the uterus, usually in the fallopian tube, rarely in the ovary or peritoneal cavity.
WARNING :A n EP may involve life-threatening tubal rupture (rupture of the tube by the evolution of pregnancy). The EP is a THERAPEUTIC EMERGENCY.. Incidence: 1 to 3% of pregnancies or about 100 to 175 GEU/an/100000 women. Mortality following an ectopic pregnancy has become exceptional. RISK FACTORS
-Smoking (risk factor) -History of salpingitis -History of ectopic pregnancy - History of tubal surgery, abortion -Intrauterine contraceptive -Assisted reproduction -Contraceptive pill micro progestational HOW TO MAKE THE DIAGNOSIS?
Diagnosis is difficult and relies on a tripod diagnosis-Clinic -Determination of the rate of Beta HCG -Pelvic Ultrasound Everything can be seen from the absence of pain, to moderate discomfort and intense pain -CLINICAL -Clinical triad: -Late periods -Light bleeding, récidivantesde sepia -Unilateral pelvic pain, increasing in intensity -Sign of pregnancy amenorrhea, persistent hyperthermia, signs sympathetic - A little discomfort pain caused by abdominal palpitation -Speculum: uterine bleeding Origin -Vaginal examination-Uterus smaller than should be for the term -Latero-uterine pain -Latero-uterine mass corresponding to the EP -Beta HCG ASSAY This is the only one which if negative, can eliminate the diagnosis of pregnancy and so the EP;. At the beginning of a normally implanted pregnancy, the rate of Beta HCG double every 48 hours. The kinetic rate of Beta HCG at 48 hour intervals is disrupted during an ectopic pregnancy. There is inadequate elevation or stagnation. -ULTRASONOGRAPHY -It will be by abdominal and then transvaginal -It confirms the diagnosis of ectopic pregnancy and to clarify on which side. -There are direct signs of ectopic pregnancy ultrasounds-Image latero-uterine: gestational sac or pocket of blood (haematosalpinx) -And indirect signs -Empty and thick uterus, -Effusion in the peritoneum WHAT IS THE TREATMENT OF EP ?
The patient will in most cases be hospitalized for treatment and monitoring. .The standard treatment is Surgery.It is done by laparoscopy but in the case of complications a laparotomy (abdominal incision vertical) may be required. There are two alternative treatments: :-Conservative treatment: salpingotomy: opening of the fallopian tube and aspiration of pregnancy. -When the tube is badly damaged and the contralateral tube healthy radical treatment is chosen: the Salpingectomy which corresponds to the removal of the tube.In all cases, the laparoscopic approach and conservative treatment are privileged. The treatment will be as conservative as possible. Finally, in the same operation, a prognosis for future fertility will be done. There are alternatives to surgery that are::-MEDICAL TREATMENTIts indications are limited, it is necessary that: :-USG asymptomatic -Beta HCG <5000UI / L -EP is not visible on ultrasound -No peritoneal It is by injection of methotrexate, whose goal is the destruction of the EP. This treatment involves prolonged monitoring of the decay of Beta HCG until the negativity. In the case of a failure, treatment is laparoscopic. -The non treatment The non treatment may be considered in certain situations. Close monitoring is appropriate in this case. <>WARNING! ! After an ectopic pregnancy, the risk of recurrence is important. WHAT CONTRACEPTION TO TAKE AFTER AN EP?
You should take a contraceptive method blocking ovulation, thus preventing the recurrence of ectopic pregnancy: ideally oestroporogestative contraception.In fact, the IUD and micro progestins should be avoided because they do not prevent ovulation.
Victor Hugo