Download Free Medical CLINICAL PRESENTATION OF A CASE PID TURNED OUT TO BE ECTOPIC PREGNANCY PowerPoint Presentation

CLINICAL PRESENTATION OF A CASE PID TURNED OUT TO BE ECTOPIC PREGNANCY PowerPoint Presentation

DOWNLOAD MEDICAL POWERPOINT PRESENTATION

About This Presentation

Description : Check out this medical presentation on Abdominal Pregnancy/Ectopic Pregnancy, which is titled "CLINICAL PRESENTATION OF A CASE PID TURNED OUT TO BE ECTOPIC PREGNANCY", to find a case of ectopic pregnancy.

Tags : Abdominal Pregnancy, Ectopic Pregnancy, CLINICAL PRESENTATION, CASE PID, ectopic pregnancy

Published on : Jul 28, 2021 | Views : 1905 | Downloads : 11

Shareable Url :

Embed Code :

Comment

Transcript

Slide 1-

CLINICAL PRESENTATION OF A CASE PID~TURNED OUT TO BE ECTOPIC PREGNANCY Dr.B.Saranya (1 YEAR OBG PG IN SBMCH) Dr.K.Saraswathi (HOD OF OBG DEPARTMENT)
Slide 2-

27 yrs. old lady, married 1½ yrs. presented to OP with C/o lower abdominal pain and C/o spotting P/V from day 7 of the cycle C/o fever for 10days.
Slide 3-

MENSTRUAL CYCLE : Regular cycles. 3/28days cycle. Not associated with clots/pains. MARITAL H/O: Married – 1½ yrs. Non consanguinous marriage.
Slide 4-

PAST H/O: No h/o DM, HT, BA, Epilepsy, Thyroid. No h/o any previous surgeries. PERSONAL H/O : Mixed diet. Bowel and bladder habits normal. FAMILY H/O: Nil significant.
Slide 5-

ON EXAMINATION G ON EXAMINATION: Patient anxious in pain febrile, hydration fair. Pallor +, No pedal edema. BP – 100/60 mmhg PR – 68/min CVS – s1s2 +. RS - NVBS+.
Slide 6-

P/A : Soft, bs+. Tenderness in right iliac fossa +. P/V – cx  uterus retroverted ut normal size All fornices tender. Diagnosis - 27yrs old lady ? ectopic pegnancy /?PID.
Slide 7-

USG ABDOMEN: A Heterogenous lesion 5.6×3cm in left adnexa close to left ovary. A ring lesion 2×2cm with thick hyperechoic rim and showing peripheral vascularity. Blood Investigation  Hcg-672 miu/ml
Slide 8-

2 *2 cm of G.sac (left isthumus)
Slide 9-

Ectopic Pregnancy
Slide 10-

An ectopic pregnancy is a complication of pregnancy in which the pregnancy implants outside the uterine cavity. Usually ectopic pregnancies are not only viable but are also very dangerous for the mother as it used to be followed by a massive internal bleeding.
Slide 11-

ppt slide no 11 content not found
Slide 12-

ppt slide no 12 content not found
Slide 13-

ETIOLOGY Any factor that causes delayed transport of the fertilised ovum through the tube. Fallopian tube favours implantation in the tubal mucosa itself thus giving rise to a tubal ectopic pregnancy. These factors may be Congenital or Acquired.
Slide 14-

CONGENITAL Tubal Hypoplasia Tortuosity Congenital diverticuli Accessory ostia Partial stenosis Elongation Intamural polyp Entrap the ovum on its way.
Slide 15-

ACQUIRED CAUSES INCREASING AGE PID(6 TO 10 TIMES ) TUBAL LIGATION CONTRACEPTION FAILURE PREVIOUS ECTOPIC PREGNANCY TUBAL RECONSTRUCTIVE SURGERY INFERTILITY
Slide 16-

PREVIOUS ABORTIONS TUBAL ENDOMETRIOSIS. CIGARETTE SMOKING DES EXPOSURE FIBROIDS TRANS PERITONEAL MIGRATION OF OVUM.
Slide 17-

ACUTE ECTOPIC PREGNANCY
Slide 18-

ppt slide no 18 content not found
Slide 19-

7 CHRONIC ECTOPIC PREGNANCY Patient would have recovered from previous attack of acute pain. Pt may present with amenorrhoea, dull aching lower abdominal pain, vaginal bleeding, dysuria, frequency of micturation or retention of urine and rectal tenesmus.
Slide 20-

INVESTIGATION  BLOOD INVESTIGATION.   HCG. SPECIAL INVESTIGATIONS  ULTRASOUND.  LAPAROSCOPY  LAPAROTOMY  DILATATION & CURETTAGE  CULDOCENTESIS  MAGNETIC RESONANCE  IMAGING
Slide 21-

 HCG: URINE PREGNANCY TEST –ELISA IS SENSITIVE TO 10-50miu/ml. & ARE POSITIVE IN 95%OF ECTOPIC PREGNANCY. QUANTITATIVE BETA HCG VALUE THAT IN CONJUNCTION WITH TRANSVAGINAL ULTRASOUND CAN USUALLY MAKE THE DIAGNOSIS. WHEN HCG LEVEL < 2000 IU/L DOUBLING TIME HELP TO PREDICT VIABLE VS NONVIABLE PREGNANCY.
Slide 22-

ppt slide no 22 content not found
Slide 23-

MANAGEMENT: MEDICAL MANAGEMENT: The administration of methotrexate intramuscularly may be a suitable treatment for ectopic pregnancy in certain circumstances. Methotrexate is an antimetabolite which inhibits folate reductase . Administering a single 75mg IM injection of methotrexate is a suitable treatment for ectopic pregnancy in cases where beta hcg is<3000IU/ml.
Slide 24-

THE REGIMEN INVOLVES ADMINISTRATION OF METHOTREXATE AS 1mg/kg on days 0,2,4,and 6 followed by 4 doses of leucovorin as 0.1mg/kg on days 1,3,5,7 because of higher incidence of adverse effect and increased need for motivation and compliance ,the multiple dosage has fallien out of favour in us. SUITABLE CRITERIA: NORMAL RENAL AND LIVER FUNCTION SERUM HCG LESS THAN 3000IU/ML. MINIMAL OR MILD SYMPTOMS ONLY NO EVIDENCE OF HAEMOPERITONEUM ECTOPIC MASS LESS THAN 5CM DIAMETER. NO EVIDENCE OF FETAL ACTIVITY.
Slide 25-

SURGERY: Laparotomy. Laparoscopy. INDICATION: Pt not suitable for medical management. Medical therapy has failed. Pt has a heterotopic pregnancy with a viable intrauterine pregnancy. Pt is hemodynamically unstable and needs immediate treatment. CONTRAINDICATED PT medically treatable. PT having other medical conditions that would make the risks associated surgery unacceptable,.
Slide 26-

LAPAROSCOPY: INDICATION: MORE APPROPRIATE IN STABLE SITUATION. SHORTER OPERATING TIME. LESS BLOOD LOSS. SHORTER STAY IN HOSPITAL LESS NEED FOR ANALGESIA.
Slide 27-

ppt slide no 27 content not found
Slide 28-

MILKING OR FIMBRIAL EXPRESSION: THIS IS IDEAL IN DISTAL AMPULLARY OR INFUNDIBULAR PREGNANCY. IT HAS GOT INCREASED RISK OF PERSISTENT ECTOPIC PREGNANCY.
Slide 29-

Follow up after conservative surgery With weekly Serum β HCG titre till it is negative. If titre increases methotrexate can be given.
Slide 30-

SUMMARY - KEY POINTS Incidence of ectopic pregnancy is rising while maternal mortality from it is falling. Ectopic pregnancy can be diagnosed early (before it ruptures) with recent advances in Immunoassay to detect S-hCG , high resolution USG, and dignostic Laparoscopy. There has been shift in the M/m from ablative surgery to conservative fertility preserving therapy Laparotomy should be done when in doubt The choice today is Laparoscopic treatment of unruptured ectopic pregnancy. Careful monitoring and proper counselling of patients is mandatory.
Slide 31-

CASE OF TUBAL ECTOPIC PREGNANCY PRESENTED AS PID A CASE OF 27YRS OLD LADY P3L3 PRESENTED WITH ABNORMAL MENTRUATION WITHOUT A PERIOD OF AMENORRHOEA WAS DIAGNOSED TO HAVE LEFT TUBAL ECTOPIC PREGNANCY AFTER P/V EXAMINATION AND ULTRASONOGRAPHY. MENSTRUAL CYCLES NORMAL.UPT –VE .BETA HCG 542IU/ML.PT WAS TAKEN UP LAPAROSCOPIC LEFT SALPINGECTOMY.
Slide 32-

REFERENCES Farquhar CM. Ectopic pregnancy. Lancet. 2005 Aug 13-19. 366(9485):583-91. Kadar N, Bohrer M, Kemmann E, Shelden R. The discriminatory human chorionic gonadotropin zone for endovaginal sonography: a prospective, randomized study. Fertil Steril. 1994 Jun. Riaz RM, Williams TR, Craig BM, Myers DT. Cesarean scar ectopic pregnancy: imaging features, current treatment options, and clinical outcomes. Abdom Imaging. 2015 Oct. 40 (7):2589-99. WILLIAMS OBSTRETICS AND GYNACECOLOGY 23RD EDITION
Slide 33-

Thank you