pregnant · Uncategorized

Laparoscopic Management of Ectopic Having a baby


Vitamins to get pregnant fast Ectopic pregnancy is probably one of the abnormal outcomes of pregnancy in 2% of pregnant woman and it is considered as implantation of a fertilized egg outside of the endometrial cavity. It remains an important reason for maternal morbidity and mortality when left untreated and is the reason for as many as 9% of maternal death with this country. Quantitative measurements of the beta subunit of human chorionic gonadotropin (ß-hCG) and transvaginal ultrasonography have improved the accuracy of diagnosis and let earlier detection of ectopic pregnancies.

History of the steps:
In modern medicine the capacity to diagnose and treat ectopic pregnancies has significantly improved, thereby cutting down on the maternal risks. Recently Laparoscopy has revolutionized the same way as of managing the ectopic pregnancy says Prof. R.K. Mishra the recipient of Global Laparoscopic Trainer award of 2008 and Director of Laparoscopy Hospital, New Delhi.

Approximately 97.7% of most ectopic pregnancies take place in the fallopian tubes, plus the others within the ovary, abdomen, or cervix. The ampullary pregnancy would be the most commonly encountered site of implantation (80%), followed by the isthmus (11%), fimbria (4%), cornua (2%), and interstitia (3%). Approximately 85% of ectopic pregnancies take place in multigravid women. In the United States, rates are nearly twice as high for women of other races in comparison to white women.

Common health risk factors for ectopic pregnancy include tubal damage, smoking, and altered motility in the fallopian tube. Bad smoking habits within the new generation women serves as a threat in about one third of ectopic pregnancies and may even help contribute to decreased tubal motility by damage onto the ciliated cells in the fallopian tubes.

Altered tubal motility could also occur like the result of oral contraceptive.

Progesterone only oral contraceptive and progesterone intrauterine devices have been linked to increased danger of an ectopic pregnancy.

Clinical Symptoms:
Ectopic pregnancy can be diagnosed by typical triad includes bleeding and abdominal pain and a positive pregnancy test result. The clinical presentation can therefore be confusing, since symptoms overlap with miscarriage. A third of ladies have no clinical signs and 9% have no warning signs of ectopic pregnancy. Because of this, almost half of cases commonly are not diagnosed along at the first prenatal visit by their gynecologists.

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On physical examination signs include lower abdominal tenderness following or absent rebound and pelvic tenderness usually much worse upon the affected side. Gynaecologists are able to find abdominal rigidity, involuntary guarding, and severe tenderness along with an idea of hypovolemic shock with tachycardia, should alert the clinician to some surgical emergency; this may possibly take place in approximately 20% of cases. On per vaginal examination, the uterus could be slightly enlarged and soft, and uterine or cervical motion tenderness may suggest peritoneal inflammation.

Indications for surgery in ectopic pregnancy include women having the following criteria:

o Not suitable candidate for medical therapy
o Failed medical therapy
o Heterotopic pregnancy with a viable intrauterine being pregnant
o Hemodynamically unstable and requiring immediate treatment method
Medical therapy:
While methotrexate has remained the simplest and popular drug utilized in medical therapy for an ectopic pregnancy, other protocols have been used, namely potassium chloride, hyperosmolar glucose, RU 486, and prostaglandins.

Surgical therapy:
Vitamins to get pregnant fast Surgical therapy might be open laparotomy or using the laparoscopy. According to Prof. R. K. Mishra all ectopic pregnancies requiring surgery should be treated laparoscopically. Health risk factors for converting laparoscopy to laparotomy should be evaluated and will include multiple prior surgeries, pelvic adhesions, skill of the surgeon and surgical staff, accessibility to the apparatus, and condition of a given patient. In case the ectopic pregnancy is at the fimbria, then fimbrial evacuation is feasible, in the absence of indications for salpingectomy. Partial salpingectomy can be indicated when the pregnancy is in the mid portion of the tube, not one of the indications for salpingectomy can be found, and the patient might be a candidate for later tubal reanastomosis.


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