"Diagnosis and Management of Ectopic Pregnancy"
JOSHUA H. BARASH, MD; EDWARD M. BUCHANAN, MD; and CHRISTINA HILLSON, MD, Thomas Jefferson University, Philadelphia, Pennsylvania
Am Fam Physician. 2014 Jul 1;90(1):34-40.
An ectopic pregnancy is when a fertilized egg implants anywhere in the womans body, other than the uterus. It occurs in 1-2% of all pregnancies, and is a top cause or pregnancy-related deaths. Risk factors include sterilization, advanced maternal age, history of PID, cigarette smoking, previous tubal surgery, and previous ectopic pregnancy. Symptoms include first-trimester bleeding, peritoneal signs, and abdominal pain. A transvaginal ultrasound can be done after 5.5 weeks gestation to see if there is an intrauterine pregnancy, which will rule out an ectopic (unless there are two fetuses). If not found, it is prudent to image the areas of the pelvis where an ectopic pregnancy may likely be found.
An important lab value to look at is the bHCG discriminatory level. When the bHCG increases to 1500-2000 mlU/mL, an intrauterine pregnancy should be seen with ultrasound (about 5.5 weeks). Laparoscopy is another option if the location cannot be found. The bHCG level should also increase by 50% every two days in intrauterine pregnancies. The bHCG will typically not increase this fast in ectopics (although 20% of the time it does!) A sudden drop in serial bHCG may signify a nonviable or a ruptured ectopic. Falling levels need to be monitored until they are undetectable, to confirm resolution of pregnancy.
Women with suspected ectopic pregnancy need to have their Rh status determined to decide if RhoGam immunoglobulin should be given.
Once it is determined that that an ectopic pregnancy is present, treatment can be decided upon. Patients with extensive bleeding or intravascular compromise will benefit from a salpingectomy. If fertility is to be preserved, a salpingostomy is preferred. Otherwise a patient can be prescribed methotrexate, which inhibits cell replication and DNA synthesis. In order to prescribe methotrexate, the gestational sac should be smaller than 3.5cm. Factors that increase treatment failure include cardiac activity in the embryo, free blood in the abdomen, high progesterone, or high bHCG (>2000 mlU/mL). Methotrexate is contraindicated in immune compromise, liver or kidney damage, asthma, or PUD. Following treatment, the bHCG decreases at least 15% within 7 days. It takes 5-7 weeks for the bHCG to be undetectable.
I want to thank Dr Emu a very powerful spell caster who help me to bring my husband back to me, few month ago i have a serious problem with my husband, to the extend that he left the house, and he started dating another woman and he stayed with the woman, i tried all i can to bring him back, but all my effort was useless until the day my friend came to my house and i told her every thing that had happened between me and my husband, then she told me of a powerful spell caster who help her when she was in the same problem I then contact Dr Emu and told him every thing and he told me not to worry my self again that my husband will come back to me after he has cast a spell on him, i thought it was a joke, after he had finish casting the spell, he told me that he had just finish casting the spell, to my greatest surprise within 48 hours, my husband really came back begging me to forgive him, if you need his help you can contact him with via email: Emutemple@gmail.com or add him up on his whatsapp +2347012841542 is willing to help any body that need his help.
ReplyDelete