Ectopic
pregnancy Disturbed - Ectopic pregnancy is a pregnancy where
implantation / nidasi / fruit attachment pregnancy outside the normal
place, ie outside the uterine cavity, while the so-called ectopic
pregnancy is interrupted experiencing an ectopic pregnancy abortion
tubal rupture in the wall (Wibowo, 2007 ).
Division by location:
Tubal ectopic pregnancy: pars interstitial, isthmus, ampulla, infundibulum, fimbria.
Ectopic pregnancy uterus: the cervical canal, diverticulum, cornua, rudimentary horn.
Ovarian ectopic pregnancy:
Ectopic pregnancy intraligamenter
Abdominal ectopic pregnancy
The combination of inner and outer uterine pregnancy
Ectopic pregnancy is most common in the tube, this is caused by the presence of barriers journey fertilized ovum to the uterine cavity, it can be caused by:
The existence of the fallopian sikatrik
Congenital abnormalities of the fallopian
Tubal physiological disorders due to hormonal influences ((Prawirohardjo, 2005).
The incidence of tubal pregnancy is 1 in 150 deliveries (USA). The incidence of ectopic pregnancy is likely to increase.
These events are influenced by the following factors:
The increasing prevalence of tubal disease due to Sexually Transmitted Diseases (STDs) resulting in partial tubal occlusion. Salpingitis occur, especially inflammation endosalping resulting in narrowing of the lumen of the tube and berkurangan cilia tubal mucosa due to infection which facilitates the inflantasi zygote inside the tube.
Peritubal adhesion that occurs after infection such as appendicitis or dometriosis. Tuba can be bent or lumen narrowing.
Ever had previous ectopic pregnancy. The increased risk is probably due to salpingitis happened before.
Meningkatnnya the use of contraceptives to prevent pregnancy, such as the IUD and injections derivate progestin.
Operation repair tubal patency, the failure of sterilization, and increase the incidence of ectopic pregnancies.
Abortion provokatus with infection. The more often the act of abortion provokatus higher possibility sapingitis.
Fertility happens by drugs hyper ovulation, fertilization infitro.
Tumors that change the shape of the tube (myoma uteri and tumor atneksa)
Better diagnosis techniques of the past so that it can detect early ectopic pregnancy.
Ectopic Pregnancy Causes Impaired
Etiology of ectopic pregnancy has been widely investigated, but mostly the cause is unknown. Each pregnancy begins with fertilization of the egg in the ampulla tuba, and in the course of uterine eggs obstacles so on saan nidasi still dituba, or nidasinya in tubes made easy.
Implantation may occur in:
Fimbriae ends of the fallopian tubes (in 17 percent of cases)
The ampulla (in 55 percent of cases)
The isthmus (in 25 percent of cases)
The tuba section interstitial (in 2 percent of cases)
Ectopic Pregnancy Signs And Symptoms Impaired
Clinical picture undisturbed tubal pregnancy is not typical, and the patient and doctor are usually not aware of any abnormalities in pregnancy, until the occurrence of tubal abortion or tubal rupture. In general, patients showing symptoms of early pregnancy, and may feel a little pain in the lower abdomen that is not how ignored. On vaginal examination the uterus enlarged and flabby, although maybe not as big as her pregnancy. Tuba containing products of conception because lembeknya hard palpable on bimanual examination.
Symptoms and signs of tubal pregnancy disturbed very different, a lot of bleeding are suddenly in the abdominal cavity until the presence of vague symptoms, so it is difficult to make a diagnosis. Symptoms and signs depend on the length of ruptured ectopic pregnancy, abortion or tubal rupture, her pregnancy, the degree of bleeding that occurs, and the general state of the patient before pregnancy.
Pain is a symptom that arises relates to whether the ectopic pregnancy has ruptured. High-risk women should undergo screening as early as possible before they become symptomatic. For others, symptoms of ectopic pregnancy is most often experienced pelvic and abdominal pain (95%) and amenorrhea accompanied spoting or vaginal bleeding in a certain degree
Abnormal menstruation, many women do not report partly amenre, they misinterpret uterine bleeding that often occurs in tubal pregnancy as actual menstruation. When support for endometrial endocrine decreases, less bleeding and sometimes found in tubal pregnancy.
Vaginal bleeding, with the demise of the decidua eggs degenerate and necrosis, subsequently issued in the form of bleeding. Bleeding is generally sediki and dark brown, but a lot of bleeding per vagina should lead our thoughts to the usual abortion.
Shock because hipovolemi, clearer signs of shock when the patient is sitting, there are also oliguri.
Enlargement of the uterus, the uterus enlarges ectopic pregnancy as well as the effect of pregnancy hormones HORMONES, but generally slightly smaller than the uterus at the same intrauterine gestational age.
Tumor in the pelvic cavity, the pelvic cavity chewy soft palpable tumors caused by blood collection tubes and surrounding areas.
Changes in the blood, it can be presumed that hemoglobin levels fell in ruptured ectopic pregnancy because a lot of bleeding into the abdominal cavity.
Ectopic Pregnancy Diagnosis Impaired
Diagnostic tools that can be used are ultrasound, laparoscopy or kuldoskopi. The diagnosis of ruptured ectopic pregnancy in a sudden did not experience any kind of difficulty, but the kind of chronic or atypical can be difficult.
Anamnesis, menstruation is usually too late for some time and sometimes there are subjective symptoms early pregnancy. Lower abdominal pain, shoulder pain, tenesmus, dapay stated. Vaginal bleeding occurs after lower abdominal pain.
General examination, the patient looked in pain and pale, the bleeding in the abdominal cavity signs of shock can be found. On the spur of the moment kind of not lower abdomen just a bit swollen and tender.
Gynecological examination, signs of early pregnancy may be found. Cervical movement causes pain. If the uterus can be palpated, it will be felt slightly enlarged and sometimes palpable tumors of the uterus in addition to the limits elusive. Suu sometimes rises, so complicate difference with pelvic infection.
Laboratory tests, hemoglobin and red blood cell count is useful in the diagnosis of ruptured ectopic pregnancy, especially if there are signs of bleeding in the abdominal cavity. In the case of the type not customarily found sudden anemia, but keep in mind that the new hemoglobin decrease seen after 24 hours.
Dilatation and scrapings, are generally not recommended, because of the possibility of pregnancy in the same uterus ectopic pregnancies, only 12 to 19% scrapings showed ectopic pregnancy decidua reaction, endometrial changes in the form of arias-stella reaction is not typical for an ectopic pregnancy.
Culdocentesis, is an examination of ways to find out if there is no blood douglas pouch. This method is very useful in helping to make the diagnosis of ectopic pregnancy. You do this by using the spinal needle into the cavity douglas ditusukan no.18 and 10 ml syringe made exploitation. When the suction of blood is found, then it is sprayed on gauze and note whether the blood is issued; a). Fresh blood red in a few minutes will be frozen, the blood is derived from the punctured vein or artery. b). old blood is brown to black is not frozen, or in the form of small clots, blood shows that there hematokel retrouterina.
Ultrasound, useful for the diagnosis of ectopic pregnancy. Definitive diagnosis is when the uterus is found outside the gestational sac in which the fetal heart rate appears.
Laparoscopy, only used as a diagnostic aid last for ectopic pregnancy, if the results of the assessment of other dubious diagnostic procedure. Through a laparoscopic procedure, the content of the inner tool can dinilai.secara systematically assessed the state of the uterus, ovaries, fallopian, douglas pouch and broad ligament.
Handling Ectopic Pregnancy Impaired
In general, the handling is laparotomy. In such actions, some things must be considered and taken into account, namely:
Condition of the patient at the time
Patients will desire reproductive function.
Location ectopic pregnancy
Pelvic organ anatomic conditions
The ability of doctors microsurgical techniques operator
Invitro fertilization local technological capabilities
Results of these considerations need to be done to determine whether salpingektomi on tubal pregnancy, or conservative surgery can be done in the sense just do salpingostomy or reanastomosis tube. If the bad condition of the patient, eg, in a state of shock better done salpingektomia.
If the patient is examined and suspected ectopic pregnancy, she should be sent to the hospital without vaginal examination. If he is in a state of shock, the infusion should be installed and delivered as soon as possible. Morphine can be given, if the woman is in pain.
Division by location:
Tubal ectopic pregnancy: pars interstitial, isthmus, ampulla, infundibulum, fimbria.
Ectopic pregnancy uterus: the cervical canal, diverticulum, cornua, rudimentary horn.
Ovarian ectopic pregnancy:
Ectopic pregnancy intraligamenter
Abdominal ectopic pregnancy
The combination of inner and outer uterine pregnancy
Ectopic pregnancy is most common in the tube, this is caused by the presence of barriers journey fertilized ovum to the uterine cavity, it can be caused by:
The existence of the fallopian sikatrik
Congenital abnormalities of the fallopian
Tubal physiological disorders due to hormonal influences ((Prawirohardjo, 2005).
The incidence of tubal pregnancy is 1 in 150 deliveries (USA). The incidence of ectopic pregnancy is likely to increase.
These events are influenced by the following factors:
The increasing prevalence of tubal disease due to Sexually Transmitted Diseases (STDs) resulting in partial tubal occlusion. Salpingitis occur, especially inflammation endosalping resulting in narrowing of the lumen of the tube and berkurangan cilia tubal mucosa due to infection which facilitates the inflantasi zygote inside the tube.
Peritubal adhesion that occurs after infection such as appendicitis or dometriosis. Tuba can be bent or lumen narrowing.
Ever had previous ectopic pregnancy. The increased risk is probably due to salpingitis happened before.
Meningkatnnya the use of contraceptives to prevent pregnancy, such as the IUD and injections derivate progestin.
Operation repair tubal patency, the failure of sterilization, and increase the incidence of ectopic pregnancies.
Abortion provokatus with infection. The more often the act of abortion provokatus higher possibility sapingitis.
Fertility happens by drugs hyper ovulation, fertilization infitro.
Tumors that change the shape of the tube (myoma uteri and tumor atneksa)
Better diagnosis techniques of the past so that it can detect early ectopic pregnancy.
Ectopic Pregnancy Causes Impaired
Etiology of ectopic pregnancy has been widely investigated, but mostly the cause is unknown. Each pregnancy begins with fertilization of the egg in the ampulla tuba, and in the course of uterine eggs obstacles so on saan nidasi still dituba, or nidasinya in tubes made easy.
Implantation may occur in:
Fimbriae ends of the fallopian tubes (in 17 percent of cases)
The ampulla (in 55 percent of cases)
The isthmus (in 25 percent of cases)
The tuba section interstitial (in 2 percent of cases)
Ectopic Pregnancy Signs And Symptoms Impaired
Clinical picture undisturbed tubal pregnancy is not typical, and the patient and doctor are usually not aware of any abnormalities in pregnancy, until the occurrence of tubal abortion or tubal rupture. In general, patients showing symptoms of early pregnancy, and may feel a little pain in the lower abdomen that is not how ignored. On vaginal examination the uterus enlarged and flabby, although maybe not as big as her pregnancy. Tuba containing products of conception because lembeknya hard palpable on bimanual examination.
Symptoms and signs of tubal pregnancy disturbed very different, a lot of bleeding are suddenly in the abdominal cavity until the presence of vague symptoms, so it is difficult to make a diagnosis. Symptoms and signs depend on the length of ruptured ectopic pregnancy, abortion or tubal rupture, her pregnancy, the degree of bleeding that occurs, and the general state of the patient before pregnancy.
Pain is a symptom that arises relates to whether the ectopic pregnancy has ruptured. High-risk women should undergo screening as early as possible before they become symptomatic. For others, symptoms of ectopic pregnancy is most often experienced pelvic and abdominal pain (95%) and amenorrhea accompanied spoting or vaginal bleeding in a certain degree
Abnormal menstruation, many women do not report partly amenre, they misinterpret uterine bleeding that often occurs in tubal pregnancy as actual menstruation. When support for endometrial endocrine decreases, less bleeding and sometimes found in tubal pregnancy.
Vaginal bleeding, with the demise of the decidua eggs degenerate and necrosis, subsequently issued in the form of bleeding. Bleeding is generally sediki and dark brown, but a lot of bleeding per vagina should lead our thoughts to the usual abortion.
Shock because hipovolemi, clearer signs of shock when the patient is sitting, there are also oliguri.
Enlargement of the uterus, the uterus enlarges ectopic pregnancy as well as the effect of pregnancy hormones HORMONES, but generally slightly smaller than the uterus at the same intrauterine gestational age.
Tumor in the pelvic cavity, the pelvic cavity chewy soft palpable tumors caused by blood collection tubes and surrounding areas.
Changes in the blood, it can be presumed that hemoglobin levels fell in ruptured ectopic pregnancy because a lot of bleeding into the abdominal cavity.
Ectopic Pregnancy Diagnosis Impaired
Diagnostic tools that can be used are ultrasound, laparoscopy or kuldoskopi. The diagnosis of ruptured ectopic pregnancy in a sudden did not experience any kind of difficulty, but the kind of chronic or atypical can be difficult.
Anamnesis, menstruation is usually too late for some time and sometimes there are subjective symptoms early pregnancy. Lower abdominal pain, shoulder pain, tenesmus, dapay stated. Vaginal bleeding occurs after lower abdominal pain.
General examination, the patient looked in pain and pale, the bleeding in the abdominal cavity signs of shock can be found. On the spur of the moment kind of not lower abdomen just a bit swollen and tender.
Gynecological examination, signs of early pregnancy may be found. Cervical movement causes pain. If the uterus can be palpated, it will be felt slightly enlarged and sometimes palpable tumors of the uterus in addition to the limits elusive. Suu sometimes rises, so complicate difference with pelvic infection.
Laboratory tests, hemoglobin and red blood cell count is useful in the diagnosis of ruptured ectopic pregnancy, especially if there are signs of bleeding in the abdominal cavity. In the case of the type not customarily found sudden anemia, but keep in mind that the new hemoglobin decrease seen after 24 hours.
Dilatation and scrapings, are generally not recommended, because of the possibility of pregnancy in the same uterus ectopic pregnancies, only 12 to 19% scrapings showed ectopic pregnancy decidua reaction, endometrial changes in the form of arias-stella reaction is not typical for an ectopic pregnancy.
Culdocentesis, is an examination of ways to find out if there is no blood douglas pouch. This method is very useful in helping to make the diagnosis of ectopic pregnancy. You do this by using the spinal needle into the cavity douglas ditusukan no.18 and 10 ml syringe made exploitation. When the suction of blood is found, then it is sprayed on gauze and note whether the blood is issued; a). Fresh blood red in a few minutes will be frozen, the blood is derived from the punctured vein or artery. b). old blood is brown to black is not frozen, or in the form of small clots, blood shows that there hematokel retrouterina.
Ultrasound, useful for the diagnosis of ectopic pregnancy. Definitive diagnosis is when the uterus is found outside the gestational sac in which the fetal heart rate appears.
Laparoscopy, only used as a diagnostic aid last for ectopic pregnancy, if the results of the assessment of other dubious diagnostic procedure. Through a laparoscopic procedure, the content of the inner tool can dinilai.secara systematically assessed the state of the uterus, ovaries, fallopian, douglas pouch and broad ligament.
Handling Ectopic Pregnancy Impaired
In general, the handling is laparotomy. In such actions, some things must be considered and taken into account, namely:
Condition of the patient at the time
Patients will desire reproductive function.
Location ectopic pregnancy
Pelvic organ anatomic conditions
The ability of doctors microsurgical techniques operator
Invitro fertilization local technological capabilities
Results of these considerations need to be done to determine whether salpingektomi on tubal pregnancy, or conservative surgery can be done in the sense just do salpingostomy or reanastomosis tube. If the bad condition of the patient, eg, in a state of shock better done salpingektomia.
If the patient is examined and suspected ectopic pregnancy, she should be sent to the hospital without vaginal examination. If he is in a state of shock, the infusion should be installed and delivered as soon as possible. Morphine can be given, if the woman is in pain.
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