Dr. Mohamed Sabry
How To Differentiate Clinically between Abortion & Ectopic Pregnancy
@ The main presentation of abortion is bleeding & the main presentation of ectopic is pain.
@ Pain & tenderness in ectopic is more in one iliac fossa & in abortion is suprapubic (very important sign).
@ Vaginal bleeding is fresh bright red in case of abortion & dark brown in case of ectopic dt. the long journey of blood from tube through uterus till cx & vagina, that makes it hemolysed.
@ By P/V; if you moved cx to any side (Rt./Lt.) there will be severe pain in case of ectopic pregnancy & not in abortion.
@ Live Clinical Scenario of Unruptured Ectopic:
How to suspected ectopic from history & examination?
A case of primary infertility for 3 years dt. severe PID who received induction of ovulation outside & now PG after +ve pregnancy test, 6-8 wk, come to maternity ER/clinic C/O severe lower abdominal pain with mild brownish spotting; then by examination there is severe tenderness in one iliac fossa more than suprapubic & P/V minimal bleeding with cervical motion tenderness to one side. Vital signs; BP normal, pulse high normal dt. pain. Take the pt. from her hand to the U/S room, check if there is intrauterine GS. If there is IUGS, take breath as this is most probably threatened abortion, but still there is a very small risk of heterotropic pregnancy (one baby intrauterine & another one ectopic); admit this pt. for good evaluation of adnexia by transvaginal U/S & do serial B. HCG. red and ruby wears for prom party
If the other option; there is no intrauterine GS, mostly this is ECTOPIC; do good evaluation to the adnexia to discover the intact GS. By this, you most probably diagnosed or excluded Ectopic pregnancy without any investigations yet.
@ Live Clinical Scenario of Ruptured Ectopic:
A case with same or similar scenario as before but generally not well, pale, feeling faint or loss of consciousness, much more pain, distended abdomen, tenderness elsewhere, tachycardia like pulse 120/m, hypotensive like BP 80/40, by scan empty uterus with darkness intraabdominal around the uterus & adnexia, urgent CBC show low Hb & low Hct.
@ What Next?
- Unruptured Ectopic: admit the pt. to ward to confirm diagnosis by transvaginal U/S & serial B.HCG every 2 days with subnormal rise (not doubling) with close observation for any symptoms or signs of rupture till confirming diagnosis for management.
- Ruptured Ectopic: its a clinical diagnosis from the first presentation of a case with positive pregnancy test & surgical abdomen. Prepare good a mount of blood after cross matching & take the pt. for laparotomy.
To be continued for Management,