Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e
|Section 11. Obstetrics and Gynecology >|
Sections: Epidemiology, Pathophysiology, Clinical Features, History, Physical Examination, Diagnosis, Pregnancy Testing, Laboratory Tests
and Ectopic Pregnancy, Us and Ectopic
Pregnancy, Invasive Diagnostic
Techniques, Culdocentesis, Laparoscopy, Dilatation and
Curettage, Treatment, Surgical Approach, Medical Treatment, Rh Seroconversion and
Indications for Anti-D Immunoglobulin, Disposition
Topics Discussed: chorionic gonadotropin, beta subunit, human; colpoceliocentesis; dilatation and curettage; ectopic pregnancy; laparoscopy; methotrexate; pregnancy tests; pregnancy, intrauterine; rh antigen.
Excerpt:"Ectopic pregnancy occurs when a conceptus is implanted outside of
the uterine cavity.Reported pregnancies include live births, legally induced abortions,
and ectopic pregnancies. The current incidence of ectopic pregnancy
is difficult to determine from available data but is probably increasing.
Overestimation of ectopic pregnancy incidence is possible because
the denominator, reported pregnancies, could be biased by lack of
reporting of illegally terminated pregnancies or undetected spontaneous
abortions. Reasons postulated for the increased incidence of ectopic
pregnancy include the increased incidence of sexually transmitted
tubal infections, unsuccessful tubal sterilizations, assisted reproductive
techniques, previous pelvic surgery, and more sensitive and earlier diagnostic
techniques.The classic triad of symptoms in ectopic pregnancy is abdominal pain
with vaginal bleeding or spotting in a woman with amenorrhea. The
PPV of this triad is low, is more common in threatened or spontaneous
abortion than in ectopic pregnancy, and may also occur in nonpregnant
women. Many other presentations occur, ranging from sudden abdominal
pain with life-threatening hypovolemic shock to an asymptomatic
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