MEDICAL MANAGEMENT OF UNRUPTURED ECTOPIC PREGNANCY

DR.K.RAVALI(RESIDENT). DR.JYOTHI.G.S(PROFESSOR) DR.SUJANI B.K.(H.O.D)

DEPARTMENT OF OBG
RAMAIAH MEDICAL COLLEGE,BENGALURU

INTRODUCTION –Ectopic pregnancy is the implantation and development of blastocyst outside the normal endometrial cavity .

Here we present three cases of un ruptured ectopic pregnancy ,who presented to us with different manifestations and their outcome.

CASE -1  CCCCCC Case -2 Case 3

Mrs H ,aged 30 yrs , primigravida with 7 weeks 4 Mrs.D of age 25 yrs G2P1L1 with 6 weeks 2 days Mrs G aged 29 years G3P1L1 with 5 weeks period of
days presented with period of gestation presented with gestation presented with

History of 2 ½ months of amenorrhea History of 1 ½ month of amenorrhea History of 1 ½ month amenorrhea ,

History of conception after 3 cycles of ovulation C/o pain in the left side of abdomen since 3 days C/O pain on the right side of lower abdomen since 2 days
induction
USG done on 02/09/17 UPT done ,was positive
In regular ANC scan found to have ectopic
gestational sac in right adnexa. A well defined anechoic rounded lesion USG done on 15/04/17
measuring 13x11 mm is seen in the right ovary
With peripheral ring of vascularity Showed right adnexal ectopic .Well defined sac like structure
Uterus anteverted , normal size; ET- 10mm
There is no evidence of an embryo or yolk sac with echogenic contents with peripheral vascularity seen
Anechoic cystic structure is noted in right adnexa within. adjacent to right ovary on colour Doppler .No evidence of
with echogenic structure within ,measuring 1.2cm No free fluid in the abdomen and pelvis fetal pole and yolk sac .Minimal free fluid in right adnexa
corresponding to 7w4d ,fetal pole no cardiac and POD
Impression : Features suggestive of Gestational
activity. sac/? Corpus Luteal cyst in the right ovary
DATE BETA HCG MEDICATION
Right ovary not separately seen. mIU/ml
DATE BETA HCG MEDICATIONS 15/04/17 1122
Left ovary cystic structure seen 13x17mm 16/04/17 Inj Methotrexate
mIU/ml
22/08/17 333.2 50 mg IM
Minimal free fluid in pod
26/08/17 656.6
DATE BETA HCG MEDICATION 31/08/17 985.7 17/04/17 Inj leucoverin 5
mIU/ml 02/09/17 1636 mg IM
24/09/17 7300 Inj 03/09/17 Inj 18/04/17 394.9
Methotrexate Methotrexate
50 mg IM 80 mg IM
25/09/17 Inj Leucovarin 04/09/17 Inj leucoverin
5 mg IM 8 mg IM
26/09/17 5877 Inj 05/09/17 2166 INJ
Methotrexate Methotrexate
50 mg IM 80 mg IM
27/09/17 Inj leucovarin 5 06/09/17 2069 Inj Leucoverin
mg IM 8 mg IM
28/09/17 4999 09/09/17 1656
30/09/17 3584 15/09/17 700.44
2/10/17 2159 16/10/17 1.99

DISCUSSION

• Indications for medical

management
1. Hemodynamically stable patient
2. Initial s Bhcg < 3000 IU/L
3. Tubal diameter < 4cms
4. No fetal cardiac activity
5. No intra abdominal haemorrhage Doppler shows classic ring of fire –increased
Advantage vascularity typical of ectopic pregnancy

 To avoid surgery and anaesthesia

,their complications
CONCLUSION -Ectopic pregnancy is the
 Increased chance of subsequent differential diagnosis when a sexually
intrauterine pregnancy
active female has abnormal bleeding/
 Less risk of recurrence . abdominal pain
REFERENCES:
 Williams obstetrics 24th edition 1.Maximum 3 doses of methotrexate
 Arias practical guide to high risk
RREFERENCE injection can be given
pregnancies 4th edition
 Ian Donald practical obstetrics problems 2.Avoid pregnancy for 3 months