TEXILA AMERICAN UNIVERSITY COLLEGE OF MEDICINE CLINICAL CASE PRESENTATION COMPILATION GREESHMA RAMACHANDRAKUMAR REMA 2015010088 DATE OF SUBMISSION


TEXILA AMERICAN UNIVERSITY
COLLEGE OF MEDICINE

CLINICAL CASE PRESENTATION COMPILATION

GREESHMA RAMACHANDRAKUMAR REMA
2015010088
DATE OF SUBMISSION: – 27/09/2018
GYNECOLOGY CLINICAL CASE
ECTOPIC PREGNANCY

HOSPITAL NO: –
ATTENDING PHYSICIAN: Dr. Rafi Rozan
SIGNATURE: ________________________

GRADED BY:
GRADE: ____________________________

Points Allocated
CONTENT 50
RELEVANCE & IMPACT 30
REFERENCES 10
FORMAT 10
TOTAL 100

SIGNATURE: ________________________

TABLE OF CONTENT
S.NO TITLE ROTATION FOR OFFICE USE
1 Ectopic pregnancy gynecology

OUTLINE:
• Introduction
• Abstract
• Case report
• History taking
? Chief complaint
? history of present illness
? Past medical history
? Past surgical history
? Allergic history
? Transfusion history
? Family history
? Drug history
? Trauma history
? Social history:
? Review of systems:
? Diagnostic report
• Physical examination
• Discussion
? Definition
? Epidemiology
? Types
? Risk factors
? Complication
? Prevention
• Treatment
• Summary
• Reference

INTRODUCTION:
A fertilized ovum implanting and maturing outside of the uterine endometrial cavity, with the most common site being the fallopian tube (97%), followed by the ovary (3.2%) and the abdomen (1.3%). If undiagnosed or untreated, it may lead to maternal death due to rupture of the implantation site and intraperitoneal hemorrhage.
ABSTRACT:
Ectopic pregnancy (EP) occurs in 1–2% of pregnancies, and is associated with significant morbidity and mortality. Women with abdominal pain or vaginal bleeding in early pregnancy, or risk factors for EP, are generally assessed by Early Pregnancy Assessment Units. Diagnosis is predominantly by trans-vaginal ultrasound supported by quantified serum human chorionic gonadotrophin (hCG). The resolution limit of trans-vaginal ultrasound means not all EPs can be identified, leaving women with a ‘Pregnancy of Unknown Location’. Management for EP has moved away from surgery with growing experience in medical management, and evidence-based recognition of expectant management for selected women. Surgery will always have a role in the management of women with EP who are acutely unwell, when medical management is not likely to work, or has failed. On-going areas of research include improvements in women’s risk stratification at their first attendance with symptoms, shortening time until diagnosis of EP, and combination medical treatments
CONCLUSION
Tubal rupture is a complication of late diagnosed tubal pregnancy that is more difficult to treat conservatively and often indicates tubectomy or segmental resection. In 5% to 15% of treated ectopic pregnancy cases, remnant conception product parts may require a final methotrexate injection.

Keyword: ectopic pregnancy ,human chorionic gonardotrophin, methotrexate, salpingectomy, salpingotomy.

CASE REPORT:

No: in Reg.: 16661

Date of birth: 20/07/1997

Age: 21y/o

Sex: female

Race: african

Referral source: referred from woodlands hospital
Source and Reliability: from the patient
CHIEF COMPLAINT:
• Lower abdominal pain and vomiting × 2/7

HISTORY OF PRESENT ILLNESS:
• 21 year old G2P1001 at gestational age of 9+4.(LMP) with a cheaf complaint of lower abdominal pain and vomiting from 2 days with ultrasound suggestive of ruptured ectopic pregnancy, referred from woodlands hospital.
PAST MEDICAL HISTORY:
• No past medical history
PAST SURGICAL HISTORY
• No past surgical history reported
ALLERGIC HISTORY:
• Not reported
TRANSFUSION HISTORY
• Nil
FAMILY HISTORY
• Nil
DRUG HISTOTY
• Nil
TRAUMA HISTORY
• Nil
SOCIAL HISTORY:
• No history of smoking or alcohol

GYNECOLOGIC HISTORY

• MENARCHE : 11y/o
• Last menstrual period : 22/ 06/ 2018
• Regular menstrual cycle
• No family planning method
• Denies any STI
• More than 1 sexual partners
• Unplanned pregnancy

REVIEW OF SYSTEMS:

• No other positive findings

DIAGNOSTIC REPORT
VITALS
P – 86 bpm
BP – 146/89 mmHg
T – 95.6 0F
SPO2 – 96 %
RR – 22 bpm
PHYSICAL EXAMINATION
APPEARANCE:

• Patient was seen lying in the bed with no signs of cardio pulmonary or painful distress.

MUCOUS MEMBRANE:

• Pink and dry

RESPIRATORY SYSTEM:

• BAE clear × 2, no adventitious breath sounds

CARDIOVASCULAR SYSTEM:

• S1S2 M0 , cap refill ; 2 sec

ABDOMEN:

• Flat, depressible, generalised tenderness, guarding +

EXTREMITIES

• NROM ×4, No peripheral oedema

NERVOUS SYSTEM

• Conscious, alert, oriented × 3, no neurological deficit,

SPECULUM EXAMINATION

• OS closed, appear normal, no PV bleeding

BIMANUAL EXAMINATION

IMPRESSION:

• 21y/o old G2P1001 GA 9+4 (LMP) with the diagnosis of ruptured ectopic pregnancy.

PLAN

DISCUSSION
DEFINITION
A fertilized ovum implanting and maturing outside of the uterine endometrial cavity, with the most common site being the fallopian tube (97%), followed by the ovary (3.2%) and the abdomen (1.3%). If undiagnosed or untreated, it may lead to maternal death due to rupture of the implantation site and intraperitoneal hemorrhage.

EPIDEMIOLOGY
• In the US, trends in the rate of ectopic pregnancy among overall pregnancies in females ages 15-44 years have remained relatively stable. Incidence in the US rose from 0.5% in the 1970s to 2% in the 1990s. This rise has been linked with the increased incidence of pelvic inflammatory infections and smoking, along with early pregnancy diagnostic algorithms and higher rates of pregnancy resulting from assisted reproductive technology. Decreased inpatient treatments and early pregnancy failures that do not result in a delivery or admission to the hospital may obscure true incidence rates. Global rates are similar to those in the US with recent reports showing rates of 1.1% in the UK, 1.49% in Norway, and 1.62% in Australia. However, despite the increasing incidence of ectopic pregnancy, the mortality associated with this condition has progressively decreased. In the US, the ectopic pregnancy mortality ratio decreased by 56.6%, from 1.15 to 0.50 deaths per 100,000 live births between 1980-1984 and 2003-2007. Age 35 years at presentation are associated with higher rates of ectopic pregnancy.

CLASSIFICATION
• Tubal pregnancy (97%)
May implant in ampulla (73.3%), isthmus (12.5%), fimbria (11.6%), and interstitium and cornua (2.6%).
• Ovarian pregnancy (1% to 3%)
Unlike tubal pregnancy, not associated with IUD use or genital infection (strict histopathologic diagnostic criteria apply).
• Cervical pregnancy (