Clinical Findings of Tubal Ectopic Pregnancy

 CLINICAL FINDINGS

 

Abdominal and pelvic findings are notoriously scant in many women before tubal rupture. Prior to rupture, the di-agnosis of an ectopic pregnancy is primarily based on labo-ratory and ultrasound findings. With rupture, however, nearly three-fourths of women will have marked tender-ness on both abdominal and pelvic examination, and pain is aggravated with cervical manipulation. A pelvic mass, in-cluding fullness posterolateral to the uterus, can be palpated in about 20% of women. Initially, the ectopic pregnancy may feel soft and elastic, whereas extensive hemorrhage produces a firmer consistency. Many times, discomfort pre-cludes palpation of the mass. Avoidance of pelvic examina-tions may actually help avert iatrogenic rupture.

 

Fever is not expected, although a mild elevation in temperature in response to intraperitoneal blood may occur. A temperature of 38°C may suggest an infectious cause to a patient’s symptoms. Abdominal distension and tenderness, with or without rebound, rigidity, or decreased bowel sounds, may be seen in cases of intra-abdominal bleeding. Abdominal tenderness is variable; it is present in 50% to 90% of patients with ectopic pregnancies. Cervical motion tenderness caused by intraperitoneal irritation and adnexal tenderness are commonly found. An adnexal mass is present in roughly one-third of cases, but its absence does not rule out the possibility of an ectopic implantation. The uterus may enlarge and soften throughout the first trimester, thus simulating an intrauterine pregnancy. A slightly open cervix with blood or decidual tissue may be found and mis-taken for a threatened and/or spontaneous abortion.

Comments

Post a Comment

Popular posts from this blog

Hirsutism and Virilization

Image
  Hirsutism and Virilization Hirsutism  is excess terminal hair in a male pattern of H  distribution. It is manifested initially by the appear-ance of midline terminal hair. Terminal hair is darker, coarser, and kinkier than vellus hair, which is soft, downy, and fine. Care must be taken to evaluate the pos-sibility that excess terminal hair is familial, not patholog-ical, in origin. A scale used for the evaluation of hirsutism is shown in Figure 36.1. When a woman is exposed to excess androgens, terminal hair first appears on the lower abdomen and around the nipples, next around the chin and upper lip, and finally between the breasts and on the lower back. Usually, a woman with hirsutism also has acne. For women in Western cultures, terminal hair on the abdomen, breasts, and face is considered unsightly and presents a cosmetic problem. As a result, at the first sign of hirsutism, women often consult their physician to seek a cause for the excess hair growth and seek trea...
Read more

Radiation Therapy

  RADIATION THERAPY   Ionizing radiation  causes the production of free hydrogenions and hydroxyl ( OH) radicals. With sufficient oxygen, hydrogen peroxide (H 2 O 2 ) is formed, which disrupts the structure of DNA and, eventually, the cell’s ability to divide. As with chemotherapy, killing is by first-order kinetics.  Because dividing cells are more sensitive to radiation damage and because not all cells in a given tumor are dividing at any one time, fractionated doses of radiation are more likely to be effective than a single dose.  Providing multiple lower doses of radiation alsoreduces the deleterious effects on normal tissues.   The basis of fractionated dosage comes from the  “four Rs” of radiobiology:   ·       Repair of sublethal injury.  When a dose is divided,the number of normal cells that survive is greater than if the dose were given at one time (higher total amounts of radiation can be tolerated in fracti...
Read more