Ectopic Pregnancy

ECTOPIC PREGNANCY

• Fertilized egg grows somewhere else besides the uterus – Usually happen in the fallopian tube (tubal pregnancy)  

• Maybe serious and life  threatening

@ Risk • Becoming pregnant while having an IUD (intrauterine device) in place • Endometriosis or other conditions that cause blockage in your fallopian tubes • Having ectopic pregnancy before • Having infections of the female organs, e.g.pelvic inflammatory disease  

• Past surgery of your fallopian tubes or your abdomen  

Diagnosis (ultrasound & specific assays) • Uncertainty – differentiating between failing pregnancy, threatened abortion and intrauterine or ectopic pregnancy

• Delay – determining whether the blastocyst or embryo is in the uterus or in the fallopian tube

• Unconfident practitioner to act in the absence of a well-grounded diagnosis  

  – Although, prohibitive abortion law allows treatment of ectopic

Management options

 

 

Option1: Laparotomy with salpingectomy/ Laparoscopy • Opening of the tubes and removal of embryonic and trophoblastic tissue • For fertile women with:

– no conditions to perform serial measurements of serial betahCG or decreasing serum betahCG <1000 mIUyml – confirmed or not confirmed ectopic pregnancy – women’s informed decisions to accept the risk of tubal rupture with internal hemorrhage and its significant risk

 

 

Option2: Medical treatment with methotrexate • Relatively new treatment for ectopic pregnancy; standardized protocol is not yet to defined – Amount of methotrexate – Frequency of follow-up visits – Types of routine tests for monitoring

• For asymptomatic women with: – serum beta-hCG <2000 mIUyml  

American College of Obstetricians and  – tubal size <2 cm   Gynecologists (ACOG); Dec 1998 – no fetal cardiac activity

Potential problems • drug-related side effects • treatment-related complications • treatment failure

 

– success rates: 67% to 100%, with a median of 84% for the single-dose regimen; – Successful cases: requires up to 25% more than a single dose – Failed therapy: additional treatment   • Tubal rupture ~ surgical

• treatment is given to help the mother • fetus is very unlikely to survive • serious injury to female organs, or even die from the pregnancy

 

 

Ethical Issues

 

 

Pregnancy • Medical definition: – a female is “pregnant” when ‘having a child or offspring developing in the uterus’

• Legal definition:

 

– when a blastocyst or embryo exists outside the uterus, such as when created in vitro and cryopreserved,  there is no

Ectopic Pregnancy • Principle of double effect: effect – ending embryonic life in treating ectopic pregnancy is a commonly cited illustration of proper application of the principle of double effect, and is not considered as inducing abortion.  

 

Ectopic Pregnancy • Principle of nonmaleficence: maleficence – Where comparable means exist for early diagnosis of ectopic pregnancy, postponing intervention a woman requests until tubal rupture, endangering her life or health, appears unethical, and illegal  

 

Legal Issues

 

 

UK Abortion Act of 1967 • Section 4 (1) – ‘‘No person shall be under any duty to participate in any treatment authorized by this Act to which he has a conscientious objection’’

• Section 4 (2)

 

– ‘‘Nothing in subsection (1) of this section shall affect any duty to participate in treatment which is necessary to save the life or to prevent grave permanent injury   to the physical or mental health

UK Abortion Act of 1967

Woman survive

Criminal negligence  

 

thank you…