| |
Symptoms
and signs are extremely variable depending on whether or not
the pregnancy has ruptured.
Culdocentesis (cul-de-sac puncture) is an important tool for
the diagnosis of ruptured ectopic pregnancy, but is less useful
than a serum pregnancy test combined with ultrasonography.
If non-clotting blood is obtained, begin treatment at once.
Differential diagnosis
The most common differential diagnosis for ectopic pregnancy
is threatened abortion. Others are acute or chronic pelvic
infection, ovarian cysts (torsion or rupture) and acute appendicitis.
If available, ultrasound may help to distinguish a threatened
abortion or twisted ovarian cyst from an ectopic pregnancy.
Immediate management
| :: |
Order
crossmatched blood and arrange for immediate laparotomy. |
Do
not wait for blood before performing surgery.
|
| :: |
At
surgery, inspect both ovaries and fallopian tubes:
| • |
If
there is extensive damage to the tubes, perform
salpingectomy (the bleeding tube and the products
of conception are excised together): this is the
treatment of choice in most cases |
| • |
Rarely,
if there is little tubal damage, perform salpingostomy
(the products of conception can be removed and
the tube conserved). This should be done only when
the conservation of fertility is very important to
the woman, as the risk of another ectopic pregnancy
is high. |
|
Autologous blood transfusion
If significant haemorrhage occurs, autologous transfusion can be used if the
blood is unquestionably fresh and free from infection (in later stages of pregnancy,
blood is contaminated with amniotic fluid, etc. and should not be used for autotransfusion).
The blood can be collected after the abdomen is opened.
| 1 |
Scoop
the blood into a basin and strain through gauze to
remove clots. |
| 2 |
Clean
the top portion of a blood donor bag with antiseptic
solution and
open it with a sterile blade. |
| 3 |
Pour
the woman’s blood into the bag and reinfuse it
through a filtered set
in the usual way. |
| 4 |
If
a donor bag with anticoagulant is not available, add
sodium citrate
10 ml to each 90 ml of blood. |
For
further details of the use of gauze filtration, see The
Clinical Use of Blood (WHO, 2001, page 275).
|
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