Pregnancy and Ectopic Pregnancy

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    Normal Pregnancy and EctopicPregnancy in Woman

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    , )6(

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    Normal Pregnancyin woman

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    How to detect the pregnancy?

    Two types of tests ( in Serum or Urine):

    Qualitative human chorionic gonadotropin(hCG) : gives yes or No results.

    Quantitative or beta human chorionicgonadotropin: Gives exact level of hCG

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    Maternal Physiology Basal metabolic rate increases 15 % Cardiac output increases 30 40 % Blood volume increases 30 % O2 utilization increases 20 % Renal tubule reabsorption increases 50% Glomerulus filtration rate increases 50%

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    Weight gain and pregnancy Average: 10.9 kg, may reach 34 kg Fetus: 3.2 kg

    Extraembryonic fluids / tissues: 1.8 kg Uterus: 0.9 kg Breasts: 0.9 kg Body fluids: 2.7 kg Fat accumulation : 1.3 kg

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    Hormonal changes duringpregnancy

    hCG - detected within few days of

    implantation (7 10 days)

    - increase rapidly during earlypregnancy to a peak occurring 60 days post- conception.

    - Decreased gradually to reachminimum level at term.

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    Human Placental Lactogen (hPL)

    - Increased Progressively during pregnancy- Biologically, Similar to growth hormone- Affect carbohydrate and lipid metabolism.

    Estrogens

    -

    Biosynthesis by mother, fetus, placenta- Affect uterus and other reproductive organs.- influence carbohydrate, lipid, and bone metabolism

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    Progesterone

    - rise progressively throughout pregnancy. - Progesterone relaxes smooth muscle, which

    causes atony of the gastrointestinal andurinary tracts.

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    Hematological changes duringpregnancy

    Plasma volume increases by about 50% RBC volume increases by about 30% WBC count increases during pregnancy by

    about 20% Platelet count decreases, but stays within

    normal limits

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    Gastrointestinal System duringpregnancy

    Decreased motility due to influence of progesterone .

    Reduced gastric acid secretion.

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    Daily dietary requirements of pregnant woman

    Calories: increased 15% kcal/day, or you need about2200 cal/day

    Protein: an additional 10 to 30 gm /day (about 75 gm/day total)

    Iron: supplement 30 to 60 mg of elemental iron per day

    Calcium: 1200 mg needed per day Foliate: supplement 200 to 400 g per day

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    Nausea and Vomiting duringpregnancy

    Peaks during first Trimester. Positive correlation with birth weight Nausea 50-70%of pregnant women Vomiting- 40-50%of pregnant women Less than 2% is solely in the morning.

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    Possible causes of Nausea andvomiting

    Elevated hCG level Elevated estrogen / progesterone level Bacterial ( Heliocobacter pylori ) Serotonin levels

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    Definition of Ectopic pregnancy

    Ectopic means " out of place ." In an ectopicpregnancy, a fertilized egg has implanted outside theuterus. The egg settles in the fallopian tubes in morethan 95% of ectopic pregnancies ( Tubalpregnancies ).

    The egg can also implant in the ovary, abdomen, or the cervix (ovarian , cervical or abdominal pregnancies )

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    Signs and Symptoms of ectopicpregnancy

    Ectopic pregnancy can be difficult to diagnose Pain (sharp and stabbing ) in pelvis. Vaginal bleeding. Pain in shoulder and neck ( irritates certain nerves) dizziness or fainting (caused by blood loss) low blood pressure (also caused by blood loss) lower back pain

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    Causes of Ectopic Pregnancy Inability of fertilized eggs to work its way quickly

    enough down the Fallopian tube into the uterus.

    Pelvic inflammatory disease (PID) caused by

    gonorrhea that cause blockage of Fallopian tube. Endometriosis (cells from the lining of the uterus

    implant and grow elsewhere in the body and causeblockages

    Rarely, birth defect or abnormal growth can alter shape of tube and disrupt the eggs process.

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    Diagnosis of Ectopic pregnancy If woman know she is pregnant serum quantitative hCG level

    Normally, Its levels double every 2 days for the first several weeks of pregnancy, so if hCG levels are lower than expected for your

    stage of pregnancy, one possible explanationmight be an ectopic pregnancy.

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    Diagnosis of Ectopic pregnancy ultrasound examination, whether the uterus

    contains a developing fetus or if masses arepresent elsewhere in the abdominal area.

    The doctor may also give pelvic exam tolocate the areas causing pain, to check for anenlarged, pregnant uterus, or to find anymasses.

    All above together.

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    Options for Treatment

    Treatment varies depending on:

    - Medically stable the woman is.- Size and location of the pregnancy

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    Options for Treatment An early ectopic pregnancy can sometimes

    be treated with an injection of methotrexate,which stops the growth of the embryo .

    If the pregnancy is further along, she willlikely need surgery to remove the abnormal

    pregnancy using laparoscopy provided withcamera.

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    What About Future Pregnancies? Some women with ectopic pregnancy will

    have difficulty becoming pregnant againespecially those had fertility problems

    before .

    Future pregnancy depends on fertility before

    ectopic and size of damage.

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    Who's at Risk for an Ectopic Pregnancy?

    women who are over 35 age. PID. a previous ectopic pregnancy. surgery on a fallopian tube. infertility problems or medication to

    stimulate ovulation. Women used Intrauterine device (IUD).

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    Thank you for your listening