ECTOPIC PREGNANCY

a rebellious embryo may decide to implant itself outside the uterus!

After the fertilization of the egg by a viable sperm, the resultant embryo travels from the fallopian tube down into the cavity of the uterus. Implantation occurs when the embryo is attached to the uterine wall and continues to develop until full term gestation.

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However, for reasons that are not fully understood, a rebellious embryo may decide to implant itself outside the uterus!

Ectopic Pregnancies (EP) account for about 11:1000 pregnancies. More than 80% of such rebels implant in the fallopian tube, hence the name “Tubal Pregnancy”, often used interchangeably with EP.

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Other recognized locations of EP are the abdominal cavity, ovaries, cervix and cesarean section scar.

Because of the limited space for growth within the tube or other ectopic sites, rupture and severe internal bleeding could occur starting from 6-8weeks. Ruptured EP is a life-threatening condition and one of the major causes of maternal mortality.

What are the risk factors for EP?

  • Previous history of EP
  • Previous history of infertility and its treatment (assisted reproductive techniques)
  • Pelvic inflammatory disease (PID)
  • Intrauterine contraceptive device use at the time of conception
  • Endometriosis (presence of the uterine lining outside of the uterus)
  • Pelvic or tubal surgery
  • Smoking

The only way to ensure prompt diagnosis and treatment of EP is to have a high index of suspicion by recognizing the telltale signs.

 

The symptoms are variable and non-specific but there is a classical triad reported by many patients:

  1. Missed period (6-8weeks)
  2. Lower abdominal pain
  3. Mild vaginal bleeding or brownish discharge. 

 Other symptoms include:Shoulder tip pain (sign of internal bleeding-ruptured EP),  Sudden collapse (due to severe blood loss)

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    A diagnosis is usually confirmed by identification via ultrasound scan, supported by the level of an early pregnancy hormone known as Human Chorionic Gonadotropin B (BHCG). The modality of treatment depends on the clinical status.

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    *Surgical management – in ruptured EP, with acute severe blood loss, emergency surgical intervention must be done, together with blood transfusion to save the patient. 

    *Medical management – using methotrexate, in clinically stable patients who are compliant 

    *Expectant/Conservative management – in small sized EP and falling BHCG where the body is expected to get rid of the “rebel” by itself. This is reserved for a select few cases.

    Below is a summary of events in a woman with ectopic pregnancy and how the doctor chooses how best to help her.

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    Anxiety and co…

    Anxiety disorders are the most commonly encountered psychological disorders among adults

    If you have never felt anxious, something is wrong with you. It is okay to worry temporarily especially when we have to make important decisions when we are faced with a challenge or a test/exam. However, it is a different case entirely when this is blown out of proportion. Anxiety disorders are the most commonly encountered psychological disorders among adults and they interfere with performance, relationships and other healthy daily activities.  Have you read about Stress?

    Anxiety disorders are the most commonly encountered psychological disorders among adults and they interfere with performance, relationships and other healthy daily activities.

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    Nobody wants to be labeled as crazy, especially in an African society where stigmatization thrives like wild-fire. For this reasons, critical issues pertinent to assessing anxiety disorders are bordered on;

    • Sensitivity to making the diagnosis
    • Anxiety in a mask of productivity
    • Other psychiatric diagnoses associated with it
    • Medical conditions and medications that can cause or exacerbate anxiety disorders.

    Risk Factors

    • Shyness, or behavioral inhibition, in childhood
    • Being female
    • Having poor economic resources
    • Being divorced or widowed
    • Exposure to stressful life events in childhood and adulthood
    • Anxiety disorders in close biological relatives
    • Parental history of mental disorders

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    The anxiety disorders that will be examined in this write-up will include:

    1. Panic disorder
    2. Generalized anxiety disorder
    3. Obsessive compulsive disorder
    4. Post-traumatic stress disorder
    5. Social phobia and specific phobia.

    As each disorder is explored, emphasis will be placed on assessment of commonly encountered psychiatric and medical conditions that contribute to anxiety symptoms. However, before considering the specific anxiety disorders to be presented in this program, it is useful to highlight the following issues:

    Psychiatric Disorders associated with Anxiety Disorders

    • Major depressive disorder
    • Substance abuse disorders – alcohol, marijuana
    • Somatization disorders (fatigue, chest pain, headache, insomnia, non-specific GI complaints)
    • Complex anxiety disorders – ( Post-traumatic stress disorder with Panic disorder)

    Medical Conditions associated with Exacerbating Anxiety

    • Hyperthyroidism
    • Adrenal Dysfunction
    • Angina
    • Hypoglycemia

    Medications and Substances associated with Exacerbating Anxiety

    • Stimulants (Amphetamines, caffeine, cocaine, and other over the counter “natural stimulants”)
    • Withdrawal from drugs, including alcohol
    • Heavy metals and toxins
    • Steroids
    • Rapid withdrawal from some antidepressants

    General Action plan in dealing with anxiety and associated disorders

    1. Assessment for suicide risk, particularly in patients with depression and panic disorder, substance abuse or high levels of agitation.
    2. Identification of severity of anxiety disorder (chronic or episodic)
    3. Identification of substance abuse
    4. Assessment of key symptoms of panic disorder, fear of dying and/or fear of going crazy
    5. Assessment for depression or other mood disorder
    6. Inquiry as to the presence of anti-social behavior
    7. Exploration of presence of precipitating event or trauma
    8. Being alert to people with anxiety disorders who have insomnia, headache, non-specific GI complaints, cognitive complaints

    We will be talking extensively about mental health and major associative conditions in the comings weeks. Stay tuned. Read about Stress here.