1. ECTOPIC PREGNANCY

2. Ectopic pregnancy is an implantation of a fertilized ovum in a site other than the endometrial lining of the uterus

4. הריון חוץ רחמי בחצרוצה

6. RISK FACTORS Tubal damage caused by PID; surgery Endometriosis
Previous ectopic pregnancy
Presence of an IUD
Congenital anomalies of the tube
IVF
Advanced maternal age

7. CLINICAL SIGNS One-sided lower abdominal pain Slight vaginal bleeding
These are the signs of an ectopic that has NOT ruptured

8. CLINICAL THERAPY
Assessment of menstrual history; especially the last menstrual period
Blood test– BetaHCG; CBC; Blood type-cross match US HL
D/D for appendicitis; ovarian cyst; torsion of ovary; UTI; spontaneous abortion

9. MEDICAL MANAGEMENT
Methotrexate (MTX) IM with follow-up of BetaHCG till the beta is down
The woman is instructed to return to the hospital immediately if she experiences heavy bleeding, severe pain and dizziness.

10. CLINICAL SIGNS OF ECTOPIC THAT HAS RUPTURED
Severe one-sided lower abdominal pain
Fainting and\or dizziness
Right shoulder pain
Signs of hypovolemic shock

12. CLINICAL THERAPY NPO US IV Blood type and cross-match
CBC; PTT;PT; Biochemistry
2 PC Blood
Immediate surgery—laparoscopic salpingectomy or abdominal salpingectomy

13. CLINICAL MANAGEMENT Assessment of the vaginal bleeding
Assessment of the hemovac (if there is one)
Vital signs
Urine output (catheter)
Pain management
I & O
Emotional support; grieving

14. אפשרויות הטיפול בהריון חוץ רחמי
מעקב והסתכלות תרופתי כירורגי
Methotrexate Laparatomy Laparascopy
expectant
management
כריתת חתך חליבה
חצוצרה בחצוצרה
Milking Salpingostomy Salpingectomy

15. DISCHARGE COUNSELING Prevent infection
Symptoms to report (pain, bleeding and fever)
Follow-up visit
Emotional support