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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 beta-
hCG or decreasing serum beta-
hCG <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
– tubal size <2 cm American College of Obstetricians and 
    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 non-
maleficence:
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…