Managing Complications in Pregnancy and Childbirth: - IAWG

Vaginal bleeding in early pregnancyS-15TABLE S-4Symptoms and signs of ruptured and unruptured ectopicpregnancyUnruptured Ectopic PregnancyRuptured Ectopic Pregnancy• Symptoms of early pregnancy(irregular spotting or bleeding,nausea, swelling of breasts, bluishdiscoloration of vagina and cervix,softening of cervix, slight uterineenlargement, increased urinaryfrequency)• Abdominal and pelvic pain• Collapse and weakness• Fast, weak pulse (110 per minute ormore)• Hypotension• Hypovolaemia• Acute abdominal and pelvic pain• Abdominal distension a• Rebound tenderness• PalloraDistended abdomen with shifting dullness may indicate free blood.DIFFERENTIAL DIAGNOSISThe most common differential diagnosis for ectopic pregnancy isthreatened abortion. Others are acute or chronic PID, ovarian cysts(torsion or rupture) and acute appendicitis.If available, ultrasound may help distinguish a threatened abortion ortwisted ovarian cyst from an ectopic pregnancy.IMMEDIATE MANAGEMENT• Cross-match blood and arrange for immediate laparotomy. Do notwait for blood before performing surgery.• At surgery, inspect both ovaries and fallopian tubes:- If there is extensive damage to the tubes, performsalpingectomy (the bleeding tube and the products ofconception are excised together). This is the treatment ofchoice in most cases (page P-109);- Rarely, if there is little tubal damage, perform salpingostomy(the products of conception can be removed and the tubeconserved). This should be done only when the conservationof fertility is very important to the woman, as the risk ofanother ectopic pregnancy is high (page P-111).AUTOTRANSFUSIONIf significant haemorrhage occurs, autotransfusion can be used if theblood is unquestionably fresh and free from infection (in later stages of