java barcode library open source ECTOPIC PREGNANCY in Objective-C

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ECTOPIC PREGNANCY
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Amenorrhea or irregular bleeding and spotting Pelvic pain, usually adnexal Adnexal mass by clinical examination or ultrasound Failure of serum level of hCG to double every 48 hours No intrauterine pregnancy on transvaginal ultrasound with serum -hCG of > 2000 mU/mL
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Treatment
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A Preconception Therapy
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Preconception therapy is aimed at detection of maternal or paternal defects that may contribute to abortion A thorough general and gynecologic examination is essential Polycystic ovaries should be ruled out A random blood glucose test and thyroid function studies (including thyroid antibodies) should be done Detection of lupus anticoagulant and other hemostatic abnormalities (proteins S and C and antithrombin III deficiency, hyperhomocysteinemia, anticardiolipin antibody, factor V Leiden mutations) and an antinuclear antibody test may be indicated with second trimester losses Endometrial tissue should be examined in the postovulation stage of the cycle to determine the adequacy of the response of the endometrium to hormones The competency of the cervix must be determined and hysteroscopy or hysterography used to exclude submucous myomas and congenital anomalies Chromosomal (karyotype) analysis of both partners rules out balanced translocations (found in 5% of infertile couples) Studies have focused on the major histocompatibility complex of chromosome 6, which carries HLA loci and other genes that may influence reproductive success Some women demonstrate a lack of maternal antibody response to paternal lymphocytes, which is customarily found in normal women after successful childbearing However, several randomized controlled trials have found no benefit of intravenous immunoglobulin therapy for recurrent spontaneous abortion
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Ectopic implantation occurs in about one out of 150 live births About 98% of ectopic pregnancies are tubal Other sites of ectopic implantation are the peritoneum or abdominal viscera, the ovary, and the cervix Any condition that prevents or retards migration of the fertilized ovum to the uterus can predispose to an ectopic pregnancy, including a history of infertility, pelvic inflammatory disease, ruptured appendix, and prior tubal surgery Combined intrauterine and extrauterine pregnancy (heterotopic) may occur rarely In the United States, undiagnosed or undetected ectopic pregnancy is currently the most common cause of maternal death during the first trimester
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A Symptoms and Signs
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They may be acute or chronic 1 Acute (40%) Severe lower quadrant pain occurs in almost every case It is sudden in onset, lancinating, intermittent, and does not radiate Backache is present during attacks Shock occurs in about 10%, often after pelvic examination At least two-thirds of patients give a history of abnormal menstruation; many have been infertile 2 Chronic (60%) Blood leaks from the tubal ampulla over a period of days, and considerable blood may accumulate in the peritoneum Slight but persistent vaginal spotting is reported, and a pelvic mass can be palpated Abdominal distention and mild paralytic ileus are often present
B Postconception Therapy
Provide early prenatal care and schedule frequent office visits Complete bed rest is justified only for bleeding or pain Empiric sex steroid hormone therapy is contraindicated
B Laboratory Findings
Blood studies may show anemia and slight leukocytosis Quantitative serum pregnancy tests will show levels gener-
CMDT 2008
conditions permitting, patency of the contralateral tube can be established by injection of indigo carmine into the uterine cavity and flow through the contralateral tube confirmed visually by the surgeon In a stable patient, methotrexate (50 mg/m2) intramuscularly given as single or multiple doses is acceptable medical therapy for early ectopic pregnancy Favorable criteria are that the pregnancy should be less than 35 cm in largest dimension and unruptured, with no active bleeding Iron therapy for anemia may be necessary during convalescence Give Rho(D) immune globulin (300 mcg) to Rh-negative patients
ally lower than expected for normal pregnancies of the same duration If pregnancy tests are followed over a few days, there may be a slow rise or a plateau rather than the near doubling every 2 days associated with normal early intrauterine pregnancy or the falling levels that occur with spontaneous abortion
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