Ectopic pregnancies I encountered

This is the No.  1500 th. of my postings.   In Burmese 1500 love is LOVE between the couples. Love between the parents vs children or amongst siblings is 528.

An ectopic pregnancy is a complication of pregnancy in which the pregnancy implants outside the uterine cavity. Usually ectopic pregnancies are not only viable but are also very dangerous for the mother as it used to be followed by a massive internal bleeding. Most of these ectopic pregnancies are situated in the Fallopian tube and used to call as tubal pregnancies, but implantation can also occur in the cervix, ovaries, and abdomen. An ectopic pregnancy is an Obstetric emergency, and, if not diagnosed or treated properly in time could be fatal. Long time ago, before the advent of UPT (Easy instant urine for pregnancy test) kids or strips and the arrival of Ultra Sound machines, many doctors , including me, could missed or failed to detect the Ectopic Pregnancies. When I was very young, Burmese popular actress Mary Myint passed away with ruptured ectopic pregnancy.

 

Oviduct with an ectopic pregnancy (tubal pregn...

Image via Wikipedia

Young doctors, medical students and present generation may be difficult to understand or hard to believe that we grew up in the era of pre TV, VCR, CD, VCD, DVD, MP3, MP4, Digital cameras, computers, CT Scan, Ultra Sound, MRI, HIV, Cellular/Hand phones, SMS, MMS, Video games, Compuer games, Black berry, iPhone, Internet, e-mail, blogs, YouTube, Face books, Twitter etc…Or some were just invented or widely available to use by the public or relevant professionals.

In the early years as a young doctor from 1976 to 80’s we don’t have the private labs in Mandalay. Most of us knew one lab technician only (but there could be a few) moonlighting at his house to do few tests but especially for Urine test for Pregnancy and Infections. He was injecting the urine of the patients into the Toads and the cloacal discharge then was examined for the presence of sperm. It was because of the reaction to the stimulation with mammalian chorionic gonadotropin. Only in 1982, I was tipped off by a friend that we could request the Professor, Head of Department of Pathology Department of Mandalay General Hospital to get permission to test with the strips.

The first ever Ultra Sound Machine arrived MGH when the present Rector Dr Than Win was already doing his MSc O&G. Professor, Head of Department of O&G assigned that machine to Dr Than Win.

The colour films were available in Mandalay in late 70s only. During our wedding we managed to take only a few colour photos only. No VCR video cameras available at that time. My sister-in-law Nilar (now w/o Dr NAK) was attending Physics Masters and her computer printout samples were made by, “Printing Press” with special requests.

I read about Video players, VCRs, MRI, AIDS/HIV discovery in the Newsweeks and Times magazines. I just read about Cardiotocography (CTG) or electronic fetal monitor (EFM) in the book and when the Obstetrician Professor in UH asked me to read and interpret the CTG of a labour patient in the labour room, I just tried to read for the first time. He just kept quiet without any comment.

The Internet readied Computer was placed in the centre of UM Library reading room. We are told or taught once during the orientation how to search the books or information. I was scared to use for the first time. So when the Gynae Professor ordered us to search a thesis topic in the library and to present him within two weeks, I was scared. Ultrasound, CTG, monitors in ICUs and computer, CT Scans…all these made me scared or in a state of phobia. Even the Pager we need to keep all the time were a cause of tension. No wonder I sometimes I felt that those pagers were punishment boxes from hell.

Let us go back to the main topic, Ectopic Pregnancy. We failed to detect early especially when they came very early before any complications and if there were minimal signs and symptoms. One or two patients I referred to the A&E with the, “Threatened Abortion” or early signs of miscarriage were found out to be ectopic pregnancies. The patients I saw in University Hospital who were already diagnosed by the referrers are not worth mentioning here.

Once while I was on duty (on call) in UHKL, one consultant surgeon called me on the phone to prepare an Appendicitis Patient. I routinely prepare and then sent the urine for pregnancy test. As the patient was the unmarried sister of a VIP, the nurses were angry and took as an insult. I told them that I even never asked her about the history of sex or doubt her menstrual history but just checking it as a routine to exclude the possibility of pregnancy related complications. But when the test showed the positive result and it turned out to be an ectopic pregnancy, the surgeon thanked me and declared that I had saved his neck.

On 27.02.11 Moe Moe (not her real name) came to my clinic with painful period which is continuing for ten days. As she was married, I asked her about, “family planning”, she replied that there were non but she never missed period. As she had increased frequency of urine and long history of PV Discharges I suspected the possibility of infection. But as she was anaemic, pale, told me that she had fainted in the workplace and she had severe pain/tenderness in RIF and SPA I requested to allow me to test her urine for combur 10 and UPT. At first she was not willing but agreed after explaining about the dangers of IUD, missed abortion and other complications. UPT was positive, I diagnosed as Ectopic Pregnancy, sent to A&E HKL, operated on that night. Confirmed ectopic pregnancy.

From Wikipedia: In a normal pregnancy, the fertilized egg enters the uterus and settles into the uterine lining where it has plenty of room to divide and grow. About 1% of pregnancies are in an ectopic location with implantation not occurring inside of the womb, and of these 98% occur in the Fallopian tubes.

Detection of ectopic pregnancy in early gestation has been achieved mainly due to enhanced diagnostic capability. Despite all these notable successes in diagnostics and detection techniques ectopic pregnancy remains a source of serious maternal morbidity and mortality worldwide, especially in countries with poor prenatal care.[2]

In a typical ectopic pregnancy, the embryo adheres to the lining of the fallopian tube and burrows into the tubal lining. Most commonly this invades vessels and will cause bleeding. This intratubal bleeding hematosalpinx expels the implantation out of the tubal end as a tubal abortion. Tubal abortion is a common type of miscarriage. There is no inflammation of the tube in ectopic pregnancy. The pain is caused by prostaglandins released at the implantation site, and by free blood in the peritoneal cavity, which is a local irritant. Sometimes the bleeding might be heavy enough to threaten the health or life of the woman. Usually this degree of bleeding is due to delay in diagnosis, but sometimes, especially if the implantation is in the proximal tube (just before it enters the uterus), it may invade into the nearby Sampson artery, causing heavy bleeding earlier than usual.

If left untreated, about half of ectopic pregnancies will resolve without treatment. These are the tubal abortions. The advent of methotrexate treatment for ectopic pregnancy has reduced the need for surgery; however, surgical intervention is still required in cases where the Fallopian tube has ruptured or is in danger of doing so. This intervention may be laparoscopic or through a larger incision, known as a laparotomy.

Please continue to read all at the source:Ectopic pregnancy, from Wikipedia, the free encyclopedia.

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3 Responses to “Ectopic pregnancies I encountered”

  1. She Didn’t Know She Was Pregnant >> Parenting.com « heartchasms Says:

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  2. AMAR NATH PANDEY Says:

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  3. chronic appendicitis Says:

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    [...]Ectopic pregnancies I encountered « Dr Ko Ko Gyi’s Blog[...]…

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