Friday, 6 November 2015

Ectopic pregnancy & miscarriage

Cemak Asma: Salam doctor.. Me n my frens have a few questions.
1. How many weeks of gestation can we diagnose a pregnancy as ectopic? Sbb ada setengah patient tu doc suruh tunggu dulu baru confirmkan.

Dr Shaiful Ehsan: Q1: Ectopic pregnancy can be diagnosed as early as clinical suspicion is high....either in early 1st trimester till 3rd trimester....
I did mention to some of u guys that while I in H Keningau we did encounter ectopic pregnancy in ovary not detected early and that time already around 30 - 32 weeks....
If clinical suspicion is high...TVS is good enough to see free fluids and adnexal mass in which u need to do laparosopic surgery to identify and manage...
There is no point of waiting as it will rupture and leads to sepsis & death...

Usually wait is for missed miscarriage for those opt for conservative management....
Or on TVS no suspicious findings were found in which patient most probably had wrong date!!!!

2. How can molar pregnancy lead to preecplampsia? Is it because of the hyperthyroid state?

Dr Shaiful Ehsan: Q2: Molar pregnancy is associated with excessive hormones released from placenta....including anti angiogenic proteins from its trophoblast...
Antiangiogeneses = inadequate blood vessel formation = culprit for PIH and PE...

3. Regarding inevitable miscarriage.. Some books classify complete and incomplete miscarriage under inevitable but some dont.. Yg classify inevitable as it own entity, dy kata on ultrasound we can still see fetal heart activity. But this is not present if complete n incomplete miscarriage.. So kami dah pening 😅 inevitable ni nak letak bawah mana? Huhu

Dr. Shaiful Ehsan:Q3: incomplete or complete miscarriage is an outcome.....
Of any miscarriage either inevitable or missed miscarriage that treat conservatively and passed out...
Complete miscarriage means ET is already thin...no REMAINING POC....
Incomplete there is still remaining POC...

Above statement that u shared is misleading...tq

Cemak Asma: So doctor if inevitable miscarriage, will it still be possible to see fetal heart activity? I dont quite understand this part

Dr Shaiful Ehsan: The golden difference between inevitanle and threatened miscarriage is cervical os opening...
Presence or absence FH is not part of criteria for inevitable miscarriage....

Nevertheless it is more common to have absence FH in inevitable miscarriage...

Yupp...u still can have FH in inevitable miscarriage
 Btw...threathened miscarriage MUST HAVE FH...tq

Cemak Asma: Ohh okay doctor.. Thank you



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Adlina: Assalamualaikum Dr. How ruptured fallopian tube due to ectopic pregnancy can cause diarrhea?

 Dr Shaiful Ehsan: Waailaikumsalam adlina, ruptured ectopic pregnancy will cause intraperitoneal harmorrhage....blood is irritants in which will induce inflammatory cascade upon contact with bowel or surface...
Eg making contact with diaphgram will cause shoulder tip pain
Making contact with bowel will induce inflammation of the bowel wall, increase peristaltic movement & reduced absorption....= diarrhea

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