1. HEMORRHAGES DURING PREGNANCY

2. ECTOPIC PREGNANCY Ectopic pregnancy is one in which the products of conception develop outside the uterine cavity. By far the commonest site is the fallopian tube. The fallopian tube is about 10 cm long. The diameter of the lumen varies from 1 mm in the interstitial portion to about 5 mm at the fimbriated end.

4. The musculature is of two layers, an inner circular and an outer longitudinal, and peristaltic movements are particularly strong during and after ovulation. The mucosa is arranged in plications or folds which become much more complete and plentiful as the infundibulum is approached.

5. Ectopic implantation may be fortuitous or the result of a tubal abnormality which obstructs or delays the passage of the fertilised ovum.

17. Diagnosis Clinical symptoms: 1. Pregnancy signs: - suppression of menses; - mammary glands swelling; - changes of taste, olfaction and other sensations typical for pregnancy; - early gestosis signs (sickness, vomiting, oth.); - positive immunologic reactions on gestation (HCG in blood serum and urine).

19. 4. Symptoms of intraabdominal hemorrhage (in case of EP disorder): - loss of resonance in abdominal flanks; - positive Kulenkampf’s syndrome (there are signs of abdominal irritation when there is no local muscular tension in lower parts of abdomen; - in horizontal position of the patient there is a positive bilateral “frenicus” symptom, and in vertical position – vertigo (dizziness), loss of consciousness; - in case of significant hemoperitoneum there is a Shchotkin – Bloomberg symptom; - progressive decrease of hemoglobin, erythrocytes, hematocrits indeces according to the blood test data.

20. 5.General state distress ( in case of EP disorder): - asthenia (weakness), vertigo (dizziness), loss of consciousness, cold sweat, collapse, hemodynamic disorders; - sickness, reflex vomiting; - meteorism, single diarrhea.

22. SYMPTOMS AND SIGNS PAIN in the lower abdomen is always present and may be either constant or cramp-like. It may be referred to the shoulder if blood tracks to the diaphragm and stimulates the phrenic nerve, and it may be so severe as to cause fainting. The pain is caused by distension of the gravid tube, by its efforts to contract and expel the ovum, and by irritation of the peritoneum by leakage of blood. VAGINAL BLEEDING occurs usually after the death of the ovum and is an effect of oestrogen withdrawal. It is dark brown and scanty and its irregularity may lead the patient to confuse it with the menstrual flow and thus, inadvertently, give a misleading history. In about 25% of cases tubal pregnancy presents without any vaginal bleeding.

23. INTERNAL BLOOD LOSS can be severe and rapid and the usual signs of collapse and shock will appear. Acute internal bleeding is the most dramatic and dangerous consequence of tubal pregnancy, but it is less common than the condition presenting by a slow trickle of blood into the pelvic cavity.

24. DIFFERENTIAL DIAGNOSIS 1. Salpingitis. 2. Miscarriage. 3. Appendicitis. 4. Torsion of pedicle of ovarian cyst. 5. Rupture of corpus luteum or follicular cyst. 6. Perforation of peptic ulcer.

25. SALPINGITIS Swelling and pain are bilateral, fever is higher and a pregnancy test is usually negative. There may be a purulent discharge from the cervix.

37. Obstetrical bleedings

75. False fused placenta True fused placenta

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