Ektopična trudnoća i aktivnosti primalje u dijagnosticiranju i liječenju ektopične trudnoće

An ectopic pregnancy is a pregnancy implanted outside the uterine cavity. It is also called ectopic, but since the abnormal gland may also be inside the uterus, the more precise and comprehensive name is ectopic. It needs to be diagnosed early and adequately treated because a ruptured ectopic pregnancy is a life-threatening condition and therefore the mortality rate is high. Ectopic pregnancy occurs in 1-2% of all pregnancies. A particular form of ectopic pregnancy is heterotopic pregnancy, a condition when both intra-maternal and ectopic pregnancies are present and occurs in 1/30,000 births. An ectopic pregnancy can be divided into tubal and extracorporeal pregnancies. Although non-tubal pregnancies represent only 5% of all ectopic pregnancies, they have a higher mortality rate than tubal pregnancies. The classic triage of symptoms, which occurs in the half of women, is amenorrhea, bleeding, and abdominal or pelvic pain, most commonly on the side of ectopic pregnancy. Acute form of tubal ectopic pregnancy is specific by ruptured of the fallopian tube, abdominal bleeding into and cardiovascular collaps. In the subacute form, pregnancy continues to develop, abdominal pain and amenorrhea are present and bleeding is involved. In quiet asymptomatic amenorrhea is present, but there is no sign of bleeding or pain. It is most commonly diagnosed with a anamnesis, serial measurement of biochemical markers and transvaginal ultrasound, and sometimes requires curettage, culdocentesis, or diagnostic laparoscopy. Ectopic pregnancy is characterized by irregular growth, so serial measurement of hCG levels is needed. A sign suggesting a high probability of tubal pregnancy during transvaginal ultrasound examination is an adnexal mass, moving separately from the ovary, called a 'blob' sign, with an empty gestational sac sometimes described as a hyperchoic ring, called a 'bagel'. Curettage is used in cases where there is a doubt between intrauterine and ectopic pregnancy and when hCG values are low. Culdocentesis was once used as the main diagnostic method, but today it has been replaced by laparoscopy, the gold standard in the diagnosis and treatment of ectopic pregnancy. Treatment depends on the shape of the ectopic pregnancy, the patient's condition and her desire for future reproduction. It can be treated expectively, medicamentally and surgically. Early diagnosis and adequate treatment of this pathological condition is necessary for the woman to survive and in the future to be possible to reproduce later. Teamwork between doctors and midwives, their knowledge and skills, and patient support are crucial to achieve this.