How will you manage a case of a acute ruptured ectopic pg

Management of ruptured ectopic pg:D-06,07,10,12    J-08

Clinical features :

Symptoms :

1.Short period of amenorrhoea

2.Sudden severe lancinating lower abdominal pain

3.Per vaginal bleeding

4.Patient may go into collapse and shock

Signs:

General examination:

*Anaemia

*low BP

*Rapid thready pluse

*Cold clammy skinskin

Per abdominal Examination :

*Lower abdominal tenderness ,rigid and distended

*Shifting dullness maybe elicited

*Gut maybe distended

Pervaginal Examination :

No mass usually felt through the cervix

Investigations:

1.Blood for TC,DC,ESR,HB,Blood grouping and Rh typing

2.USG of uterus

3.Pg test

4.colponentry

5.curettage

6.laparoscopy

Rx:

A.General Treatment :

1.Immediate Hospitalization

2.Iv channel open

3.Blood transfusion

4.Inf:Hartman solution

5.catheterization

6.Antibiotics 

B.Specific treatment :

1.if family is complete :salpingectomy+9other sided tubectomy

2.if family in incomplete and other sided tube healthy:Salpingectomy

3.if family is incomplete and other sided tube unhealthy :Partial

4.if tube is intact:

*Salpingotomy

*

Salpingostomy

*Milking