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PREGNANCY
• Fertilized egg grows
somewhere else besides
the uterus
– Usually happen in the
fallopian tube (tubal
pregnancy)
• Maybe serious and life-
threatening
@ Risk
• Becoming pregnant while having
an IUD (intrauterine device) in
place
Option1: Laparotomy with
salpingectomy/ Laparoscopy
• Opening of the tubes and
removal of embryonic and
trophoblastic tissue
• For fertile women with:
– no conditions to perform serial
measurements of serial beta-
hCG or decreasing serum beta-
hCG <1000 mIUyml
– confirmed or not confirmed
ectopic pregnancy
– women’s informed decisions to
accept the risk of tubal rupture
with internal hemorrhage and its
significant risk
Option2: Medical treatment
with methotrexate
• Relatively new treatment for
ectopic pregnancy;
standardized protocol is not
yet to defined
– Amount of methotrexate
– Frequency of follow-up visits
– Types of routine tests for
monitoring
• For asymptomatic women
with:
– serum beta-hCG <2000 mIUyml
– tubal size <2 cm American College of Obstetricians and
Gynecologists (ACOG); Dec 1998
– no fetal cardiac activity
Potential problems
Ethical Issues
Pregnancy
• Medical definition:
– a female is “pregnant”
when ‘having a child or
offspring developing in the
uterus’
• Legal definition:
– when a blastocyst or
embryo exists outside the
uterus, such as when
created in vitro and
cryopreserved, there is no
Ectopic Pregnancy
Ectopic Pregnancy
• Principle of non-
maleficence:
maleficence
– Where comparable means
exist for early diagnosis of
ectopic pregnancy,
postponing intervention a
woman requests until tubal
rupture, endangering her
life or health, appears
unethical, and illegal
Legal Issues
UK Abortion Act of 1967
• Section 4 (1)
– ‘‘No person shall be under any
duty to participate in any
treatment authorized by this Act
to which he has a conscientious
objection’’
• Section 4 (2)
– ‘‘Nothing in subsection (1) of this
section shall affect any duty to
participate in treatment which is
necessary to save the life or to
prevent grave permanent injury
to the physical or mental health
UK Abortion Act of 1967
Woman survive
Criminal
negligence
thank you…