Ultrasonography – used as the most important tool for diagnosing extra-uterine pregnancy. To monitor effectiveness of medical treatment for the relief of abdominal pain. Ectopic pregnancy should be considered in any patient presenting early in pregnancy with vaginal bleeding or lower abdominal pain in whom intrauterine pregnancy has not yet been established. Studies have shown that an elevated risk of 1.6 to 3.5 times is more common for smokers than non-smokers to develop ectopic pregnancies. Vitamin D – used to correct depressed folic acid levels brought about by antimetabolite treatment, Powerlessness related to early loss of pregnancy. This is called a tubal pregnancy. Previous ectopic pregnancy. It is the leading cause of 1st trimester death and causes 0.5 deaths/100,000 live births. Ectopic pregnancy should be considered in any patient presenting early in pregnancy with vaginal bleeding or lower abdominal pain in whom intrauterine pregnancy has not yet been established. Progesterone levels – They are helpful in aiding with diagnosis as progesterone is: Remaining relatively constant during the first trimester of normal and ectopic pregnancy, Independent and not correlated with B-HCG levels, If initially abnormal, progesterone levels do not return to reference range. Salpingostomy and Salpingectomy. Ectopic Pregnancy Diagnosis When an ectopic pregnancy is suspected, the first step may be to do a pregnancy test , or qualitative hCG test, if the woman has not already had a positive pregnancy test. Extrauterine pregnancy is still one of the leading causes of maternal morbidity & mortality. This book covers the latest modalities in the diagnosis, treatment & management of ectopic pregnancy. Ectopic pregnancy is a high-risk condition that occurs in 1.9 percent of reported pregnancies. This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment. It is this hormone that pregnancy tests detect. Edema, headaches, low blood pressure, and pain are associated with the patient’s blood loss. In an ectopic pregnancy, however, the zygote will implant into another area in the mother's body, usually in the fallopian tube. Nursing diagnoses handbook: An evidence-based guide to planning care. A potentially life-threatening condition in which the embryo, mammalian implants outside the cavity of the uterus. Desired Outcome: The patient will re-establish a functional body fluid volume and a balanced input and output status. Ectopic pregnancy typically presents 6 to 8 weeks after the last normal menstrual period, but can present earlier or later. Desired Outcome: The patient will demonstrate relief of pain as evidenced by a pain score of 0 out of 10, stable vital signs, and absence of restlessness. Ultrasonography in Reproductive Medicine and Infertility is essential reading for clinicians working both in IVF clinics and in office practice. Prevent Anemia in Pregnancy. [New 2016] B Expectant management is an option for clinically stable women with an ultrasound . Maternal prognosis is good with early diagnosis and prompt treatment, such as laparotomy, to ligate bleeding vessels and repair or remove the damaged fallopian tube. These can include missed periods, breast tenderness, nausea, vomiting, fatigue, or frequent urination (peeing). Place the patient in complete bed rest if there is evidence of severe bleeding. Without timely diagnosis and treatment, ectopic pregnancy can become a life-threatening situation. Answer (1 of 3): Pelvic pain in the first trimester would call for an ultrasound to attempt to determine the cause. An ectopic pregnancy happens when the egg, traveling from the ovary to the uterus, gets stuck. Please follow your facilities guidelines and policies and procedures. It can cause life-threatening bleeding and needs medical care right away. Menu Pragmatic and reader-friendly, Ectopic Pregnancy: A Clinical Casebook will be an excellent resource for reproductive medicine specialists, obstetricians and gynecologists, and family and emergency medicine physicians alike. It can be difficult to diagnose an ectopic pregnancy from the symptoms alone, as they can be similar to other conditions. In a normal pregnancy, the fertilized egg moves from the fallopian tube into the uterus, where the pregnancy develops. This site is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com. In most cases, the exact cause of ectopic pregnancy remains unknown. The true incidence worldwide is uncertain; however, in the United States, the incidence ranges from 2.7 to 6 deaths per 10,000 live births. Artificial induction of ovulation through injectable gonadotropin therapy has been linked to a 4-fold increased risk, therefore suggesting that multiple egg cells and high hormone levels plays a major role in ectopic pregnancy. The most important advances in diagnosis Nursing Assessment. Keywords: Ectopic pregnancy, vaginal bleeding, Extra- uterine pregnancy I NTRODUCTION Female reproductive system consists of two ovaries, fallopian tubes and uterus. A potentially life-threatening condition in which the embryo, mammalian implants outside the . This can be a useful way of identifying ectopic pregnancies that aren't found during an ultrasound scan, as the level of hCG tends to be lower and rise more slowly over time than in a normal pregnancy. Nurse Tutoring, Nursing school help, nursing school, Nursing student, nursing student help, NCLEX, NCLEX Practice exams If an ectopic pregnancy is found during the procedure, small surgical instruments may be used to remove it to avoid the possible need for a second operation later on. The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. This work has been selected by scholars as being culturally important, and is part of the knowledge base of civilization as we know it. The results of the test can also be useful in determining the best treatment for an ectopic pregnancy. Scarring of the structures brought about by previous ectopic pregnancies contributes to future episodes. A positive pregnancy test and no visible gestational sac in the uterus on ultrasound should always make for a presumptive diagnosis of ectopic pregnancy and if the diagnosis is not immediately obvious should trigger further investigations and follow-up until the final outcome of the pregnancy is known. St. Louis, MO: Elsevier. Offers guidance on the use of ultrasonography in a clinical setting, covering benign and malignant gynecological disease and infertility. It has also permitted a more conservative approach to the management of ectopic pregnancy. Your email address will not be published. The Ectopic Pregnancy Trust recommends that healthcare workers should exercise caution in all women of childbearing age in order to rule out an EP. General gynecologists, gynecologic endocrinologists, infertility specialists, gynecologic endoscopists, and gynecologic oncologists will find attractive, new information in this book. This is because the fertilized egg starts releasing a specific pregnancy hormone, called human chorionic gonadotropin (hCG), regardless of where it implants. It might be hard for you to have a typical pregnancy afterward. Differential Diagnosis of Ectopic Pregnancy - Morbidity and Mortality. Choice of birth control. This will often show whether a fertilised egg has become implanted in one of your fallopian tubes, although occasionally it may be very difficult to spot. The probe emits sound waves that bounce back to create a close-up image of your reproductive system on a monitor. {{configCtrl2.info.metaDescription}} This site uses cookies. If the pregnancy occurs in the fallopian tube (tubal pregnancy), it may cause the . However, some of the causes that may lead to ectopic pregnancy include; 1. To treat the vaginal bleeding and deficient fluid volume related to ectopic pregnancy in the appropriate setting. In ectopic pregnancy, implantation occurs in a site other than the endometrial lining of the uterine cavity—ie, in the fallopian tube, uterine cornua, cervix, ovary, or abdominal or pelvic cavity. Top Treatment Tips. Your doctor or nurse may do a pelvic exam, blood test, or ultrasound to . To increase the oxygen level by allowing optimal lung expansion. Post-surgery, advise the patient to: Have no strenuous activity for a few weeks.Apply support on the abdomen when coughing, laughing, or moving by placing a pillow over the abdominal areaInform the healthcare team if the pain medications are not working. Ectopic pregnancy, also called extrauterine pregnancy, is when a fertilized egg grows outside a woman’s uterus, somewhere else in their belly. Early diagnosis is essential, though as an untreated ectopic pregnancy can result in a ruptured fallopian tube, resulting in serious complications for the pregnant person. Prepare the patient for immediate surgical intervention for the removal of the ectopic pregnancy. If the pregnancy continues longer . Saunders comprehensive review for the NCLEX-RN examination. This guideline covers diagnosing and managing ectopic pregnancy and miscarriage in women with complications, such as pain and bleeding, in early pregnancy (that is, up to 13 completed weeks of pregnancy). The condition is the leading cause of pregnancy-related death in the first trimester. It involves the utilization of sound waves in assessing the intra uterine and abdominal structures. Ectopic Pregnancy Symptoms. Place the patient on a nothing by mouth (NBM or NPO) status. Fertility treatments. The aim of this review is to determine the current state of data about the diagnosis and the treatment of non-tubal ectopic pregnancies. Fluid retention may be evident if the patient has an unexplained weight gain. If you have the symptoms of an ectopic pregnancy and a positive pregnancy test, you may be referred to an early pregnancy assessment service for further testing. Initially, an ectopic pregnancy may feel like a normal pregnancy, with some of the usual signs and symptoms, such as a missed period, swollen, tender breasts, nausea or an upset stomach. If a woman of . Use of progestin-only oral contraceptives or progestin-only implants (IUD) may put a woman at risk for ectopic pregnancy. An ectopic pregnancy can develop in different locations. Fallopian Tube Disorder. Salpingectomy is the surgical resection of the unruptured ectopic pregnancy and the involved fallopian tube through laparoscopy. The definitive diagnosis of ectopic pregnancy can be made with ultrasound visualization of a yolk sac and/or embryo in the adnexa. If you get pregnant again, since one ectopic pregnancy raises your risk of having another one, be mindful of changes in your body until your doctor can confirm that it’s growing where it should. Assess vital signs, conduct physical examination, and commence daily weight monitoring. Ectopic Pregnancy Symptoms, Signs, And More In a normal pregnancy, the egg will travel down the fallopian tube and embed itself into the uterus. To alleviate the symptoms of acute abdominal pain. Pharmacologic agents, such as methotrexate followed by leucovorin, may be given orally when ectopic pregnancy is diagnosed by routine sonogram before the tube has ruptured. This book contains the practical methods to early diagnosis of various forms of ectopic pregnancies and their modern management. Ectopic pregnancy can be difficult to diagnose because symptoms often are like those of a normal early pregnancy. In a healthy pregnancy, the fertilized egg attaches to the inner uterine wall. Other supportive medical treatments for the management of ectopic pregnancy are: Nursing Diagnosis: Deficient Fluid Volume related to active blood loss secondary to ectopic pregnancy, as evidenced by an average blood pressure level of 85/50, body weakness, decreased urinary output, and pale, clammy skin. No pregnancy in the uterus and a possible mass in the area of a fallopian tube: This would likely lead to diagnosis of a possible ectopic pregnancy. Prepare for blood transfusion as required. Due to the nature of placement, the embryo cannot fully mature and this will eventually lead to death. Often, an ectopic pregnancy terminates within a few days of conception, and you may experience only mild symptoms. The purpose of this document is to review information on the current understanding of tubal ectopic pregnancy and to provide guidelines for timely diagnosis and management that are consistent with the best available . nursestudynet@gmail.com A positive pregnancy test and no visible gestational sac in the uterus on ultrasound should always make for a presumptive diagnosis of ectopic pregnancy and if the diagnosis is not immediately obvious should trigger further investigations and follow-up until the final outcome of the pregnancy is known. In the UK, 1 in 80-90 pregnancies are ectopic. However, tubal ectopic pregnancy in an unstable patient is a medical emergency that requires prompt surgical intervention. This highly practical text on gynecologic emergencies includes sonographic findings and laparascopic investigations and management for point-of-care assessment. If you have the symptoms of an ectopic pregnancy and a positive pregnancy test, you may be referred to an early pregnancy assessment service for further testing. A woman with signs or symptoms of an ectopic pregnancy requires immediate medical care. Pain may also spread to the shoulder if bleeding into the abdomen has occurred. Salpingectomy is the surgical resection of the unruptured ectopic pregnancy and the involved fallopian tube through laparoscopy. Findings Diagnosis involves a combination of . The guideline covers diagnosis of early pregnancy loss, including the use of ultrasound scanning and biochemical testing. Investigations incur costs and the use of serial measurements may delay decision making. Buy on Amazon. In the United States, the estimated prevalence of ectopic pregnancy is 1% to 2%, and ruptured ectopic . This book contains the practical methods to early diagnosis of various forms of ectopic pregnancies and their modern management. Accurate early diagnosis is life-saving, reduces invasive diagnostic procedures & allows conservative treatment that can preserve fertility. Cornual pregnancies occur in the upper and lateral portion of the uterus. This is when an intrauterine pregnancy occurs at the same time as an ectopic pregnancy. Consider talking to a fertility specialist, especially if you had a fallopian tube removed. St. Louis, MO: Elsevier. Maternity, Nursing Care Plans Your doctor will probably do tests that include a pregnancy test and a pelvic exam. 57 A culdocentesis that produces any . By clicking Subscribe, I agree to the WebMD, Smart Grocery Shopping When You Have Diabetes, Surprising Things You Didn't Know About Dogs and Cats, Latest Facts on COVID-19 Vaccine Boosters, COVID Vaccine 5 Times More Protective Than Natural Immunity, Brain Fog Can Persist 8 Months After COVID, Moon Phases May Affect Sleep Differently in Men and Women, Dr. Whyte's Book: Take Control of Your Cancer Risk, How Breast Cancer Changed My Life ... and Me, Health News and Information, Delivered to Your Inbox, Ectopic Pregnancy - Ectopic (Extrauterine) Pregnancy, Pregnant With Allergies? Weakness, dizziness, or fainting. The condition is the leading cause of pregnancy-related death in the first trimester. Early Pregnancy is the first book to embrace a multidisciplinary approach to this rapidly growing field. For women who got pregnant naturally, the risk of this is much lower and is estimated to range from 1 in 4,000 to 1 in 30,000. This book contains the practical methods to early diagnosis of various forms of ectopic pregnancies and their modern management. This may be due to endometriosis, scar tissue from previous abdominal surgeries, inflammation or infection such as chlamydia, use of an IUD, or following IVF treatments. If a woman of reproductive age presents with abdominal pain, vaginal bleeding, syncope, or hypotension, the physician s … Some of the tests you may have are outlined below. 57 A culdocentesis that produces any . Epidemiology The overall incidence has increased over the last few decades and is currently thought to affect 1-2% of pregnancies. Salpingostomy is the surgical removal of the unruptured ectopic pregnancy from the fallopian tube utilizing laparoscopic technique. The definitive diagnosis of ectopic pregnancy can be made with ultrasound visualization of a yolk sac and/or embryo in the adnexa. A condition in which a fertilized egg grows outside of the uterus, usually in one of the fallopian tubes. Providing rapid solutions to the most difficult problems posed by ectopic pregnancy, the focus throughout this study is on diagnosis and management issues. By continuing to browse this site you are agreeing to our use of cookies. In cases of heavy bleeding, the pregnancy may initially be diagnosed as a miscarriage. Symptoms most often appear 6 to 8 weeks after the last normal menstrual period. This involves inserting a small probe into your vagina. To provide optimal comfort to the patient. Imbalances in hormones and abnormal development of the zygote may also play a role in ectopic pregnancy. It used to be that about 90% of women with ectopic pregnancies had to have surgery. Sometimes it is a pregnancy that is not in the middle. Nursing care plans: Diagnoses, interventions, & outcomes. Failure to address the diagnosis of ectopic pregnancy correctly and promptly will result to rupture depending on the implantation site, therefore leading to massive bleeding, shock, disseminated intravascular coagulopathy (DIC), and death. They can be in other locations, such as uterine cervix; ovary; and abdominal cavity (pregnancy, abdominal). Ectopic pregnancy occurs when a fertilized ovum implants outside of the uterine cavity. Your doctor will make very small cuts in your lower belly and insert a thin, flexible tube called a laparoscope to remove the ectopic pregnancy. Early signs of an ectopic pregnancy include: An ectopic pregnancy can cause your fallopian tube to burst or rupture. Diagnosis . Definition Ectopic Pregnancy: A pregnancy in which the fetus develops outside the womb, typically in a fallopian tube Amenorrhoea: Absence of mentruation Laproscopy: A surgical procedure in which a fibre-optic instrument is inserted through the abdominal wall to view the organs in the abdomen or permit small-scale surgery Laparotomy: A surgical incision into the abdominal cavity, for diagnosis . Without timely diagnosis, ectopic pregnancy poses a great threat to the mother’s life. Usually due to a corpus luteum cyst of pregnancy (a normal structure) or perhaps stretching of the uterus and it's attachments. Speak to the patient and family about the need for hospitalization for the treatment of serious hemorrhage and the need for surgery. Ectopic pregnancy is a leading source of morbidity and mortality in pregnancy, accounting for 1% to 2% of all pregnancies. Ectopic pregnancy : Diagnosis, Complications and Managment. Consuming salt between 2 to 4 g per day is ideal as a very low salt intake may increase dehydration. Early symptoms and signs include pelvic pain . It's very important that the diagnosis of ectopic pregnancy is certain before receiving this treatment. Most ectopic pregnancies (>96%) occur in the fallopian tubes, known as tubal pregnancy. A ruptured fallopian tube can cause life-threatening internal bleeding. PERSISTENT ECTOPIC PREGNANACY This is a complication of salpingotomy / salpingostomy when residual trophoblast continues to survive because of incomplete evacuation of the ectopic pregnancy. Vaginal ultrasound. At 6-12 weeks of pregnancy, the trophoblast would be large enough to rupture the fallopian tube. Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). You’re more likely to have an ectopic pregnancy if you: It could also happen if you become pregnant while you have an intrauterine device (IUD) for birth control. [The most common sites include the ampulla and isthmus of the fallopian tube. Pain may also spread to the shoulder if bleeding into the abdomen has occurred. Desired Outcome: The patient will demonstrate relief of pain as evidenced by a pain score of 0 out of 10, stable vital signs, and absence of restlessness. Buy on Amazon, Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Heavy vaginal bleeding may result to hypotension and lower level of consciousness. If it's still not clear whether you have an ectopic pregnancy or the location of the pregnancy is unknown, a laparoscopy may be carried out. Monitor the patient’s level of consciousness using AVPU. Read more about surgery for an ectopic pregnancy. An ectopic pregnancy occurs when a fertilized egg implants somewhere other than the main cavity of the uterus. The presenting signs and symptoms are similar to other ectopic pregnancies . Next review due: 27 November 2021. There might be pain in the pelvis, abdomen, or even the shoulder or neck . Morbidity and mortality. 3,6,9 However, in the developing world it has been estimated that 10% of women admitted to hospital with a diagnosis of ectopic pregnancy ultimately die from the condition. Ectopic pregnancy can be challenging to diagnose based on symptoms alone because symptoms may not always be obvious. Ectopic pregnancy may be treated in several ways, depending on whether the fallopian . Ectopic pregnancy is a medical condition wherein the zygote fails to attach to the uterus and will either be on the fallopian tubes, the cervix, or any other part of the female reproductive system. Smoking. Shoulder pain – may be suggestive of peritoneal inflammation, Painful fetal movements (for advanced abdominal pregnancy), Evidence of severe low blood pressure (Hypovolemic shock) – orthostatic blood pressure changes, tachycardia. Blood tests to measure the pregnancy hormone human chorionic gonadotropin (hCG) may also be carried out twice, 48 hours apart, to see how the level changes over time. No unusual symptoms are usually present at the time of implantation of an ectopic pregnancy. Some of the tests you may have are outlined below. Diagnosis of Ectopic Pregnancy. Often, the first warning signs of an ectopic pregnancy are pain or vaginal bleeding. Antimetabolite therapy/ Folic acid antagonist. This book contains the practical methods to early diagnosis of various forms of ectopic pregnancies and their modern management. , 342(jun10 1), d3397-d3397. Salpingectomy is the surgical resection of the unruptured ectopic pregnancy and the involved fallopian tube through laparoscopy. In other cases, you’ll need surgery. Classical symptoms include heavy bleeding and abdominal pain, among others. "The work presented in this thesis begins with a focus on non-invasive diagnostic methods for ectopic pregnancy. hCG test for ectopic pregnancy Human chorionic gonadotropin (hCG) is a hormone produced by the placenta, an organ that develops in the womb during pregnancy. This test is necessary to differentiate between normal and abnormal pregnancies. Risk increases with prior ectopic pregnancy, tubal surgery, history of sexually transmitted infections, smoking, in vitro fertilization, or if pregnant despite IUD usage. Your doctor will probably do tests that include a pregnancy test and a pelvic exam. Ectopic pregnancies and pregnancy tests. The definitive diagnosis of ectopic pregnancy can be made with ultrasound visualization of a yolk sac and/or embryo in the adnexa. The medication is given by injection. Perform non-pharmacological pain relief methods such as relaxation techniques such as deep breathing exercises, guided imagery, and provision of distractions such as TV or radio. In more than 90% of cases, the egg implants in a fallopian tube. It is the provider's responsibility to include/consider ectopic pregnancy as a potential differential diagnosis in all sexually active women of childbearing age. If your fallopian tube hasn’t ruptured and your pregnancy isn’t far along, your doctor can give you a shot of methotrexate (Trexall). Women with an ectopic pregnancy may have irregular bleeding and pelvic or abdominal pain, often on one side. If it carries on, the early symptoms of an ectopic pregnancy are often same as the signs of a regular pregnancy, such as nausea, breast soreness, and fatigue. This is called laparotomy. Ectopic pregnancy may cause the patient to have low mood. Ectopic pregnancy symptoms often include pain and bleeding. Encourage the patient to have a low salt intake. In rare cases, an ectopic pregnancy can occur on an ovary or in . It should never be given at the first visit, unless the diagnosis of ectopic pregnancy is absolutely clear and a viable intrauterine pregnancy has been excluded. Desired Outcome: The patient will maintain safety and participate in measures that will protect self during the treatment. Upon palpation, an adnexal mass may be assessed. It stops the cells from growing. Ectopic Pregnancy Diagnosis . Classic symptoms and signs are pain, vaginal . They may give you an ultrasound to take a gander at your uterus and fallopian tubes. Elevate the head of the bed and position the patient in semi Fowler’s. This book contains the practical methods to early diagnosis of various forms of ectopic pregnancies and their modern management. Early signs of ectopic pregnancy are: Sharp abdominal cramps or pain; Faintness, dizziness or weakness; Light vaginal bleeding Objective . Getting checked out by a doctor is the only way to know for sure if you have an ectopic pregnancy. Nursing Diagnosis: Acute Pain related to ectopic pregnancy as evidenced by pain score of 10 out of 10, verbalization of abdominal pain, abdominal rigidity, and restlessness. Ectopic pregnancy is the leading cause of maternal death during the first trimester due to internal bleeding, therefore an urgent surgery to remove it is needed. Common Misconceptions About Postpartum Depression, Ovulation Tool: Find Your Most Fertile Days. The time of monitoring of vital signs may depend on the peak time of the drug administered. A synopsis of the use of lasers in gynecology is presented in this book; it is supported by more than 10 years of experience and backed up by studies inthe fields of experimental surgery, technical medicine and clinical gynecology. Placing the patient on “Nothing By Mouth” (NBM or NPO) is necessary to prepare the patient for emergent delivery. Ectopic pregnancy is the result of a flaw in human reproductive physiology that allows the conceptus to implant and mature outside the endometrial cavity (see the image below), which ultimately ends in the death of the fetus. As an ectopic pregnancy grows, more serious symptoms may develop, especially if a fallopian tube ruptures. Ectopic pregnancy should be considered in any patient presenting early in pregnancy with vaginal bleeding or lower abdominal pain in whom intrauterine pregnancy has not yet been established. Here are some of the many updates and additions: Extensive updating of tables and images New FDA-approved medication for multiple sclerosis New summary of recommended FDA treatment regimens for hepatitis C U.S. Preventive Services Task ... It aims to improve how early pregnancy loss is diagnosed, and the support women are given, to limit the psychological impact of . If you’re bleeding a lot or your doctor suspects that your fallopian tube is ruptured, you might need emergency surgery with a larger cut. Ovarian pregnancy like other non-tubal ectopic pregnancies may occur without the usual expected antecedent risk factors for ectopic pregnancy but does seem to have a strong association with conceptions with an intrauterine contraceptive device in place [20, 21]. An ectopic pregnancy often happens in the fallopian tube (a pair of structures that connect the ovaries and uterus). Almost as a rule, once an ectopic . It is typically at this stage that an ultrasound will reveal the problem to be an ectopic pregnancy. In a normal uterine pregnancy HCG levels will double every 48 hours, but in an EP . The first section of the book discusses evidence-based medicine methodology in the context of the two specialties. Ectopic pregnancy refers to the implantation of a fertilised ovum outside of the uterine cavity. Symptoms may include the following: Sudden, severe pain in the abdomen or pelvis. web browser that Ectopic pregnancy: signs and symptoms of an ectopic pregnancy Find out what to do if you've been diagnosed with an ectopic pregnancy.
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