Ectopic pregnancy
1-Definition&Incidence 2-Risk Factors(IMP) 3-Sites(IMP)
Def: The implantation of the fertilised ovum PID. Ampulla. (70-80%) commonest
outside the normal endometrial cavity Previous Ectopic Pregnancy. Isthmus. (10-12%)common of
Incidence:- Peritubal adhesions rupture
increasing (1:66 Pregnancies or 2%). (pelvic Surgery, endometriosis). Fimbria . (3-5%)
Mortality decreasing with earlier detection. Infertility. Interstitial ((<2%)
Accounts for 9% of maternal mortality. Contraception ???IUD Use (Probably Not as it Cornual- rudimentery (< 2%)
Recurrence Rate 10 - 20%. prevent normal pregnancy not ectopic) Ovary (< 2%)
The overall conception rate after ectopic N.B if patient suffered ectopic she is prevented from taking Abdomen 2ry or 1ry (< 2%)
POP contraception or IUD
pregnancy 60-80%. (maily omentum)
ART (heterotopic pregnancy) Cervix (< 2%)
Tubal developmental abnormalities,.
Tumors Broad ligament
4- Evaluation and Diagnosis
History and Physical Exam(c/p) Ultrasound Culdocentesis Progesterone Levels
Asymptomatic:- May or May Not Be Highly Specific if Interpreted Correctly: >25 ng/ml IUP.
Ectopic Pregnancy remains Helpful. Presence of Free-Flowing, NON-Clotting < 15 ng/ml spont.
asymptotic until it disturbed when Discriminatory Zone: Blood( diagnostic ) abortion or Ectopic.
it can present in five variations Acute TV: 1500-2000 mIU/ml Negative Tap Inconclusive May Take Several Days
&. Chronic TA: 6500 mIU/ml May Obviate U/S for Result.
Symptomatic:- +IUP: Generally Most Helpful in Emergent Situations to Clinical Use Not Yet
Amenorrhea. Excludes Ectopic. Confirm Diagnosis, But Remains Widespread.
Pain & tenderness. Ectopic pregnancy can Controversial
Vaginal Bleeding. not be excluded if the
Syncope. ectopic gestation sac is
Pelvic Mass not seen.
Clinical types Psuedo sac versus true
Undisturbed tubal pregnancy. intrauterine sac.
Subacute tubal pregnancy. Pseudo:-central & 1 ring
Acutely disturbed tubal preg due to fluid collection
Chronic type with pelvic True:-eccentric &2 rings
heamatocele. (embryo with membrans
Abdominal pregnancy
Serial BSU’s others
Level,s changes:- Discriminatory Zone:- 1-CBC
B-hCG Levels Double Every 48Hr TVS can visualise a gestational sac as early as 4-5 weeks fromLMP. 2-Laparoscop.
< 66% Rise / 48 Hrs Consistent With During this time the lowest serum beta HCG is 2000 IU/Lt. (Diang &therapeutic)
Ectopic. When beta HCG level is greater than this and there is an empty uterine 3-D & C endometrial
Single Determination Not Helpful. cavity on TVS, ectopic pregnancy can be suspected. biopsy(IMP)
Best If Done Within Same In such a situation, when the value of beta HCG does not double in 48 Differ.ectopic from
Laboratory hours ectopic pregnancy will be confirmed normal by presence of
villi
5-Differential Diagnosis(imp) 1- intrauterine pregnancy (abortion)
1-intrauterine pregnancy (abortion) Ectopic pregnancy
Pain:-colicky pain due to Pain:- usually at one side in different forms as:-
contraction,suprapubic in the form 1-colicky -due to contraction 2-dull aching _ due to stretching
of period or more 3-stabing _rupture of tube 4-shoulder pain _irritation of peritoneum
Bleeding:-fresh or spotting Bleeding :-dark blood
-ve cervical motion tenderness +ve cervical motion tenderness
2-PID (share cervical moton tenderness with ectopic) 3-complicated ovarian cystv
4-appendicitisv 5-other causes of internal hemorrhage
1-Definition&Incidence 2-Risk Factors(IMP) 3-Sites(IMP)
Def: The implantation of the fertilised ovum PID. Ampulla. (70-80%) commonest
outside the normal endometrial cavity Previous Ectopic Pregnancy. Isthmus. (10-12%)common of
Incidence:- Peritubal adhesions rupture
increasing (1:66 Pregnancies or 2%). (pelvic Surgery, endometriosis). Fimbria . (3-5%)
Mortality decreasing with earlier detection. Infertility. Interstitial ((<2%)
Accounts for 9% of maternal mortality. Contraception ???IUD Use (Probably Not as it Cornual- rudimentery (< 2%)
Recurrence Rate 10 - 20%. prevent normal pregnancy not ectopic) Ovary (< 2%)
The overall conception rate after ectopic N.B if patient suffered ectopic she is prevented from taking Abdomen 2ry or 1ry (< 2%)
POP contraception or IUD
pregnancy 60-80%. (maily omentum)
ART (heterotopic pregnancy) Cervix (< 2%)
Tubal developmental abnormalities,.
Tumors Broad ligament
4- Evaluation and Diagnosis
History and Physical Exam(c/p) Ultrasound Culdocentesis Progesterone Levels
Asymptomatic:- May or May Not Be Highly Specific if Interpreted Correctly: >25 ng/ml IUP.
Ectopic Pregnancy remains Helpful. Presence of Free-Flowing, NON-Clotting < 15 ng/ml spont.
asymptotic until it disturbed when Discriminatory Zone: Blood( diagnostic ) abortion or Ectopic.
it can present in five variations Acute TV: 1500-2000 mIU/ml Negative Tap Inconclusive May Take Several Days
&. Chronic TA: 6500 mIU/ml May Obviate U/S for Result.
Symptomatic:- +IUP: Generally Most Helpful in Emergent Situations to Clinical Use Not Yet
Amenorrhea. Excludes Ectopic. Confirm Diagnosis, But Remains Widespread.
Pain & tenderness. Ectopic pregnancy can Controversial
Vaginal Bleeding. not be excluded if the
Syncope. ectopic gestation sac is
Pelvic Mass not seen.
Clinical types Psuedo sac versus true
Undisturbed tubal pregnancy. intrauterine sac.
Subacute tubal pregnancy. Pseudo:-central & 1 ring
Acutely disturbed tubal preg due to fluid collection
Chronic type with pelvic True:-eccentric &2 rings
heamatocele. (embryo with membrans
Abdominal pregnancy
Serial BSU’s others
Level,s changes:- Discriminatory Zone:- 1-CBC
B-hCG Levels Double Every 48Hr TVS can visualise a gestational sac as early as 4-5 weeks fromLMP. 2-Laparoscop.
< 66% Rise / 48 Hrs Consistent With During this time the lowest serum beta HCG is 2000 IU/Lt. (Diang &therapeutic)
Ectopic. When beta HCG level is greater than this and there is an empty uterine 3-D & C endometrial
Single Determination Not Helpful. cavity on TVS, ectopic pregnancy can be suspected. biopsy(IMP)
Best If Done Within Same In such a situation, when the value of beta HCG does not double in 48 Differ.ectopic from
Laboratory hours ectopic pregnancy will be confirmed normal by presence of
villi
5-Differential Diagnosis(imp) 1- intrauterine pregnancy (abortion)
1-intrauterine pregnancy (abortion) Ectopic pregnancy
Pain:-colicky pain due to Pain:- usually at one side in different forms as:-
contraction,suprapubic in the form 1-colicky -due to contraction 2-dull aching _ due to stretching
of period or more 3-stabing _rupture of tube 4-shoulder pain _irritation of peritoneum
Bleeding:-fresh or spotting Bleeding :-dark blood
-ve cervical motion tenderness +ve cervical motion tenderness
2-PID (share cervical moton tenderness with ectopic) 3-complicated ovarian cystv
4-appendicitisv 5-other causes of internal hemorrhage
