INTRODUCTION

Def: Pregnancy that is implanted

outside the uterine cavity
The incidence nowadays is triple
the previously stated as 0.3%

SITES
Tubes 95%, Rt. > L
- 55% ampulla
- 25% Isthmic
Cervix, Rud. Horn
Ovaries
Peritoneal Abdominal

PRESENTATIONS
- Silent On routine
examination or
laparotomy
- Acute (often rupture)
- Subacute (Variable
presentations
DDX
Threatened
miscarriage
Corpus luteum cyst:
Amenorrhea, Unilateral
pain, Spotting, No
Pregnancy sx, Negative
HCG, If ruptured Same
treatment.
PID:
Bilateral, No amenorrhea
or pregnancy sx, Signs
of infection (50%)

ECTOPIC PREGNANCY
CAUSES
Any delay in ovum passage until
implantation stage.
Tubal abnormalities: Diverticulae,
False passages, Endosalpingitis
ART
Endocrine disorders: Delayed
ovulation, Estrogen/Progesterone
Ratio.
Contraceptive failure: Minipill (46%), IUCD(4-9%), Tubal surgery
(lig., constr.)
Prior history (10-20% Recurrence)
Pathology: PID, Endometriosis
Others

COMPLICATION
-Tubal abortion
- absorption in tube
- Incomplete tubal abortion
- Tubal blood mole
- Tubal rupture
- intraperitoneal bleeding
- Broad ligaments
MANAGEMENT
- I.V. line (wide bore)
- Blood, Hb, group, cross- matching
- Once diagnosed laparatomy
laparoscopy
Expression
Salpingostomy
Salpingectomy

DIAGNOSIS
SYMPTOMS
INVESTIGATIONS
Amenorrhea (6-10 wks)
- Pregnancy test
Symptoms of pregnancy
Serum hCG correlates well with trophoblastCell
Abdominal pain (99%):
mass.
Generalised (45%), Unilateral
Ectopic rarely ruptures when cell mass is small or
(35%), Shoulder tip (25%)
hCG levels are low.
Abnormal uterine bleeding (75%) In normal pregnancy values, serum hCG > 1500
Any form
mlu/mL, must see gestational sac
Syncopal sx (35%)
In normal pregnancy, hCG Values doubles every
Adnexal tenderness (96%)
2.2 days. It doesnt occur in ectopic pregnancy.
Adnexal mass (90%)
- Blood Hb, grouping
Uterine size: Normal (70%)
- Transvaginal Ultrasound:
- 6 to 8 wks 25%
Intrauterine sac: - Pseudo sac (10-20%)
D&C curettings: -Proliferative,
- True sac (Yolk sac F.
secretory
Poles)
- Arias-stella
Adnexial mass (90%): - Sac with fetus or no
phenomenon
fetus
- Echogenic mass
(DDx. C.L)
Fluids in P.O.D: - in 80% of Ruptured ectopics

Acute appendicitis

No sx of pregnancy
UTI

- In 20% of normal
pregnancy
** If Gest sac > 20 mm or (5-6 wk), must see yolk sac
& fetal pole. if not seen, suspect either ectopic or
blighted ovum
- Laparoscopy