Type of non Risk factors Signs & Investigations Management

tubal EP Symptoms
Interstitial similar to USS:
those of tubal - interstitial line Medical - TV scan
EP adjoining the GS & guided MTX local
rupture of the the lateral aspect of injection Surgical -
uterine wall the uterine cavity cornual resection and
and severe - continuation of the salpingotom
haemorrhage myometrial mantle (wedge resection and
around the ectopic hysterectomy were
sac prev performed)

Cervical Hx of profuse Bimanual exam:

Diff Dx: instrumentation vaginal dilated ext os Medical - MTX:
intrauterine of the bleeding cervix feels systemic or ultrasound
pregnancy endocervical without distended/ globular w guided local injection
with a low canal, associated a small uterus in the preg sac.
implantation Hx of C- cramping Surgical -suction
site section pain USS: curettage &
spontaneous Asherman's no evidence of an tamponade using 30
miscarriage syndrome intrauterine GS mL foley catheter or
cervical DES exposure ballooned cervical cervical suture.
carcinoma canal/barrel shaped Occassionally need
cervical cervix uterine artery or
submucosal GS in the endocervix internal iliac artery
myoma below the uterine ligation, rarely
trophoblastic arteries hysterectomy
tumour closed internal os

Doppler USS:
blood flow around
the sac
C-section Hx of C- painless USS:
scar section vaginal empty uterine cavity TV scan guided local
myomectomy bleeding or GS located anteriorly injection of MTX (25
adenomyosis hypovolemic at the level of the int mg) in the ectopic
Hx of D&C shock cervical os covering gestation (70%-80%
manual uterine scar the visibl/presumed success rate). Surgical
removal of the rupture site of past LSCS as cervical pregnancy
placenta scar management, uterine
artery embolisation
Doppler USS: can be done to achieve
evidence of tamponade
functional
trophoblastic
circulation
a neg “sliding organs
sign”
Ovarian similar to Criteria
those of tubal 1) Gestational sac Surgical -removal of
EP must occupy a ectopic and
portion of the ovary. conservation of ovary,
2) Gestational sac rarely salpingo-
must be connected to oophorecomy.
the uterus by the Medical - systemic
ovarian ligament. MTX .
3) Ovarian tissue
must be identified in
the wall of the sac.
4) Fallopian tube on
the affected side of
the pelvis must be
intact.

Abdominal Criteria:
1) No evidence of Early Dx: MTX or
uteroplacental fistula laparoscopic removal.
2) Presence of Late Dx: laparotomy
normal tubes and followed by removal
ovaries with no of fetus +/- placenta
evidence of a recent left to resorb or
or past pregnancy removed depending
and upon its attachment.
3) Pregnancy Risk of haemorrhage
attached only to the and infection very
peritoneal surface. high.

Cornual Asymmetrical USS:

pregnancy in enlargement a single interstitial Medical or Surgical
one horn of of the early part of the Fallopian with excision of the
a bicornuate pregnant tube in the main rudimentary horn and
uterus or uterus uterine body the tube on affected
rudimentary GS is mobile & sep side.
horn of a from the uterus,
unicornuate surrounded by
uterus myometrium
vascular pedicle
adjoining the
gestational sac to the
unicornuate uterus.
Heterotopic unusual ab peritoneal irritation
simultaneous pain w Manage ectopic
occurrence spontaneous pregnancy as above:
of an miscarriage either surgical or
intrauterine profuse expectant management
and an uterine if very small ectopic.
extrauterine bleeding w
pregnancy. signs of