Ectopic Pregnancy

Supervisor : dr. Pim Gonta, Sp.OG

Definition

Pregnancy with
fertilized egg that does
not attach to
endometrial wall of
uterine cavity
 Diagnosis by
Urine, -
Implant in hCG,
endometrial Transvaginal
Sonography

Fallopian tube transit 1-2% in US

Following fertilization Ectopic Implantation

 Tubal Pregnancy
Ampularis (55%)
Isthmic (25%)
Classification
Fimbrial (17%)
Interstitial (2%)

Abnormal fallopian tube anatomy

Surgeries for a prior tubal pregnancy, for fertility restoration, for sterilization

Risk
confer
Previous ectopic pregnancy
Prior sexually transmitted disease or other tubal infection
Some contraceptive method failures

Evolution and Embryo or fetus is often absent or stunted

Tubal rupture, tubal abortion, pregnancy failure
Potential
Tubal abortion
Outcomes Hemorrhage
 Tubal Pregnancy

Clini Triad (delayed Mul Transvaginal

cal menstruation, pain, mod sonography (TVS)
Man and vaginal ality Serum -hCG level
ifest bleeding) Diag Diagnostic surgery
atio Severe lower nosi
n abdominal pain s
Pelvic pain
Tenderness
 Medical Management
Methotrexate is a folic acid antagonist
methotrexate is highly effective against rapidly
proliferating tissue such as trophoblast,
 Surgical management
Laparoscopy is the preferred surgical treatment
for ectopic pregnancy unless a woman is
hemodynamically unstable
Salphingostomy: typically used to remove a
small unruptured pregnancy that is usually < 2
cm in length and located in thedistal third of the
fallopian tube
Salpingectomy: used for both ruptured and
unruptured ectopic pregnancies


Serum -hCG levels are used to monitor

response to both medical and surgical therapy.

After linear salpingostomy, serum -hCG levels

decline rapidly over days and then more
gradually, with a mean resolution time of
approximately 20 days.
 Abdominal Pregnancy

A form of an ectopic pregnancy where the

pregnancy is implanted within the peritoneal
cavity.

Have higher mortality, but can lead to a

delivery of a viable infant.

< 1% in the US or about 1/10.000 pregnancies.

 Abdominal Pregnancy
Primary
Pregnancy that implanted directly in the abdominal cavity &
its organs
Secondary
Pregnancy that originated from a tubal pregnancy (tubal
abortion). If an early conceptus is expelled essentially
undamaged into the peritoneal cavity, its placental
attachment may persist.
Most small conceptuses are resorbed. Occasionally, they may
remain as an encapsulated mass or even become calcified to
form a lithopedion.
 Interstitial Pregnancy

A form of an ectopic pregnancy where the

pregnancy is implanted within the part of the
fallopian tube that penetrates the muscular
layer of the uterus.

2-3% of all tubal gestations.

Rupture would not occur usually until 14 to 16

weeks, often with severe hemorrhage.
 Ovarian Pregnancy

Rare

Four clinical criteria :

1. the ipsilateral tube is intact and distinct from the ovary
2. the ectopic pregnancy occupies the ovary
3. the ectopic pregnancy is connected by the uteroovarian ligament
to the uterus
4. ovarian tissue can be demonstrated histologically amid the
placental tissue

Clinical manifestation: mirror tubal ectopic pregnancy

Trans vaginal US use in diagnosis of unruptured ovarian pregnancies.

an internal anechoic area surrounded by a wide echogenic ring,
which in turn is surrounded by ovarian cortex.
Management for ovarian pregnancies has been surgical.
Small lesions have been managed by ovarian wedge
resection or cystectomy,
Larger lesions require oophorectomy.
Systemic or locally injected methotrexate has been
used successfully to treat small unruptured ovarian
pregnancies.
-hCG levels should be monitored to exclude remnant
trophoblast.
 Cervical Pregnancy
cervical glands opposite the placental attachment
site.
part or all of the placenta found below the uterine
vessels or below the peritoneal on uterus.
Incidence 1 in 8600 pregnancies, but the
incidence is increasing as a result of ART
Management: medically or surgically
First line methotrexate