SUBACUTE ECTOPIC GESTATION

 A tubal mole, with peritubal and paratubal haematocele.

 C/F – delayed period,spotting,abd discomfort,urine

retention.

 P/A – tenderness n firm tender swelling.

 Bimanual – Brown hemorrhage, Cervix soft,uterus

enlarged,post fornix swelling(firm,tender n
smooth),pushes uterus to other side( hematosalpinx)
 Urine pregnancy test

 USG – a) TVS
. b) TAS
c) Color doppler Sonography

 Beta HCG assay- doubling rate< 66% in 48 hr.

 Culdocentesis
 Diagnostic laproscopy
PSEUDO-SAC TRUE SAC
YOLK SAC WITHIN EMPTY EXTRA UTERINE SAC
EXTRA UTERINE SAC 13% HYPER-ECHOIC RING 20%
(BAGEL SIGN)
INHOMOGENEOUS MASS(60%)
(BLOB SIGN)

RING OF FIRE
ANECHOIC FLUID CULDOCENTESIS
 Expectant Management
Principle –spontaneous resolution. Protocol

Identification criteria 1. Hospitalization with strict

monitoring
1. Tubal pregnancy only
2. Daily Hb estimate
2. Hemodynamically stable
3. Serum bHCG monitoring till <10
3. Hemoperitonium <50ml IU/L
4. Adnexal Mass<3.5cm 4. TVS done twice weekly
5. Initial bHCG <1000 IU /L
Methotrexate therapy
 Linear salpingostomy

 Linear salpingotomy

 Segmental Resection
n anastomosis

 Milking of tube
Pregnancy in the fallopian tube is like a black cat on a dark
night.It may make its presence felt in subtle ways and Leap
at you or it may slip past unobserved .Although it is difficult
to distinguish from cats of other colors in
darkness,illumination clearly identifies it.