ECTOPIC PREGNANCY

RINAS KP
2018 BATCH
• DEFINED AS PREGNANCY WHERE IMPLANTATION OCCURS IN SITES OTHER THAN
THE UTERINE CAVITY

• MOST COMMON SITE : FALLOPIAN TUBE(95%)

• OTHER SITES: OVARY, CERVIX, ABDOMINAL CAVITY , CAESAREAN SCAR …

SITES OF ECTOPIC PREGNANCY
 HETEROTOPIC PREGNANCY
• AN ECTOPIC PREGNANCY COEXISTING WITH INTRAUTERINE PREGNANCY
• DELAY IN DIAGNOSIS
• ẞHCG MONITORING NOT HELPFUL
• SUSPECT HETEROTOPIC PREGNANCY ……WOMEN WHO CONCIEVE AFTER ART / CONSISTENT
PELVIC PAIN WITH AN INTRAUTERINE PREGNANCY / PERSISTENT HIGH ẞHCH AFTER
MISCARRIAGE OR TERMINATION OF PREGNANCY
• MANAGEMENT : SALPNGECTOMY BY LAPAROSCOPY OR LOCAL INJECTION OF
HYPEROSMOLAR GLUCOSE OR POTASSIUM CHLORIDE UNDER USG GUIDANCE AND
ASPIRATION OF SAC CONTENTS
 INTERSTITIAL PREGNANCY

• IMPLANTATION IN THE PROXIMAL INTERSTITIAL PART OF THE FALLOPIAN TUBE

• ADDITIONAL RISK FACTOR – PREVIOUS IPSILATERAL SALPINGECTOMY
• RUPTURE AND INTRAPERITONEAL BLEED
 CORNUAL PREGNANCY

• PREGNANCY IN A RUDIMENTARY HORN OF BICORNUATE UTERUS

• RUPTURE AND INTRAPERITONEAL BLEED
 ABDOMINAL PREGNANCY

• FERTILISED OVUM IMPLANTS IN THE PERITONEUM AND CONTINUES TO GROW

• USUALLY SECONDARY TO RUPTURE OF A TUBAL PREGNANCY
• PRIMARY ABDOMINAL PREGNANCY IS RARE
 INTRALIGAMENTOUS PREGNANCY

• BETWEEN THE LAYERS OF BROAD LIGAMENT

• SECONDARY TO TUBAL PREGNANCY
• RARE
 CERVICAL PREGNANCY

• IN THE ENDOCERVICAL CANAL BELOW INTERNAL OS

• RARE
• PREDISPOSING FACTORS : PREVIOUS D&C OR CS
• DIFFERENTIATE FROM INTACT GESTATIONAL SAC PASSING THROUGH THE
CERVIX – PAIN AND ULTRASOUND FEATURES
 OVARIAN PREGNANCY

• IN THE OVARY
• RARE
• EARLY RUPTURE
 CAESAREAN SCAR ECTOPIC PREGNANCY

• IN THE MYOMETRIAL DEFECT CAUSED BY PREVIOUS UTERINE INCISION

• TWO TYPES
• FIRST TYPE PROGRESSES INTO UTERINE CAVITY AND HAS POTENTIAL TO REACH
VIABILITY
• SECOND TYPE PROGRESSES TOWARDS SEROSAL SURFACE WITH RISK OF
RUPTURE AND HAEMORRHAGE
 INCIDENCE

INCREASING DUE TO:

1. INCREASED PREDISPOSING FACTORS
• INCREASED PREVALENCE OF STD
• INCREASED ART
• INCREASED CAESAREAN SECTIONS – PREGNANCY IN PREVIOUS SCAR

2. INCREASED DETECTION
• WIDESPREAD USE OF ULTRASOUND AND SERUM ẞHCG
1.PID
AETIOLOGY
MOST IMPORTANT CAUSE
CHLAMYDIAL INFECTION IS MORE LIKELY
PELVIC TB
POSTABORTAL AND PUERPERAL SEPSIS
AGGLUTINATION OF TUBAL MUCOSAL FOLDS WITH FORMATION OF BLIND
POCKETS
ALSO REDUCED CILIATION AND IMPAIRED TUBAL PERISTALSIS
2.CONGENITAL FACTORS
TUBAL TORTUOSITY, ACCESSORY OSTIA, DIVERTICULA, PARIAL STENOSIS

3.SALPINGITIS ISTHMICA NODOSA

TUBAL EPITHELIUM INVADING MYOSALPINX FORMING A DIVERTICULUM

4.PREVIOUS SURGERY ON THE TUBE

TUBAL RECANALISATION PROCEDURES AND TUBAL STERILISATION

5.ART
INCREASED INCIDENCE OF HETEROTOPIC PREGNANCY
6.INTRAUTERINE DEVICES
NO DIRECT CAUSE
PREVENT INTRAUTERINE PREGNANCY MORE EFFECTIVELY THAN TUBAL
PREGNANCY

7.PREVIOUS ECTOPIC PREGNANCY

12% AFTER ONE EPISODE AND 28% AFTER SECOND
 NATURAL HISTORY

• TUBAL ABSORPTION (IN EARLY CASES)

• TUBAL ABORTION

• TUBAL RUPTURE ( PRESENT AS INTRA ABDOMINAL BLEEDING AND SHOCK)

• SECONDARY ABDOMINAL PREGNANCY OR SECONDARY INTRALIGAMENTOUS

PREGNANCY
 UTERINE CHANGES

• ABSENCE OF CHORIONIC VILLI IN THE ENDOMETRIAL CURETTINGS IS THE MOST RELIABLE

FINDING

• ARIAS STELLA PHENOMENON ( HYPERPLASIA OF GLANDULAR CELLS WITH

HYPERCHROMATIC NUCLEI, CYTOPLASMIC VACOULATION AND LOSS OF CELL POLARITY

• STROMA SHOWS DECIDUALISATION AND INTERMITTENT SHEDDING OF DECIDUA

(DECIDUAL CAST)
 CLINICAL FEATURES

• CLASSIC PRESENTATION IS THE TRIAD OF

AMENORRHOEA,
IRREGULAR VAGINAL BLEEDING,
ABDOMINAL PAIN

ABDOMINAL PAIN IS USUALLY DUE TO INTRAPERITONEAL BLEED. SOMETIMES

SHOULDER PAIN DUE TO ACCUMULATION OF BLOOD IN SUBDIAPHRAGMATIC
REGION
THANK YOU