ECTOPIC PREGNANCY
Etemad Muthanna Yusif
Tikrit University, MD. PhD.
21-11-2018
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Introduction
Ectopic pregnancy is a complication of pregnancy in which
the embryo attaches outside the uterus. Signs and symptoms
classically include abdominal pain and vaginal bleeding.
Fewer than 50 percent of affected women have both of these
symptoms. The pain may be described as sharp, dull, or
crampy. Pain may also spread to the shoulder if bleeding
into the abdomen has occurred. Severe bleeding may result
in a fast heart rate, fainting, or shock. With very rare
exceptions the fetus is unable to survive.
ECTOPIC PREGNANCY
Ectopic Pregnancy
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ECTOPIC PREGNANCY
DEFINITION
Any pregnancy where the fertilised ovum
gets implanted & develops in a site other
than uterine cavity.
ectopic / extrauterine
heterotopic
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INCIDENCE
>1 in 100 pregnancies.
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SITES OF ECTOPIC PREGNANCY
1)Fimbrial 2)Ampullary 3)Isthmic 4)Interstitial 5)Ovarian
6)Cervical 7)Cornual-Rudimentary horn 8)Secondary
abdominal 9)Broad ligament 10)Primary abdominal
Ampulla (>85%)
Isthmus (8%)
Cornual (< 2%)
Ovary (< 2%)
Abdomen (< 2%)
Cervix (< 2%)
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ETIOLOGY
•
Any factor that causes delayed transport of
the fertilised ovum through the Fallopian
tube (tubal ectopic pregnancy).
•
These factors may be:
1.
congenital or acquired;
2.
mechanical or functional
Ectopic Pregnancy
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ETIOLOGY
•
CONGENITAL -
tubal hypoplasia, tortuosity, congenital
diverticuli, accessory ostia, partial stenosis
•
ACQUIRED
–
Inflammatory
: PID, septic abortion, puerperal sepsis,
medical termination → intraluminal / peritubal adhesions
–
Surgical
: tubal reconstructive surgery, recanalisation of
tubes
–
Tumoral
: broad ligament myoma, ovarian tumour
–
Miscellaneous causes
: IUD, endometriosis, ART,
hormonal perturbations → tubal disfunctions
–
Previous ectopic pregnancy
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EARLY MULTI-MODAL DIAGNOSIS
•
Vaginal ultrasound scanning (+ colour Doppler)
•
Serum beta HCG level
•
Serum progesterone levels < 5ng/mL
•
Uterine curettage
•
Culdocentesis
•
Laparoscopy / laparotomy
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METHODS OF EARLY DIAGNOSIS
Multi-modality diagnosis results
1.
TV – US
- Demonstration of the gestational sac
with or without an alive embryo outside the uterus .
- Ruptured ectopic with fluid in the cul-de-
sac and an empty uterus.
2. Culdocentesis
- in emergent situations to confirm
diagnosis, highly specific if performed and interpreted
correctly → presence of free-flowing, NON-clotting
blood
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Ruptured tubal (ampullary) early pregnancy
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DIFFERENTIAL DIAGNOSIS
•
Threatened or incomplete abortion
•
Salpingo-ooforitis
•
Appendicitis
•
Twisted ovarian cyst
•
Rupture of a corpus luteum / follicular cyst
•
Other abdominal conditions
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MANAGEMENT
•
Depends on the stage of the
disease and the condition of
the patient at diagnosis.
1.
COMPLICATED ECTOPIC PREGNANCY
2.
NON-COMPLICATED ECTOPIC PREGNANCY
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Ectopic Pregnancy
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MANAGEMENT OF
COMPLICATED ECTOPIC PREGNANCY
TREATMENT – ALWAYS SURGICAL
•
Salpingectomy
of the offending tube
•
Posterior colpotomy -
if pelvic
haematocele is infected → to drain
the pelvic abscess
•
Salpingo-oophorectomy
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MANAGEMENT OF NON-COMPLICATED
=
UNRUPTURED ECTOPIC PREGNANCY
•
SURGICAL
•
MEDICAL TREATMENT
•
EXPECTANT MANAGEMENT
OPTIONS
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SURGICAL TREATMENT OF
UNRUPTURED
ECTOPIC PREGNANCY
•
Carried out by Laparoscopy /
Laparotomy.
•
The procedures are:
–
Salpingectomy / Cornual resection /
Excision
–
Conservative surgery (in cases of
Infertility & desire for pregnancy)
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MEDICAL TREATMENT
•
Trophotoxic substance:
– Methtrexate
- resolution of tubal / abdominal
pregnancy by systemic administration
–
Interferes with the DNA synthesis
•
Ectopic pregnancy size should be < 3.5 cm.
•
IV/IM/Oral, usually along with Folinic acid.
•
Injection into the ectopic pregnancy sac or affected tube
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Thank you