Ectopic pregnancy

Notes

## Basic introduction

  • Ectopic pregnancy is pregnancy outside the endometrial lining of the uterine cavity. It can occur in the fallopian tube (the most common), uterine cornua (horn of the uterus), cervix, ovary, or abdominal or pelvic cavity.
  • Ectopic pregnancies usually rupture or involute (shrink).
  • Ectopic pregnancies can be acute or chronic (slow leak)

## Statistics

  • It has a prevalence rate of 2% of all the pregnancies; ectopic pregnancy carries a risk of recurrence of 10 to 25%

##Predisposing factors to ectopic pregnancy

  • Conceiving after having a tubal ligation
  • Conceiving while an IUD is in place.
  • Endometriosis
  • Infertility
  • STDs (especially Chlamydia and Gonorrhea)
  • Maternal age of 35-44 years
  • Previous ectopic pregnancy
  • Previous pelvic or abdominal surgery.
  • Pelvic Inflammatory Disease (PID)
  • Several induced abortions.
  • Smoking of cigarettes
Symptoms
  • Sudden abdominal pain
  • Hemorrhagic shock (is more likely and rapid in ruptured cornual pregnancies and as well as in advanced pregnancies).
  • Anemia
  • Occasional fainting
  • Abdominal distension and tenderness
  • Amenorrhea (6 -9 wks)
  • Cervical excitation
  • Low grade fever
  • Irregular per vaginum bleeding (of dark blood)
  • Cervical motion tenderness
  • Unilateral or bilateral adnexal tenderness
  • Adnexal mass
Diagnosis
  • Pregnancy test (detection of beta - hCG) and quantitative beta – hCG levels
  • Ultrasonography
  • Paracentesis of non-clotting blood
  • Culdocentesis is positive with clot blood (more common in chronic cases) – but this procedure requires experience)
  • Group and cross-match the blood in preparation for probable transfusion
  • Determine HB
Differential
  • Abortion
  • Appendicitis
  • Ovarian torsion
  • Kidney stone
  • Pelvic Inflammatory Disease (PID)
  • Ruptured ovarian cyst
Prevention
  • Mitigations of the risk factors
Management
  • This is usually a medical emergency
  • Set IV lines
  • Open surgical resection
  • Laparoscopic surgical resection

IM methotrexate (a single dose of 50 mg/m2) in case of unruptured tubal pregnancies that are less than 3 cm in diameter with no fetal heart activity  and Beta-hCG level of less than 5,000 mIU/mL)

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