Ectopic pregnancy is the implantation of a fertilized ovum outside the uterine cavity. It is a life-threatening emergency if undiagnosed or untreated.
Common Sites of Ectopic Pregnancy:
- Fallopian Tube (95%)
- Ampullary (70%) – Most common
- Isthmic (12%)
- Fimbrial (11%)
- Interstitial (2–3%)
- Ovarian (3%)
- Abdominal (1%)
- Cervical (<1%)
Risk Factors for Ectopic Pregnancy
1. Tubal Damage or Surgery:
- Pelvic inflammatory disease (PID) → Chlamydia, Gonorrhea
- Previous ectopic pregnancy
- Tubal sterilization or tubal surgery
- Intrauterine device (IUCD) use
2. Assisted Reproductive Techniques (ART):
- In vitro fertilization (IVF)
- Ovulation induction
3. Maternal Factors:
- Advanced maternal age (>35 years)
- Smoking
- Previous miscarriage or abortion
Clinical Features of Ectopic Pregnancy
1. Unruptured Ectopic Pregnancy:
- Amenorrhea (6–8 weeks)
- Unilateral lower abdominal pain
- Scanty vaginal bleeding (Dark brown "prune juice" discharge)
- Adnexal tenderness & mass on examination
2. Ruptured Ectopic Pregnancy (Medical Emergency):
- Severe lower abdominal pain
- Hypotension, tachycardia, shock
- Referred shoulder tip pain (due to diaphragmatic irritation)
- Abdominal distension & guarding
Diagnosis of Ectopic Pregnancy
- Urine Pregnancy Test: Positive (Detects hCG).
- Serum β-hCG Levels:
- Slowly rising or plateauing β-hCG (<66% increase in 48 hours).
- Transvaginal Ultrasound (TVS):
- No intrauterine pregnancy (empty uterus).
- Adnexal mass with or without fetal pole.
- Free fluid in pouch of Douglas (suggests rupture).
- Culdocentesis (Rarely Used):
- Blood in the pouch of Douglas indicates rupture.
- Diagnostic Laparoscopy:
- Direct visualization of ectopic pregnancy if uncertain diagnosis.
Management of Ectopic Pregnancy
1. Medical Management (For Unruptured & Hemodynamically Stable Cases)
- Methotrexate (MTX) Regimen:
- Single Dose: 50 mg/m² IM Methotrexate
- Check β-hCG on Days 4 & 7.
- Successful if β-hCG decreases by ≥15%.
- Contraindications for Methotrexate:
- Ruptured ectopic pregnancy
- Severe anemia or liver/kidney dysfunction
- Gestational sac >4 cm or fetal cardiac activity present
2. Surgical Management (For Ruptured or Large Ectopic Pregnancy)
- Salpingectomy (Removal of Fallopian Tube):
- Preferred for ruptured ectopic or completed families.
- Salpingostomy (Preserving the Tube):
- For women desiring future fertility.
- Laparoscopic Surgery:
- Gold standard for stable patients.
- Laparotomy (Open Surgery):
- For unstable or emergency cases.
Complications of Ectopic Pregnancy
- Rupture → Life-threatening Hemorrhage
- Hypovolemic Shock
- Infertility (Due to tubal damage)
- Recurrence in future pregnancies
Prevention of Ectopic Pregnancy
- Early treatment of STDs (Chlamydia, Gonorrhea)
- Avoidance of risk factors (Smoking, Multiple sexual partners)
- Regular follow-up in high-risk women with early ultrasound
Summary of Ectopic Pregnancy
|
Feature |
Key Points |
|
Definition |
Implantation outside uterus (95% tubal) |
|
Risk Factors |
PID, Tubal surgery, ART, IUCD |
|
Symptoms |
Amenorrhea, Abdominal pain, Vaginal bleeding |
|
Diagnosis |
β-hCG, Transvaginal ultrasound |
|
Medical Treatment |
Methotrexate for unruptured cases |
|
Surgical Treatment |
Laparoscopic salpingectomy/salpingostomy |
|
Complications |
Rupture, Hemorrhage, Shock, Infertility |
