PATHOPHYSIOLOGY of ECTOPIC PREGNANCY

Coitus

Entry of spermatozoon in the cervix then to the fallopian tube Union of ovum and spermatozoon at distal 3rd of fallopian tube

Predisposing Factors: Beyond conceivable age Congenital anomalies in the fallopian tube

Precipitating Factors: Tubal damage caused by: o Chronic salphingitits o Pelvic Inflammatory Disease o Use of IUD more than 2 years o Previous pelvic/tubal surgery Previous ectopic pregnancy Maternal cigarette smoking

Legend: Signs and Symptoms Diagnostic evaluation Management Complications Manifested by the patient

Obstruction/damage in the tube

Narrowing of the fallopian tube

Prevents egg from reaching the uterus

Blastocyst implants outside the endometrium of the uterus (6-12 wks)

Abdomen

Fallopian tube: o Ampullary portion of the tube Isthmic segment of the tube Fimbrae Cornual and interstitial portion of the tube

Ovary and Cervix

Laparatomy o o o

Hysterectomy Oophorectomy

Salpingectomy Fimbraectomy Cornuectomy Co

Amenorrhea

Implantation within the fallopian tube

Limited decidual reaction

Much higher BP in tubal arteries than uterine arteries

Decreased muscle lining of the tube

Decreased resistance to the invading trophoblastic tissue

Serum pregnancy test shows HCG

Placental dislodgement

Growing zygote ruptures the slender tube/trophoblast cells break through with narrow base Cauldocentesis Ultrasound

Tearing and destruction of blood vessels

Progesterone secretion stops

Tube ruptures

Uterine decidua sloughs off

Bleeding/vaginal spotting Sharp stabbing pain at L/R lower abdomen

Tachycardia Tachypnea Hypotension Lightheadedness Narrowed pulse pressure

Pain radiating to shoulder Rigid abdomen Cullens sign

Blood accumulation in the peritoneum

Conception products expelled into pelvic cavity

Hct Hgb

Hemorrhage

Shock

Modified trendelenburg Fluid resuscitation O2 supplementation Blood transfusion as indicated