ECTOPIC

PREGNANCY
A fertilized ovum implants in
an area other than the endometrial lining of the uterus

Classification
Sites of ectopic pregnancy
Tubal (98-99%)
Ovarian pregnancy (0,5%)
Adominal (~1/15.000 pregnancies)
Cervical implantation
Intraligamentous
Heterotropic pregnancy
Bilateral ectopic

Tubal pregnancy

Ampullary (55%)
Isthmic (25%)
Fimbrial (17%)
Interstitial (angular,cornual) (2%)

Risk factors
a.Pelvic inflammatory disease
b.Previous tubal surgery
c.Use of intrauterine contraceptive devices
d.Previous ectopic pregnancy
e.In vitro fertilization
f.Smoking
g.Previous abdominal surgery

Symptoms & Signs

A.Symptoms:
1.Pain (pelvic or abdominal pain) (100%)
2.Bleeding (abnormal uterine bleeding)
(75%)
3.Amenorrhea (50%)
4.Syncope (1/3 1/2 case)
5.Decidual case (5 10%)

B.Signs :
Tenderness
- Diffuse or localized abdominal
tenderness (> 80%)
- Adnexal and/or cervical motion
tenderness (75%)
Adnexal mass
Uterine changes

Special Examination
1.Ultrasound
2.Laparoscopy
3.D & C
4.Laparotomy
5. Culdosentesis

Differential Diagnosis
* Appendicitis
* Salpingitis
* Ruptured corpus luteum cyst
* Ruptured ovarian follicle
* Abortion
* Ovarian torsion
* Urinary tract infection

Treatment
Divided into two catagories:
1.Ruptured ectopic pregnancy and/or active
bleeding
2.Unruptured ectopic pregnancy
(do not have active bleeding)

Emergency treatment
Hospitalize the patient
Insert a large-bore IV into large vein
Obtain hemogram,clotting panel,and blood of
type and crossmatch
Administer antishock measures as indicated:
- IV crystalloid
- blood vcomponent trasnfusion
- give oxygen

Surgical treatment

a.Salpingectomy
b.Partial salpingectomy
c.Salpingostomy
d.Fimbrial expresssion

Medical treatment
Medical therapy is increasingly utilized for
unruptured ectopic gestations with minimal
bleeding
Medical therapy is most safe and effica-cious in
ectopic gestations with following:
* beta hCG < 5000 IU
* hematosalpinx < 3 cm
* peritoneal fluid < 300 CC
* patient is capable of complying with the
necessary follow -up

Medical therapy
Mehotrexate
Given intramuscularly, 50 mg/m2 on day 1
Repeat hCG is performed on day 4 and 7
1) if hCG level declines < 15% between day
4 and 7, a second dose methotrexate is
given
2) if hCG level declines > 15% between day 4
and 7,the hCG titers arefollowed weekly until
titer is < 15 ml IU/ml
Mean time to resolution is 35 day