ECTOPIC PREGNANCY

Definition : An ectopic pregnancy is one in which the fertilized ovum is

implanted and develops outside the normal uterine cavity.

Implantation sites

Extra uterine Uterine

Ampulla (55%) Cervical

Isthmus(25%) Angular

Infunditulum Cornual
(18%)

Intestinal
(20%)

Primary
Inteperitoneal(common)

Secondary

Extra Peritoneal
(Brood Ligament)

Clinical Features:
A. Acute Ectopic
B. Unruptured
C. Sub-acute or chronic or old
Acute Ectopic :
An Acute Ectopic is less common and is associated with rupture or abortion
with massive intraperformed haemmorhage.
Patient :Between 20-30 yrs of age usually nullipa
Mode of Onset : Acute with persistent unilateral uneasiness.

Symtoms :
 A short period of amenorhea.
 Abdominal pain
 Vaginal Bleeding
 Feeling of nausea, vomiting
 Fainting even syncope

Signs :
 Patient is quite, conscious , looks blached.
 Pallor
 Features of shock
 Abdomen – tense, tumid, tenders
 Muscles guard absent
 Bimanual examination – extreme ,tenderness, no mass felt through
formia, uterus float as if water

B. Unruptured Ectopic :
Symptoms :
 Presence of delayed period or spoting features suggestive of
pregnancy.
 Uneasiness on are side flants.
Signs :
 Bimanual examination – Uterus smaller than the period of
amenorrhoea.
 A pulsative small mass may be felt through one fernix separated from
the uterus.

C. Chronic Or Old Ectopic

Symptoms :
 Amenorrhoea of short period.
 Lower abdominal pain
 Vaginal Bleeding
 Symptoms of bladder irritation.

Signs :
 Patient looks ill.
 Varying degree of pallor
 Increase pulse nate
 Features of shock absent.

Abdominal Examination : Tenderness and muscle guard on lower abdomen

esp. affected side.
Cullen’s sign – dark bluish discoloration around umblias.

Bimanual Examination is painful and Reveals – Vaginal Mucosa (Pale)

 Uterus seems to be normal
  Extreme tenderness on movement of cervix.
 An ill defined, boggy and extremely tendes mass is felt through
bostesolateral folnix to pouch of Douglas.

Diagnosis Of Ectopic Pregnancy :

A. Acute : The classical history of acute abdominal catastiophe with fainting
attack and collapse associated with features of intra-abdominal haemorrhage
in a woman of child bearing age points to diagnosis of ectopic pregnancy.

B. Subacute and chronic :

 Blood examination – leucocytosis, increased ESR
 Culdocentesis
 Estimation of HCF
 Laparoscopy
 Rilatation and Cureltage
 Serum Progesteron
 Laparotomy

Differential Diagnosis ;
 Incomplete abortion in retroverted uterus
 Salphingitis
 Appendicitis
 Twisted ovarian tumor
 Ruptured Chocolate cyst.