BIO 215: HUMAN PHYSIOLOGY

ECTOPIC
PREGNANCY
Presented by yara al beaini,joman
Amer,Dania Karameh.
Table of content
1.Background
2.Aetiology
3.Physiology
4.Clinical features & diagnosis
5.Management
Background
• Typically presents 6-8 weeks after last normal
menstrual period, but can present earlier or later.

• Defined as A fertilised ovum implanting and

maturing outside of the uterine endometrial cavity,
with the most common site being the fallopian
tube (97%, followed by the ovary (3.2%) and the
abdomen (1.3%).
 Aetiology
• 2 conditions lead to ectopic pregnancy:
conditions that hamper the transport of a fertilised
oocyte to the uterine cavity

conditions that predispose the embryo to premature

implantation
Classification Of ectopic
pregnancy
• Tubal pregnancy (97%)
• Ovarian pregnancy (1% to 3%)
• Cervical pregnancy (<1%)
• Interstitial pregnancy (2%)
• Hysterotomy scar pregnancy (<1%)
• Abdominal pregnancy (1.4%)
• Heterotopic pregnancy (1:4000)
• Ectopic pregnancy after hysterectomy
Patho+physiology
• Oocyte migration difficulty is most often associated with
abnormal fallopian tube anatomy.
• This can result from tubal pathology (e.g., chronic salpingitis,
salpingitis isthmica nodosa), tubal surgery (e.g. reconstruction,
sterilisation), or in utero DES exposure.
• It is thought that alterations in molecular signalling between the
oocyte and the implantation site may make an ectopic
pregnancy more likely.
• As the ectopic grows, the outer layer of the fallopian tube
stretches. This ultimately leads to tubal rupture and bleeding.
Clinical features &
diagnosis
• Abdominal pain:
Typically, unilateral lower abdominal pain; however, patient may
present with generalized or upper abdominal pain.
Pain with vomiting may be indicative of tubal rupture
• Amenorrhoea
LMP typically 6-8 weeks before presentation.
• Vaginal bleeding:
Abdominal tenderness
Adnexal tenderness or mass
Blood in vaginal vault
Investigation
• Urine pregnancy test. Results +ve (HCG)
• high resolution transvaginal ultrasound (TVUS)
What is TVUS?
Used to determine the location of pregnancy

• It is visualised by either Doughnut sign

(presence of a heterogeneous adnexal
mass separate from 2 clearly identified
ovaries
• or ring of fire (increased blood flow to the
ectopic gestation seen on Doppler)
 TVUS
Ring of fire

Donut sign Donut sign

• Result: no intrauterine
pregnancy detected;
ectopic pregnancy
visualized
Miscarriage
Clinical Features
• Often presents with vaginal bleeding in the first
trimester, accompanied by abdominal discomfort
secondary to uterine contractions.
Investigations
• Ultrasound shows intrauterine pregnancy.
• Pelvic examination may note dilation of the cervix, as
well as presence of tissue at the cervical os.
• Consecutive serum chorionic gonadotrophin levels
often do not rise appropriately (66% in 48 hours), and
progesterone levels often <15.9 nmol/L (<5 ng/mL).
Acute appendicitis
Investigations:
Ultrasound sensitivity of 85% to 90% and specificity of
92% to 96%; may show appendix with outer diameter >6
mm, no compressibility, lack of peristalsis, or
periappendiceal fluid.
• WBC count >10,000 cells/mm^3.
Ovarian torsion
Clinical Features
• Sudden onset, severe, unilateral lower abdominal
pain that worsens intermittently over many hours.
• Peritoneal signs are often absent.
Investigations
• Ovarian enlargement secondary to impaired venous and
lymphatic drainage is the most common sonographical
finding in ovarian torsion.
• Absence of arterial blood flow may also be used for
diagnostic purposes, but this is often absent in the early
stages of torsion.
Thank
you!
Do you have any questions?