1

Ectopic
Pregnancy
(EP)
Professor: Zhang Xing Tao
Dept. Gynecology & Obstetric
Zhongnan Hospital of Wuhan
University
2
3

Fertiliz
e

Sexual
intercourse
(coitus)
Sperm
Vaginal
Cervix
Uterus
Tubal
lumen
ovary
4
Fertilization
Fertilization
means that the
union of a
sperm with a
mature ovum
it takes place
in the outer
third of the
fallopian tube

Prefac
e
5
5
Preface
After Fertilization
The ovum passes
down The
fallopian Tube
and it fakes
about Three To
four days to
reach The
endometrium
where embeding
Take place
 Preface
6

When The
ferfilized
ovum embeds
outsid The
uterine cavity
.The condition
is Known as
ectopic
pregnancy
7
Preface
The commonest
site is in The
Fallopian Tube
but The
pregnancy may
occasionally be
embeded in
The ovary or in
The addomen
8
Preface

Ninety-five percent of
ectopic pregnancies are tubal

The ampulla is the most

common tubal site for
implantation, followed by the
isthmus, the fimbria and the
interstitial area
9
10

Preface
 Ectopic pregnancy is a
comparatively common, dangerous
and potentially fatal condition
 The past decade has seen decline
in the mortality from ectopic
pregnancy
11
Preface
The condition may have become
more common because
of the increased incidence of
pelvic inflammatory disease, the
use of intrauterine device, the great
increase in female tubal sterilization
and anastomosis of fallopian tube
12
13

Aetiology
The cause is a partial

obstruction of the fallopian tube,

insufficient to prevent sperm from

fertilizing the ovum in the tube but

sufficient to prevent the ovum

passing through to the uterus cavity

14
Aetiology
The main cause of ectopic
pregnancy are as follows:
 Salpingitis: chronic salpingitis are
due to pelvic inflammatory disease,
sexually transmitted disease,
tuberculosis
 Fallopian tube operation:
sterilisation, anastomosis
15
16
Aetiology
 Intrauterine device maybe result

in salpingitis
 Congenital abnormal fallopian

tube: too long or dysfunction

 Other: pelvic tumor
17

Pathoiog
y
18

Pathology

The trophoblast implanted on the tubal

mucosa, erodes the tube wall. Intratubal

or intraperitoneal bleeding occurs and as

a rule the embryo then dies

19
20

Pathology

The endometrium reacts to the hormonal

stimulus of the trophoblast by converting
itself into a decidua, which is generally
cast off in pieces, causing the irregular
uterine bleeding which is a symptom of
ectopic pregnancy
21

Pathology
Tubal pregnancy may terminate
in several ways and the clinical
features will vary accordingly.

Tubal rupture. Trophoblast

erodes through the tube causing
massive and sometimes fatal
haemorrhage
22

Pathology
Tubal abortion
The fertilized ovum separates from
the wall of the tube and is gradually
squeezed out the fimbriated end, from
which bleeding takes place
The contractions of the tube
during this process cause colicky
abdominal pain
23

Pathology
Pelvic haematocele

Slow effusion of
blood forms a large
haematoma in the
pouch of douglas
24
25
Pathology

Secondary abdominal pregnancy

The placenta may gradually grow
through the tube and find secondary
implantation in the abdominal cavity
There have been many fulltime
abdominal pregnancies, some resulting
in live births by abdominal section
26

Pathology

Intraligmentary pregnancy
Occasionally the products of
conception may perforate the tube
between the layers of the broad
ligament and continue to grown there
27

Symptoms

and signs
28

Symptoms and Signs

 There are various clinical

syndromes characteristic of ectopic
pregnancy
 If not rupture the patient is all right
 If there is profuse intraperitoneal
bleeding the patient is in danger
29

Symptoms and Signs

The classic triad of pain,

amenorrhea, and vaginal bleeding

should raise physician's suspicion

of ectopic pregnancy
30

Symptom
Amenorrhea
Amenorrhea is reported by
74 to 98% of patients with
ectopic pregnancy
It is unusual for a patient
initially to deny having missed
any periods
31

Symptom
Abdominal pain
Eighty to 100% of patient with
ectopic pregnancy will complain of
pain
The character of the pain is often
nonspecific; it may be unilateral
or bilateral. Sometimes the pain is
mild, sometimes severe
32

Symptom

Vaginal bleeding

Irregular vaginal bleeding is

usually slight and there is

sometimes no preceding

amenorrhea
33
Symptom

Syncope and Shock

Sometimes the patient
suddenly fell to the ground,
accompanied by intense pallor
(peripheral vaso- constriction)
This is the picture of massive
intraperitoneal haemorrhage
34

Sign
The physical examination of the

patient with an ectopic pregnancy

varies, depending on whether the

gestation is early and unruptured or

ruptured with a hemoperitoneum

35

Sign
If the gestation is early and

unruptured the patient is all

right, If there is heavy

intraperitoneal bleeding, the

signs as follows
36
Sign

 Pale face

Pulse was faint and fast

Blood presure become lower

There is no marked pyrexia

37
Sign

 Abdominal tenderness is
the most common physical finding

The tenderness is classically unilateral or

bilateral and in the lower quadrant

Rebound tenderness and rigidity are usually
not present except in those cases with
significant hemoperitoneum
38

Sign
However, absence of peritoneal signs
should not be used to exclude the
diagnosis of ectopic pregnancy In one
study, these were present in only 55%
of ectopic gestation with
hemoperitoneum
39

Sign

 Pelvic examination reveal an adnexal

mass in 50% of cases
40

Sign

douglas pouch fullness may be found

The pain occurs during touching the

posterior fornix or shaking the cervix

41
42

Sign

The uterus is usually normal

or slightly enlarged in 97% of

cases and is often noted to be

soft
43
44

Diagnostic aids

Clinical diagnosis of a ruptured

ectopic pregnancy with an abdomen
full of blood is not difficult
Diagnostic aids are chiefly necessary in
the early, unruptured or chronic cases
45

Diagnostic aids

 Pregnancy test
A positive pregnancy test is obtained
in a woman with ectopic pregnancy
However, a negative test does not
exclude the possibility of ectopic
pregnancy
46
Diagnostic aids

The most useful application of

ultrasound is in a case where an
early intrauterine pregnancy, with
positive fetal heart signs, can be
clearly defined
This makes the diagnonsis of
ectopic pregnancy extremely
unlikely
47
48
Diagnostic aids

Culdocentesis
Aspiration
of blood from
the posterior
vaginal fornix
The blood
don't coagulate
49

Diagnostic aids

 Abdominal paracentesis

This is only of value when

a considerable amount of blood

has already accumulated in the

peritoneal cavity
50
Diagnostic aids

Laparoscopy
This is the
most
valuable of all
the diagnosis
aids
Taking the
laparoscopy,
you can
find the
ectopic
pregnancy
51

Treatment
52

 Surgical removal of ectopic pregnincy

via laparoscopy or laparotomy

 Medical therapy with methotrexat

53
54
y

1. Location:the most likely site of

ectopie pregnancy are the

oviduct

2. Most common risk factor :

55
summary
3. Clinical finding :

symptom triad: amenorrhea, vaginal bleeding,

abdominal pain. signs : if unruptured or the

gestation is eariy the patient is all right

signs: if ruptured : hyportesion pale face

peritoneal signs
56
summary

4.Laboratory finding:positive urine or

serum β-HCG test

5.Pelvic sonography : absence of

intrauterine gestational sac

6.Aspiration of biood from the

posterion vaginal fornix

57
summary

7.Management:

surgical operation;laparoscopy

or laparotomy

midical therapy
58

Clinical situation
59
Clinical situation

She come to the office with vaginal

bleeding, and she complains of left-

side pelvic pain,her β-HCG titer is

2500mlu/ml,but an endovaginal sonogram

shows no intrauterine gestational sac

60
Clinical situation

The diagnosis is ectopic pregnancy

Perform emergency laparoscopy or

Medical therapy
61
62

 The commonest site of the E.P is:

 How long does the zygote reach the utritine
cavity?
 Most common risk factor of causing E.P
 A simple away to find the hemoperitoneum
63

 The most valuable of all the diagnosis

aids

 The common and useful method of

diagnostic aids

 The most common tubal site is:

 The terminate of E.P is: （ in brief ）

64

 Symptom traid is:

 Is the saying wright or wrong ?

1.negative urine pregnant test could

exclude the diagnosis of E.P

2.ultrasound shows no intrauterine

fetal heart signs. the dignosis of

E.P.can be defined
65

Clinical feature of ruptured

tubal pregnancy
66