Ectopic pregnancy

Department of
gynaecology and
obstetrics
 firtilized
Uterus egg Ampulla tubae uterinae

ovary
 Definition

Ectopic pregnancy
.In ectopic pregnancy ,a fertilized ovum
implants in an area other than the

endometrial lining of the uterus

 Classification and Incidence
 1 tubal （ >95% ）
 ampullary(55%),
 isthmic （ 25%),
 fimbrial(17%),
 interstitial(2%)
 2.other(<5%)
 cervical,ovarian,and abdominal
 TIME OF RUPTURE

 Rupture is usually
spontaneous.
 .1.isthmic pregnancies –
 at 6 to 8 weeks’gestation,
 .2.ampullary pregnancies
ruptute- at 8to 12weeks.
 .3.interstitial pregnancies are
the last - at 12-16wesks.
 Etiology
 Pathology

 Clinical situation

 Laboratory findings

 Special examinations

 Diagnosis

 Differental diagnosis

 Treatment
Etiology
 .tubal factors
Chronic salpingitis
dysplastic or parafunctional
Oviduct
 .ovarian factors
Fertilized egg transmigration
Etiology
 .other factors
Birth control failure
psychentonia
dyscrinism
 Etiology
 Pathology

 Clinical situation

 Laboratory findings

 Special examinations

 Diagnosis

 Differental diagnosis

 Treatment
Pathology
 little or no decidual reaction
 the trophoblast invades blood
vessels to cause local hemorrhage.
 bleeding
 arias–strlla reaction--
 no trophoblastic cells
Pathology
 Tubal abortion
 Rupture of tubal pregnancy
 Secondary abdominal pregnancy
 Persistent ectopic pregnancy
tubal abortion
rupture of tubal pregnancy
 Secondary abdominal pregnancy

 Persistent ectopic pregnancy

 Etiology
 Pathology

 Clinical findings

 Laboratory findings

 Special examinations

 Diagnosis

 Differental diagnosis

 Treatment
 Clinical findings
 SYMPTOMS
 A pain

Pelvic or abdominal
pain
subdiaphragmatic or
shoulder
. pain
pain can be
unilateral or
bilateral,localized or
generalized
 B bleeding
--- Abnormal uterine
bleeding,usually spotting

 C amenorrhes
 About half of women with ectopic
pregnancies have some spotting
 D syncope
 Dizziness, lightheadedness, and or syncope

 E Decidual cast
 mistaken for products of conception.
 2.signs
 A tenderness
.Diffuse or localized
abdomimal tenderness
 .adnexal and /or
cervical motion
tenderness

 B adnexal mass

 Bimanual examination
 C uterine changes
The uterus may undergo typical
changes of pregnancy ,including
softening and a slight increase in
size.
 Etiology
 Pathology

 Clinical situation

 Laboratory findings

 Special examinations

 Diagnosis

 Differental diagnosis

 Treatment
Laboratory findings
 1.Hematocrit-the hematocrit will
vary depending on the patient
population and the degree,if any
,of intraabdominal bleeding.
 2.White blood count-the white
blood count is variable ,and it is
not uncommon to see a
leukocytosis
 3. pregnancy test-the β-HCG is positive in
virtually 100%of ectopic pregnancies,
 however ,a positive test only confirms
pregnancy and does not indicate whether it
is intrauterine or extrauterine.
 -in normal pregnancy,HCG should double
every 2days.
 ectopic pregnancies have anormal serial
titers,
 Special examinations
 1.Ultrasound
 documenting the presence or absence of an
intrauterine pregnancy
 The presence of an adnexal mass with an
empty uterus
 .a tubal ring seen on ultrasound may
represent an unruptured extopic
Sonography of gravid uterus
Ectopic pregnancy
 .HCG titers and ultrasound complement
one another
 An intrauterine sac should be visible by
transvaginal ultrasound when the HCG Is
approximalely 1000mIU/mL, when an
empty uterine cavity is seen with a HCG
titer above this threshold, the patient is
likely to have an extopic pregnancy.
 an empty cavity is less of a concern when a
HCG below the threshold is obtained,as this
may be associated with an ectopic
pregnancy, but may also be seen with an
early IUP.
2.Laparoscopy
it is still usefull,however, in certain
situations when a definitive diagnosis is
difficult,especially in the case of a
desired,potentially viable intrauterine
pregnancy when a DandC is
contraindicated.
 3D and C
 May confirm or exclude intrauterine
pregnancy in the case of an undesired
pregnancy.when chorionic villius are
recovered,the diagnosis of an
intrauerine pregnancy is confirmed .
 on the other hand If only decidua is
obtained on D and C,ectopic pregnancy
is highly likely.
 4.laparotomy
 is indicated when the presumpite
diagnosis of ectopic pregnancy in an
unstable patient necessitates immediate
surgery,or when definitive therapy is not
possible by medical management or
laparoscopy.
 5 culdocentesis
free blood is present
in the abdomen may
be useful in the
diagnosis of
intraperitomeal
bleeding
 Etiology
 Pathology

 Clinical situation

 Laboratory findings

 Special examinations

 Diagnosis

 Differental diagnosis

 Treatment
Diagnosis
 Clinical fingdings
 Pain bleeding amenorrhea

 Physical sign
 Tenderness
 adnexal/or cervix motion tenderness
 Adnexal mass
 Uterus changes
Sonography
we could not see the gestation sac
in the uterus cavity ， but it can be
found outside the uterus
cavity 。 There is fluidify in cul-de-
sac of douglas
 pregnancy test
β – HCG is positive in some ectopic
pregnancy case 。
This is a useful index
 Culdocentesis
 non-clotting blood is meaningful
 Etiology
 Pathology

 Clinical situation

 Laboratory findings

 Special examinations

 Diagnosis

 Differental diagnosis

 Treatment
Differental diagnosis

 Abortion
 Rupture of yellow body
 Acute appendicitis
 Etiology
 Pathology

 Clinical situation

 Laboratory findings

 Special examinations

 Diagnosis

 Differental diagnosis

 Treatment
Treatment
 1.expectant management
 because many ectopic pregnancy resolve
spontaneously, it may be reasonable to
manage an asymptomatic, compliant
patient expectantly if HCG titers are
low()<200mIU/mL)or decreasing,and the
risk of rupture is low.
 2. surgical treatment
 .conservative surgery
 .A linear salpingostomy performed with a
small(<3cm),intact ampullary pregnancy
 Interstitial pregnancies require at least a
corneal wedge resection
 3.emergency treatment
 immediate surgery is indicated when the
diagnosis of ectopic pregnancy with
hemorrhage is made .
 blood products should be available as
transfusion is often necessary. There is no
place for co nservative therapy in a
hemodynamically unstable patient.
 MTX(methotrexae ） has been shown to
destroy proliferatin trophoblast and may be
effective in the mediclal management of
small,unruptured ectopic pregnancies in
asymptomatic women
 .relative contraindications include an adnexal
mass >=3.5cm or an extrauterine gestation
with fetal heart motion