ectopic%20pregnancy
ECTOPIC PREGNANCY
Ectopic pregnancy happens when the fertilized ovum implants outside the endometrial lining of the uterus.
Accurate early diagnosis is life-saving, reduces invasive diagnostic procedures & allows conservative treatment that can preserve fertility.
Ectopic pregnancy must be excluded in women of reproductive age w/ a positive pregnancy test, abdominal pain & vaginal bleeding.
Ruptured ectopic pregnancy remains to be the leading cause of maternal mortality in the first trimester.

Definition

  • Any pregnancy in which the blastocyst implants outside the endometrial lining of the uterine cavity
    • 90% are located in the fallopian tube while the rest are extratubal (eg abdominal, cervical, heterotopic, interstitial, ovarian, cornual or cesarean scar pregnancies)

Accurate early diagnosis is life-saving, reduces invasive diagnostic procedures and allows conservative treatment that can preserve fertility

  • Ectopic pregnancy must be excluded in women of reproductive age with a positive pregnancy test, abdominal pain and vaginal bleeding
  • Ruptured ectopic pregnancy remains to be the leading cause of maternal mortality in the 1st trimester

Signs and Symptoms

Clinical Presentation

  • Abdominal pain and irregular bleeding are the most common presenting symptoms
    • Bleeding is usually referred to as “spotting”, dark brown and may be intermittent or continuous
  • Symptoms usually manifest 6-8 weeks after the last normal menstrual period
  • Patient may also present with vertigo or syncope
  • Other presentations will depend on the location of the ectopic pregnancy
    • Eg pleuritic pain may result from irritation of the diaphragm by a large hemoperitoneum
  • Clinical manifestations depend on whether the ectopic pregnancy has ruptured
    • A ruptured ectopic pregnancy commonly presents with sudden onset of severe lower abdominal pain characterized as sharp, stabbing, or tearing
    • Symptoms suggestive of intra-abdominal hemorrhage include syncope, hypotension, tender abdomen with guarding or rebound, and tenderness of adnexal mass on pelvic exam

Risk Factors

Risk Factors

Low to Moderate Risk

  • Cigarette smoking
  • Vaginal douching
  • First intercourse <18 years old
  • Infertility or infertility treatments
  • History of chlamydial or gonococcal cervicitis
  • Multiple sexual partners
  • Salpingitis isthmica nodosa

High Risk

  • History of pelvic inflammatory disease (PID)
  • Previous tubal or pelvic surgery
  • Tubal ligation
  • Previous ectopic pregnancy
  • In utero diethylstilbestrol (DES) exposure
  • Current intrauterine device (IUD) use
  • Documented tubal abnormality
  • Assisted reproduction
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