ECTOPIC PREGNANCY

 “Pregnancy in which the fertilized ovum is implanted and develop outside the normal uterine cavity”

Sites of Ectopic Pregnancy:-

Extra uterine

Tubal Ovarian Angular Cannual Cervical

(Commonet 90%)

Ampulla Isthmus Infundibulum Intestitial    Abdominal

Primary Secondary

(Very rare)

Intra peritoneal Extra peritoneal

(comman) (Rare)

Tubal Pregnancy:- Pregnancy occurs in the following tube

Incidence – this is in 300 pregnancies

Anatomical site:-

Etiology:- (1) Factor that causes:-

Delayed transport of fertilized ovum through fallopian tube

Factor causing delayed – PID

Loss of cilia of lining epithelium

Favors’ Implantation in tubal mucosa

Narrowing the tubal lumen

Formation of pocket due to adhesion b/w muscular folds

(ii) Contraception failure:- IUD

Sterilization failure

(iii) Tubal surgery:- Tubal reconstructive surgery to improve fertility

Risk factors:-

History of PID

History of tubal ligation

Contraceptive failure

Previous ectopic pregnancy 

History of infertility

Tubal surgery

Previously Induced abortion

Clinical Features:-

Amenorrhea

Sudden onset of pain in iliac reign which spreads to abdomen

Vaginal bleeding

Hypovolumia

Shock & Pallor

Rest Less

Tachycardia & Hypotension

Distension & tenderness of abdomen

Cullen’s sign- which discoloration around umbilicus due to intra peritoneal bleeding

Temperature elevated

Investigations:-

CBC & HB

Blood group & cross matching

USG

Culdocentesis- Aspiration of fresh non- clotting blood

Laparoscopy

Management:- Obtain assessment data & vital signs

Monitor bleeding & initiate measures to prevent shock

IV infusion, blood transfusion & O2 Administer

Medical Management:-

To prevent tubal damage & Preserve fertility

Pt must be clinically stable

Methotraxate, prosta, glandin’s & kcl Methotraxate 50 ml IM

Repeat USG every 2-3 days

Surgical Management:- Salpingostomy (Surgical removal to fallopian tube)