Is when the conceptus implants either outside the uterus (fallopian tube , ovary or abdominal cavity ) or in an abnormal position within the uterus (cornua , cervix ). Combined tubal and uterine (heterotopic) pregnancies are very rare .
Maternal age , number of sexual partners, use of an intrauterine device, after a proven pelvic inflammatory disease (gonorrhoea, Chlamydia ), after pelvic surgery, endometriosis & IVF . Risk of recurrence is high (around 10%).
There is no pathognomonic pain or findings on clinical examination that are diagnostic of a developing extrauterine pregnancy . Vaginal bleeding (usually old blood in small amounts ) short period of amenorrhea and chronic pelvic pain (iliac fossa , sometimes bilateral ) are the most commonly reported symptoms .
Pulse rate and blood pressure must be recorded. Low blood pressure, fainting, dizziness and rapid heart rate may be noted . These symptoms are present in about 59 % typical of ruptured ectopic pregnancy (intra – abdominal bleeding ). Note: bimanual examination may provoke the rupture of the tube .
hCG levels and ultrasound findings must be interpreted together . A laparoscopy should be considered in women with hCG above the discriminatory level and absence of an intrauterine gestational sac on ultrasound .
. Treatment of ectopic pregnancy has always been surgical (salpingectomy or salpingotomy ), either by laparotomy or laparoscopy . With the wider use of ultrasound, an early diagnosis is now possible, in many cases, before the onset of symptoms .Others: medical- methotrexate, therapeutic puncture and aspiration of ectopic sac , local injections of prostaglandins, potassium chloride,or hyperosmolar glucose.
Vaginal bleeding , uterine enlargement greater than expected for gestational age and an abnormally high level of serum hCG. Pregnancy induced hypertension, hyperthyroidism, hyperemesis G, anaemia & ovarian theca lutein cysts (torsion or rupture of theca lutein cysts) .
Symptoms of choriocarcinoma are: abnormal vaginal bleeding after evacuation or delivery, dyspnoea, nerological symptoms & abdominal pain (few weeks or months and sometimes up to 10 – 15 years after their last pregnancy).
Uterine evacuation (suction curretage) under running oxytocin infusion & prepared blood (severe bleeding is common). 3% of molar pregnancy will develop to choriocarcinoma . Pulmonary complications might follow evacuation of molar pregnancy. Early diagnosis reduces the risk of severe complications. Follow up is very important for detection of changes to choriocarcinoma
Serial hCG levels is the gold standard for montioring therapeutic response of GTD after evacuation of molar pregnancy. The hCG levels should be monitored weekly until undetectable followed by monthly monitoring for 12-24 months .