Ectopic medicine Ppt by Dr Sagar J. Lande MBBS, Junior Resident, DVVPF’s MCH Ahmednagar. Ectopic pregnancy is described with its defination, Riskfactors & complications. #tubal ectopic #pregnancy #ectopic pregnancy #ectopic #tubal #tubal pregnancy #OBGY

1. Dr. Sagar Lande (MBBS)
Ectopic Pregnancy
DVVPF’s MCH, Ahmednagar
1 Presentation 2 - 19 July 2023

2. • Introduction
• Classi
fi
cation
• Etiology
• Pathogenesis
• Clinical Features
• Di
ff
erential Diagnosis
• Investigations
• Management
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3. Introduction
• Ectopic pregnancy still contributes signi
fi
cantly to the cause of mortality and
morbidity.
• Incidence over last few decades increased four fold, but mortality slashed
down by 80%.
• DEFINATION:
• An ectopic pregnancy is one in which the fertilized ovum is implanted and
develops outside the normal endometrial cavity.
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4. Classification
• According to sites of implantation
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5. 5 Presentation 2 - 19 July 2023

6. Risk factors for ectopic pregnancy
• H/o PID
• H/o Tubal ligation
• Contraception failure
• Previous ectopic pregnancy
• Tubal reconstructive surgery
• H/o infertility
• ART if tubes are patent but damaged
• IUCD use
• Previous induced abortion
• Tubal endometriosis
6 Presentation 2 - 19 July 2023

7. Tubal pregnancy
• Incidence: 1 in 300 to 1in 150
• Most common type of ectopic pregnancy
• Reasons for increased incidence:
• 1. increased prevalence of Chronic PID
• 2. Tubal Plastic operations
• 3. Ovulation induction
• 4. IUD use
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8. Etiology
• A. Salphingitis & PID
• B. Iatrogenic
• 1. Contraception failure
• 2. Tubal surgery
• 3. Intrapelvic adhesions following pelvic Surgery
• 4. ART
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9. • C. Other causes:
• 1. Previous ectopic pregnancy
• 2. Prior induced abortion
• 3. Developmental defects of the tube
• 4. Transperitoneal migration of the ovum
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10. Factors facilitating nidation in tube
• Early resumption of the trophoblastic activity d/t premature degeneration of
zona pellucid a
• Increased decidable reaction
• Tubal endometriosis
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11. Morbid anatomy
Changes in Tube
• Implantation in intercolumnar fashion
• Minimal decidual change,
• Intramuscular implantation
• Pseudocapsule
• Inadequate HCG production
• Distended tube & thinned out wall at implantation site
• Limited hyperplasia & hypertrophy in muscles & more
stretching
• Engorged blood vessels
• Hemoperitoneum in all cases of ruptured tubal
ectopic pregnancy
• Varying amount of enlargement
with increased vascularity
• Decidua develops all
characteristics of IU pregnancy
EXCEPT NO EVIDENCE OF
CHORIONIC VILLI
• Decidual cast
•
Changes in uterus
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12. Mode of termination
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13. Arias-Stella reaction
• It is characterised by a typical adenomatous change of endometrial glands.
Intraluminal budding together with typical cell changes (loss of polarity,
pleomorphism, hyperchromatic nuclei, vacuolated cytoplasm & occasional
mitosis) are collectively referred as ARIAS STELLA REACTION.
• Due to progesterone
• Present in 10-15% cases of ectopic pregnancy.
13 Presentation 2 - 19 July 2023