#Ectopic Pregnancy # Tubal Pregnancy #Tubal #Ectopic #OBGY Ectopic pregnancy PPT by Dr. S. J. Lande (MBBS) Junior Resident, DVVPF’s MCH, Ahmednagar

1. Dr. Sagar Lande (MBBS)
Ectopic Pregnancy
DVVPF’s MCH, Ahmednagar

2. • Introduction
• Classification
• Etiology
• Pathogenesis
• Clinical Features
• Differential Diagnosis
• Investigations
• Management

3. Introduction
• Ectopic pregnancy still contributes significantly 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.

4. Classification
• According to sites of implantation

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

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

8. Etiology
• A. Salphingitis & PID
• B. Iatrogenic
• 1. Contraception failure
• 2. Tubal surgery
• 3. Intrapelvic adhesions following pelvic Surgery
• 4. ART

9. • C. Other causes:
• 1. Previous ectopic pregnancy
• 2. Prior induced abortion
• 3. Developmental defects of the tube
• 4. Transperitoneal migration of the ovum

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

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

12. Mode of termination

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.