obstetrics & gynecology,

1. Ectopic Pregnancy
By Samia Manzoor
08-165
Batch : J

2. Objectives :
 what is ectopic pregnancy ?
 what are different sites, high risk groups of
ectopic pregnancy ?
 Outcomes of tubal pregnancy
 clinical features, diagnosis and treatment of
ectopic pregnancy.

3. Ectopic Pregnancy is
Implantation of a fertilized
ovum at a site other than the
normal uterine cavity.
What is Ectopic
Pregnancy ?

4. Sites of Ectopic pregnancy
(95%)

5. Risk factors of ectopic Pregnancy
Major risk factors
• Pelvic inflammatory
disease( > 50%).
• Previous tubal surgery.
• Previous ectopic
pregnancy.
• Intrauterine
contraceptive devices.
• Termination of
pregnancy.
Minor risk factors.
• Tuberculosis
salpingitis.
• Cigarette smoking.
• Age over 35 years.
• Many sexual partners.
• Congenital anomalies of
the fallopian tubes.
• Ovum transmigration.

6. Pelvic inflammatory disease.
• Intrauterine contraceptive devices.
• puerperal sepsis.
• Post abortal sepsis.
• Generalized or pelvic peritonitis.
• Gonorrhea.
• Past appendicitis.

7. Clinical features : Symptoms
1. Amenorrhea

8. 2.
Abdominal Pain
Dull ache Unruptured tubal
pregnancy.
Sharp Colicky pain
Ruptured tubal pregnancy .

9. 3.
Vaginal Bleeding
• May persist continuously or
intermittent spotting.
• Its mainly uterine in origin and
partly by ruptured fallopian tube.
• Due to breakdown of decidua after
the pregnancy dies and hormones
are withdrawn.

10. 4.
Others
• shock.
• Syncope.
• Subjective symptoms of pregnancy.
• Shoulder pain.

11. Clinical features: Signs
General physical examination
• patient is sweating,
• skin is pale, cold, clammy
• low blood pressure
• weak pulse.

12. Clinical features : Signs
Abdominal examination.
• Abdomen tenderness.
• Abdominal distension.
• Cullen’s sign (may be
positive )

13. Clinical features: Signs
Pelvic examination.
• Bluish discoloration of vulua
and vagina.
• On bimanual examination:
Tenderness on rocking of
cervix, most constant sign of
ectopic pregnancy ( chandelier
sign).

14. Clinical Presentation
• Acute ectopic pregnancy.
• Chronic ectopic pregnancy.
Patient presents with vague history,
intermittent pain and irregular bleeding. The
diagnosis can easily be missed if patient is not
evaluated thoroughly.

15. Outcomes of ectopic pregnancy
Usually the tubal pregnancy does not proceed beyond
8-10 weeks of gestation due to
 Lack of decidual reaction in the tube.
 The thin wall of the tube
 The inadequacy of the tube lumen.

16. Outcomes of ectopic pregnancy
1.
Tubal abortion
• This occurs
more if ovum had
been implanted in
the ampullary
portion of the
tube

17. 2-
Tubal rupture
• More common if
implantation
occurs in the
narrower portion
of the tube which
is the isthmus.

18. 3.
Tubal mole and pelvic hematoma.
In tubal mole gestational sac is retained in
tube and is surrounded by a blood clot.

19. 4.
Secondary abdominal pregnancy.

20. 5-
Spontaneous regression

21. Differential diagnosis
• Spontaneous abortion
• Ovarian pathology
• Corpus luteum haemorrhage.
• Acute pelvic inflammatory disease
• Appendicitis.
• Subserous fibroid.
• Retroverted gravid uterus.
• Perforated pelvic ulcer
• UTI
• Ureteric colic.

22. Diagnosis
• History
• General physical examination.
• Abdominal and pelvic examination.
• Investigations.

23. Investigation
• Most useful is Ultrasonography Empty
uterine cavity, and gestational sac on side of the body
of uterus.
• Laparoscopy. Most reliable method of making a
diagnosis of ectopic pregnancy.

24. Investigation
• Culdocentisis . Positive only in the case of
ruptured ectopic pregnancy.
•Repeated Blood
Hemoglobin in case of
atypical features.
•Total leukocyte count may
be raised.
• Abnormal levels of b-hcG.

25. Treatment
• Surgical .
• Medical.

26. Surgical treatment
Laparotomy
Indicated for
1. Ruptured tubal pregnancy
2. Patient is hemodynamically
unstable.
3. Laparoscopy is
contraindicated
4. Pregnancy is in
rudimentary horn of
uterus.
Laparoscopy
Indicated for
1. Unruptured tubal
pregnancy
2. Which cannot be treated
by medical methods.

27. Salpingectomy Tubal repair
Partial
salpingectomy
salpingotomy
Surgical procedures

28. http://medical-
dictionary.thefreedictionary.com/salpingostom
y
Salpingotomy

29. Medical Treatment
Selection criteria
 Unruptured tubal pregnancy less than 3 cm in
diameter.
 Absent haemoperitonium
 Sonographically non viable pregnancy, fetal heart
sound absent.
 B-hcG less than 2000 IU/L.
 Minimal symptoms.

30. Drugs
• Methotrexate (50mg with 2ml aqueous sol)
• Actinomycin-D
• Prostaglandin
• Mifepristone
• Hyperosmolar glucose.
• 20% potassium chloride.

31. Other ectopic pregnancies
• Ovarian
• Abdominal
• Cervical
• Heterotopic

32. “Before you were conceived I wanted you. Before you
were born I loved you. Before you were here an hour I
would die for you. This is the miracle of Mother's
Love“ By Maureen Hawkins