An ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, most commonly in the fallopian tubes. Risk factors include pelvic inflammatory disease, previous tubal surgery or ectopic pregnancies, and assisted reproductive technologies. Without treatment, ectopic pregnancies can rupture the fallopian tube causing life-threatening internal bleeding. Common symptoms include abdominal pain and vaginal bleeding.

1. ECTOPIC
PREGNANCY
ANJANA.B.S.
6TH SEM
2016 BATCH

2. DEFINITION
 An ectopic pregnancy is
defined as a pregnancy
where implantation
occurs in a site other
than the uterine cavity.
 The most common site is
the fallopian tube.

3. AETIOLOGY
 Any factor that causes delayed transport(or entrapment) of
the fertilized ovum through the fallopian tube
 favours implantation in the tube
 And can give rise to a tubal pregnancy

4. 1.Pelvic inflammatory disease
 most important cause of ectopic pregnancy
 1 episode leads to a 12% chance of ectopic , incidence rising
with each episode.
 Chlamydial infection usually subclinical -most likely cause
Endosalpingitis causes
agglutination of tubal mucosal
folds with formation of blind
pockets

5. In addition, there is reduced ciliation and impaired tubal
peristalsis. All this can lead to ovum entrapment &
implantation in the tube.
Pelvic tuberculosis – another cause of ectopic.
Post abortal or puerperal sepsis also causes peritubal
adhesions, leading to kinking & narrowing of the lumen.

6. 2. Congenital factors
 Tubal tortuosity, accessory ostia, diverticula , partial stenosis
& in uterine exposure to diethyl stilboestrol predisposes to
these abnormalities.
3. Salpingitis isthmica nodosa
 In this condition, tubal epithelium invades the myosalpinx
forming diverticulum.
 Aetiology unknown- probably caused by ovum entrapment
in the diverticula

7. 4. Previous surgery on the tube
 This includes tubal recanalization procedures & tubal
sterilisation.
 One third of pregnancies which
following tubal sterilisation turn out
to be ectopic.
 Tubal sterilisation using
electrocoagulation is associated
with a higher risk of ectopic.

8. 5. Assisted reproductive technology (ART)
 In vitro fertilisation- increased the incidence of ectopic
pregnancies
 Ectopic pregnancies constitute upto 5% of pregnancies
following ART.
 The incidence of heterotropic pregnancy (coexisting
intrauterine and extrauterine pregnancy) has also gone up
with these procedures.
 Ovulation induction also contributes.

9. 6. Intrauterine devices
 IUDs do not cause ectopic gestations, but they prevent
intrauterine pregnancy than a tubal pregnancy.
 If a pregnancy occurs with an IUD in situ, it is more likely to
be an ectopic. IUD may also increase chance of infection.
7. Cigarette smoking
 Has an increased risk- impaired immunity in smokers –
predisposes to pelvic infections.
8. Previous ectopic
 Recurrence risk is 12% after one ectopic & 28% after two
ectopics.

10. INCIDENCE
 Epidemiological trends show incidence is rising due to
increase in predisposing factors & due to increased detection.
SITES
Fallopian tube(95%) Extratubal(rare)
Ampulla (80%) Intraligamentous
Isthmus(12%) Abdominal
Infundibulum(6%) Ovarian
Interstitial (2%) Cervical
Cornual

12. NATURAL HI STORY
A. Tubal Abortion
 Most commonly seen in ampullary
pregnancy.
 If the process is complete, the products may be expelled
through ostium resulting in a complete abortion.
 Sometimes the dead ovum may remain in the tubal lumen
enclosed in clotted blood similar to a missed abortion & can
present as a chronic or old ectopic.

13. B. TUBAL RUPTURE
 Usually presents as
intraabdominal bleeding & shock.
 If the ectopic is in
• isthmus- rupture occur at 6-8
weeks.
• ampulla-rupture bit later –
widest part.
• interstitial region- much later- greater distensibility &
haemorrhage excessive.

15. C. Abdominal Pregnancy
 After tubal rupture or abortion, if the fetus is still alive, it
can very rarely result in a secondary abdominal pregnancy or
a secondary intraligamentous pregnancy.

16. D. Changes in the Uterus
o Uterus – slightly enlarged
due to myohyperplasia &
hypertrophy.
o Endometrium shows a
histological pattern called
ARIAS STELLA
PHENOMENON
o Hyperplasia of glandular cells
with hyperchromatic nuclei,
cytoplasmic vacuolation &
loss of cell polarity.

17. o Arias Stella reaction along with absence of chorionic
villi- highly suggestive of ectopic.
o Due to low levels of hormones & failing pregnancy,
decidua may be shed intermittently, giving rise to
intermittent bleeding in an ectopic.
o Sometimes, decidua may be passed as a flat, reddish
brown piece of tissue called a decidual cast.