An ectopic pregnancy occurs when a conceptus implants outside the uterine cavity, primarily in the fallopian tubes. Risk factors include tubal disease, previous ectopic pregnancies, and use of intrauterine devices, presenting clinically with abdominal pain and vaginal bleeding. Management options are based on the patient's condition and include expectant, medical, or surgical approaches depending on factors like hCG levels and ultrasound findings.

1. Ectopic Pregnancy
Kavya Liyanage

2. What is an
Ectopic pregnancy?
Implantation of the conceptus outside the
normal uterine cavity.

4. What is the
normal site of
implantation?
 Uterine endometrium

5. Common sites
of
implantation
within
the abdominal
cavity
 Fallopian tubes (95%)
 Ampulla (74%)
 Isthmus (12%)
 Fimbriae ends (12%)
 Interstitium (2%)
 Ovaries (3%)
 Peritoneal cavity (1%)

6. Heterotopic
Pregnancy
 Simultaneous development of a pregnancy within and
outside the uterine cavity
 Risk of incidence is rising with in vitro fertilization (IVF)
treatment

7. Risk factors
for
ectopic
pregnancy
 Tubal disease
 Eg- Chlamydia infection that cause pelvic infection
accounts for 40% of ectopic pregnancies
 Previous ectopic pregnancies
 Previous tubal surgery
 Subfertility
 Use of intrauterine device

8. What is the clinical
presentation?
• Subacute abdominal pain
• Vaginal bleeding in early pregnancy

9. Abdominal
pain
 The pain maybe localized to the iliac fossa
 Sometimes the pain presents as a tip of the
shoulder pain, due to the free blood in
abdominal cavity causing diaphragmatic
irritation and symptoms of dizziness

10. Per vaginal
bleeding
 Usually dark red
 Indicative of old blood

11. When the
ectopic
pregnancy
ruptures
 Massive intraperitoneal bleeding causing
 Hypovolemic shock
 Acute abdomen

12. Investigations
• Observations
• Laboratory investigations
• HCG
• Transvaginal ultrasound scan

13. Observations
 Blood pressure
 Pulse
 Temperature

14. Laboratory
investigations
 Haemoglobin
 Blood group
 β-hCG

15. HCG level
 In 85% pregnancies, hCG level almost double in every
48 hours.
 In ectopic pregnancies, the level is suboptimal.

16. Transvaginal
ultrasound
scan
(TVS)
 An intrauterine pregnancy is detected byTVS at 4.5 weeks of
gestation
 At that time hCG level is about 1500 mIU/mL.
 At 5th week of gestation, fetal heart beat is detected inTVS.
 There, the hCG level is about 3000 mIU/mL.
 A discrepancy between hCG level andTVS may suggest ectopic
pregnancy.
 Free fluid detected inTVS suggests of a ruptured ectopic
pregnancy.

17. Management basis
• Clinical presentation
• β-hCG
• Ultrasound findings
• Patient's choice

18. Management
methods
 Expectant approach
 Medical approach
 Surgical approach

19. Expectant
approach
 Suitable for haemodynamically stable and asymptomatic patients
 Assuming that significant proportion of all tubal pregnancies will
resolve with regression or tubal abortion without treatment

20. Medical
approach
 Intramuscular methotrexate
 Which is a folic acid analog that inhibit DNA synthesis
in trophoblastic cells

21. Methotrexat
e treatment
Indications
 Cornual pregnancy
 Persistent trophoblastic
disease
 Patient with one
fallopian tube and
fertility desired
 When trophoblastic cells
adherent to bowel or
blood vessel
Contraindications
 Chronic liver, renal or
haematological disorder
 Active infection
 Immunodeficincy
 Breast feeding

22. Surgical
approach
Laparoscopy
Laparotomy

23. Laparoscopy
 Less blood loss
 Shorter operating time
 Less anaelgesia
 Shorter hospital stay
 Shorter convalescence
 Mainstay of management

24. Laparotomy
 For severely compromised patients
 When endoscopic facilities are lack

25. During
surgery
Salpingectomy
 Removal of fallopian tube
 Treatment of choice when one normal tube
is remaining
Salpingotomy
 Fallopian tube opened at the site of ectopic
pregnancy and trophoblastic cells extracted
 Associated with higher rate of subsequent
ectopic pregnancy

26. ThankYou!