An ectopic pregnancy occurs when a fertilized egg implants somewhere other than the inner lining of the uterus, usually in one of the fallopian tubes. Risk factors include previous pelvic inflammatory disease, smoking, older age, prior abortions or infertility treatments. Symptoms include abdominal pain and vaginal bleeding. Diagnosis is made through ultrasound, pregnancy tests, and sometimes laparoscopy. Treatment depends on the stability of the patient but may include surgery such as salpingectomy or salpingostomy, or nonsurgical options like methotrexate for stable patients.

5. An ectopic pregnancy is one in which the fertilized ovum
becomes implanted in a site other than the normal uterine
cavity.
Ectopic pregnancy is the consequence of an abnormal
implantation of the blastocyst.

7. The possible sites from above downwards are :
1.Fallopian tube (97.7%)
• Ampulla (55%)
• Isthmus (25%)
• Fimbriated end (17%)
• Interstitial part (3%)
2.Abdominal cavity (1.4%)
3.Ovary.
4.Broad ligament.
5.Rudomentary horn of a bicornuate uterus.
6.Cervix.

10. Developmental errors.
Distortion of the tube.
PID.
Surgical obstruction.
Tubal surgery.
IUCD.
Smoking.
Salpingitis.
Artificial reproductive technique.

12. Previous PID.
Smoking.
Older age.
Previous spontaneous abortion.
Previous medical termination.
History of infertility.
Previous use of IUCD.

13. Increased prevalence of chronic PID.
Sterilization operation.
Use of progesterone only pill.
Post coital estrogen pill.
Prior induction of labor.
Previous ectopic pregnancy.
Developmental defect of tube.
Use of ovulation inducing drug.

14. Obstetric disease:
Abortion of an early intrauterine pregnancy.
Abortion followed by salpingitis.
Early pregnancy with pelvic tumor.
Retroverted gravid uterus (Threatened abortion)
Septic abortion.
Gynaecological disease :
Degenerating fibroid.
DUB.
Endometriosis.
Ovulation.
Rupture corpus luteum.
Torsion of adnexal mass.
Dysmenorrhoea.

16. USG.
Pregnancy test.
Laparoscopy.
Treatment:
Hospitalization & kept under observation.
Colpotomy: If pelvic haematocele is infected or pelvic abscess is formed
then posterior colpotomy is done.
Salpingectomy: Unaffected tube is grossly damaged , Rudimentary , Family
not complete.
Salpingostomy.

18. General investigation:
Blood: Hb% , TC , DC , ESR.
Blood grouping & Rh typing.
Special investigation:
USG for uterus & adnexa.
Pregnancy test positive 50% case.
Beta -HCG.
Serum progesterone.
Laparoscopy.

19. General treatment:
Immediate hospilization.
Haemodynamic stabilization.
Specific treatment depends on Haemodynamic stability & whrether tube is
rupture or not.
Surgical treatment ( Haemodynamic unstable patient):
Salpingectomy .
Partial salpingectomy .
Salpingotomy .
Salpingostomy .
Non surgical treatment ( haemodynamic stable patient) :
Inj.Methotraxate.
Just wait & see.

22. Noman Ahmad
18/11/2020