ectopic pregnancy diagnosis treatment risk factors high yield topic for pg preparation last minute revision

1. Ectopic pregnancy

2. • Decidua vera
• Decidua (endometrium) shed in ectopic pregnancy

3. • Implantation of the fertilized ovum outside of the uterine cavity is
known as ectopic pregnancy.

5. • Fallopian tube is the commonest site
• ampullary portion >>isthmic segment of
the tube (12%)>>the fimbria (5%), >> the
cornual and interstitial region of the tube
(2%).
• Non tubal sites of ectopic pregnancy
are a rare occurrence, with abdominal
pregnancies accounting for 1.4% of
ectopic pregnancies and ovarian and
cervical sites accounting for 0.2% each

6. High risk
• PID
• Previous ectopic
pregnancy
• Tubal sterilization
• Tubal corrective
surgery
• Documented tubal
pathology
• ART
Moderate risk
• Previous genital
infection
• Contraceptive failure
• Infertility
• Multiple partners
Low risk
• Previous pelvic or
abdominal surgery
• Smoking
• Douching
• Intercourse before 18
yrs

7. • Most common ectopic pregnancy  PID
• Maximum ectopic pregnancy is after tubal damage d/t tubal Sx or
previous ectopic pregnancy or

8. Chance of ectopic pregnancy increases with
• ART
• More chance with GIFT & IVF
• Atypical implantations are common with ART
• Contraceptive
• With contraceptive use the chance of pregnancy and therefore chance of
ectopic pregnancy decreases
• How ever with contraceptive failure the number of ectopic pregnancy
increases
• Modern IUD does not increase the risk of ectopc pregnancy . However there
is relative increase in tubal pregnancy (7 times more) with IUCD insitu

9. • Death of fetus in ectopic pregnancy is by vascular accident

10. Lithopedion
• If a larger conceptus in culde
sac for years as an
encapsulated mass or even
become calcified to form
lithopedion

11. Interstitial pregnancy
• Tubal pregnancy in interstitial part of FT
• Rupture may not occur until 16 weeks

13. • Ampullary pregnancy ruptures @ 8 weeks
• Isthmic ruptures @ 6 weeks

14. CF
• Pelvic & abdominal pain
• Amenorrhea with some degree of vaginal spotting or bleeding

15. TVS
• Is the most useful investigation in cases of suspected ectopic
pregnancy
• ABSENCE OF GESTATIONAL SAC IN UTERUS (BLOB SIGN)
• Decidual cast in uterus
• Pseudosac is seen in uterus
• Extrauterine gestational sac with or without embryo
• Fluid in POD
• Extraovarian complex adnexal mass  most sensitive & specific sign
• Dilated & thickwalled fallopian tube (adnexal ring) BAGEL SIGN
• Tubal ring sign or echogenic ring sign in Doppler
• Doughnut sign

17. Doughnut sign

18. In Doppler
• Ring of fire appearance in a
adnexa with empty gestational
sac

19. Pseudosac in uterus

28. Heterotypic pregnancy
• Tubal pregnancy may be accompanied by a co existing uterine
gestation
• Increasing d/t ART