Ectopic Pregnancy

last authored: June 2009, Reuben Kiggundu
last reviewed:

 

 

Introduction

Ectopic pregnancy (Greek ektopos, or out of place) refers to the implantation of a fertilized egg outside of the uterine cavity.

 

Locations include the fallopian tubes (isthmus 12%, fimbria 5%), cervix, ovary, cornual region of the uterus, and the abdominal cavity.

 

The abnormally implanted blastocyst grows and draws its blood supply from the site of abnormal implantation. As the gestation enlarges, it creates the potential for rupture and hemorrhage - one of its most dangerous compications.

 

 

 

 

 

 

 

 

Causes and Risk Factors

Anything that hampers the migration of the embryo to the endometrial cavity can predispose to ectopic pregnancy.

• pelvic inflammatory disease - commonest Chlamydia trachomatis (10-15% chance with future pregnancy)
• history of prior ectopic pregnancy (15-20% recurrence rate)
• history of tubal surgery and conception after tubal ligation
• use of infertility drugs or assisted reproductive technology
• use of intrauterine devices
• increasing age
• smoking
• salpingitis isthmica nodosum
• previous DES exposure
• T-shaped uterus
• prior abdominal surgery

 

 

Signs, Symptoms, and Diagnosis

 

 

 

Differential Diagnosis

Other possible conditions include:

• appendicitis
• urinary tract infection
• salpingitis
• ruptured corpus luteum cyst
• threatened abortion

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Pathophysiology

Damage to the cilia in Fallopian tubes may be responsible for ectopic pregnancy, caused by factors such as pelvic inflammatory disease (PID) or surgery.

 

 

 

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Treatments

 

Medications

methotrexate

Rhogam if appropriate

 

Non-medications

Large bore IV and fluid resuscitation

Laparatomy/laparascopy for definitive diagnosis and treatment

 

 

 

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Consequences and Course

Ectopic pregnancy can lead to massive hemorrhage, infertility, and death.

 

 

 

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Resources and References