The blastocyst normally implants in the endometrial lining of the uterine cavity. 1Implantation anywhere else is considered an ectopic pregnancy World Health Organization (2007) ,ectopic pregnancy is responsible for almost 5 percent of maternal deaths in developed countries .
Sites – Fallopian tube commonest
Factors Increasing the Ectopic Pregnancy Rates
- Increasing prevalence of sexually transmitted infections, especially those caused by Chlamydia trachomatis)
- Identification through earlier diagnosis of some ectopic pregnancies otherwise destined to resorb spontaneously
- Popularity of contraception that predisposes pregnancy failures to be ectopic
- Tubal sterilization techniques that with contraceptive failure increase the likelihood of ectopic pregnancy
- Assisted reproductive technology
- Tubal surgery, including salpingotomy for tubal pregnancy and tuboplasty for infertility.
Fate of tubal ectopic pregnancy
Tubal Abortion Abdominal Pregnancy
Broad Ligament Pregnancy
Interstitial and Cornual Pregnancy
Multifetal Ectopic Pregnancy
Symptoms and Signs
Pain. Pelvic and abdominal pain – 95 %
Abnormal bleeding. Amenorrhea with some degree of vaginal spotting bleeding -60% to 80 %
Abdominal and pelvic tenderness
Vital signs ,Fall in Blood Pressure, Tachycardia.
gastrointestinal symptoms (80 percent)
dizziness or light-headedness (58 percent
Diagnosis of Ectopic Pregnancy
Serum Progesterone levels-25 ng/mL
Medical Management–with Methotrexate
This folic acid antagonist is highly effective against rapidly proliferating trophoblast
Active intra-abdominal hemorrhage ,intrauterine pregnancy.breast feeding;
immunodeficiency,alcoholism; chronic hepatic, renal, or pulmonary disease;
blood dyscrasias; and peptic ulcer disease.
The best candidate for medical therapy is the woman who is asymptomatic, motivated, and compliant, with.
Success rate depends on
- Initial serum Beta hCG level,
Success rate is 1.5 percent if the initial serum hCG concentration was <1000 mIU/mL;5.6 percent with 1000-2000 mIU/mL; 3.8 percent with 2000-5000 mIU/mL;
and 14.3 percent when levels were between 5000 and 10,000 mIU/mL
93-percent success rate with single-dose methotrexate when the ectopic mass was <3.5 cm, compared with success rates between 87 and 90 percent when the mass was >3.5 cm.
Fetal cardiac activity -relative contraindication to medical therapy
Rupture of Persistent Ectopic Pregnancy–
This is the worst form of primary therapy failure with a 5 to 10-percent occurrence in women treated medically.
Tubal ectopic pregnancies only
Decreasing serial – BHCG levels
Diameter of the ectopic mass not >3.5 cm
No evidence of intra-abdominal bleeding or rupture by transvaginal sonography
Resolution without treatment was more likely if the initial serum -hCG level was <1000 mIU/mL.
1. F. Gary Cunningham, Kenneth J. Leveno,et al, Williams Obstetrics, 22edition, Section III, chapter10.
About the Author:
Dr Pratiksha Gupta
Department of Gynecology and Obstetrics
Dr Pratiksha Gupta
House number 11284 Laj building
No 1, doriwalan new rohtak road
Karol baghNew delhi110005
Mobile no. 09871128703