Ectopic Pregnancy

Question 1

What is ectopic pregnancy

Answer 1

An ectopic pregnancy si implantation of the zygote outside the uterine endometrium OR when
the conceptus implants either outside the uterus (fallopian tube, ovary, abdominal cavity) or ni an abnormal position within the uterus (cornua, cervix).

Question 2

What is Heterotopic pregnancy

Answer 2

combined intrauterine pregnancy
and ectopic pregnancy.

Question 3

List AETIOLOGIES of ectopic pregnancy

Answer 3

• Tubal damage (most important) e.g. from salpingitis secondary to PID, post abortal or puerperal sepsis
• Previous ectopic pregnancy
• Previous tubal surgery
• Endometriosis
• Progesterone contraceptives

Question 4

POSSIBLE LOCATIONS OF
ECTOPIC PREGNANCY 🤰 list 4

Answer 4

.1 Tubal
2. Abdominal
3. Ovarian
.4 Cervical - can cause severe
bleeding per vaginam and mimic miscarriage.

Question 5

CLINICAL PRESENTATION

Answer 5

1. Quiet or Chronic
2. Acute
   .3 Subacute or unruptured

Question 6

What should you ask while taking history for ectopic pregnancy

Answer 6

• Presenting complaint depends on whether it is ruptured or unruptured:
  i) Abdominal pain
  (i1) Amenorrhoea
  (iii) Irregular bleeding per vaginam
  (iv) Syncope

Question 7

How do you clerk for amenorrhoe

Answer 7

AMENORRHOEA:
- LMP? • Early pregnancy symptoms eg. nausea, vomiting, breast tenderness etc.
N.B:
Amenorrhea may be absent in an isthmic ectopic which ruptures very early even before the woman misses a period.

Question 8

How do u clerk BLEEDING PER VAGINAM: in ectopic pregnancy

Answer 8

• It m a y ‘ b e s p o t t i n g or m a y simulate menstrual bleeding. This si
  as a result of shedding of the endometrium because of withdrawal
  of hormonal support from the failed pregnancy.
• Adecidual cast may be seen.

Question 9

Why is bleeding 🩸 per vaginum not usually heavy in ruptured ectopic pregnancy

Answer 9

• It si not usually heavy because bleeding from ruptured ectopic si into hte peritoneal cavity. It usually occurs after abdominal pain (whereas reverse is the case in
  abortion)
• High index o f suspicion ni any woman ofreproductive age