Ectopic Pregnancy

Question 1

Define Ectopic Pregnancy

Answer 1

Developing blastocyst implants outside the endometrium lining.
EUP

Question 2

Epidemiology

Answer 2

Medical emergency
Most common cause of Maternal death
Common in T1.

Question 3

What patients should an ectopic pregnancy be considered in?

Answer 3

1. Any + pregnancy test
2. Repro age + Not on contraception

Question 4

Locations of ectopic pregnancies

Answer 4

Tubal - 93%
>Ampulla 70%
>Isthmus 12%
>Fimbriae 11%
>IS/Corneal 24%

Non-tubal
- ovarian
- abdom
- cervical

Question 5

Differential diagnosis for a case, positive urine pregnancy test

Answer 5

1. Ruptured ectopic
   (always relist as number one!!)
2. PID -salpingitis/ TOC (tubo-ovarian complex)
3. Appendicitis
4. Ovarian cyst- torsion/ hematoma

Question 6

Differentials for case, negative pregnancy test

Answer 6

1. Ruptured ectopic pregnancy
2. Miscarriage- threatened/missed
3. GTD (unlikely)
4. Implantation bleed

Question 7

Risk factors - ectopic pregnancy

Answer 7

40yo +
Smokers
Prev ectopic
Prev miscarriages
Prev induced abortion
Pelvic surgery - tubal !
Appendicitis
Genital infxn- PID most common cause.
Infertility

Question 8

What is the most dangerous site that ectopic pregnancies cam occur?

Answer 8

Ovarian & Corneal

Question 11

Describe how PID causes an ectopic pregnancy.

Answer 11

1. Dmg endosalphinx (lumen lining)
2. Agglutination- mucosa folds at tube.
3. Peritubal adhesions

Question 12

Explain how IUCD & POPill can ectopics

Answer 12

Prevents IUP by changing tubal ciliary motility.

Question 13

Describe the natural history of a tubal pregnancy

Answer 13

1. Ruptured tube- haemoperitoneum
2. Tubal abortion via fimbriae- implants @peritoneum
3. Spontaneous resolution- due to lack of B/S
   T1- troppo blastocyst resorts
   T2- calcified fetus
4. Chronic ectopic- involution of pregnancy
   Chronic inflammatory mass

Question 14

Pathophysiology of ectopics

Answer 14

1. Implantation
2. Trophoblast
   - produces hcg
   (maintains corpus luteum) = estrogen + PG
   Converts secretory endometrium–> decidua

Question 15

How long can an ectopic last in gestational weeks

Answer 15

Doesn’t extend beyond 8-10weeks

Question 16

Why doesn’t ectopic extend beyond 8-10 weeks

Answer 16

1. Tube - no deciduous run
2. Thin wall
3. Lumen diameter
4. Bleeding @implant site as trophoblast invades
5. Trophoblast & Embryo die= no horm support from decidua
   Slough off

Question 17

Clinical Triad for ectopic pregnancy

Answer 17

AVA - ectopic till proven otherwise
1. Abdom pain- sharp
2. Vaginal bleeding
3. Amenorrhea

Question 18

Characteristics of unruptured ectopic

Answer 18

Asymptomatic

Question 19

Characteristics of ruptured ectopic

Answer 19

Pain at shoulder tip