L9: Ectopic Pregnancy Flashcards
Def of Ectopic Pregnancy
Implantation of fertilized ovum outside normal uterine cavity.
Incidence of Ectopic Pregnancy
Why is incidence of Ectopic Pregnancy increasing?
↑↑ incidence of chronic PID & STDs.
↑↑ use of IUCD (specially progesterone releasing IUCD).
↑↑ rate of ART.
Better diagnostic tools.
RF for Ectopic Pregnancy
RF for Ectopic Pregnancy
- Contraceptive Failure
Failure è use of IUCD (specially progesterone releasing IUCD).
Failure è use of progesterone only contraceptives
(not conclusive).
Pregnancy after tubal sterilization.
RF for Ectopic Pregnancy
- Previous Ectopic Pregnancy
Recurrence rate is 10%.
RF for Ectopic Pregnancy
- Increased Maternal Age
Highest rate occurs in women aged 35-44 years.
RF for Ectopic Pregnancy
- Smoking
Due to altered tubal motility, ciliary action & blastocyst implantation process
RF for Ectopic Pregnancy
- Others
- Previous DES exposure
- previous abdominal surgery
- ruptured appendix
- uterine malformations
- salpingitis isthmica nodosa (microscopic presence of tubal epithelium in myosalpinx or beneath tubal mucosa).
Types & Sites of RF for Ectopic Pregnancy
Complications of Ectopic Pregnancy
Complications of Ectopic Pregnancy
- Early Complications
Complications of Ectopic Pregnancy
- Late Complications
Def of Tubal Pregnancy
Implantation of fertilized ovum into tubal wall.
Etiology of Tubal Pregnancy
- Tubal factors
- Factors in ovum
Etiology of Tubal Pregnancy
- Tubal Factors
Etiology of Tubal Pregnancy
- Mechanical Tubal factors
Etiology of Tubal Pregnancy
- Mechanical Tubal factors (Congenital)
Long tortuous tube, diverticulum or accessory ostium.
Etiology of Tubal Pregnancy
- Mechanical Tubal factors (Traumatic)
Microsurgery of tube or after tubal sterilization.
Etiology of Tubal Pregnancy
- Mechanical Tubal factors (Inflammatory)
Etiology of Tubal Pregnancy
- Mechanical Tubal factors (Neoplastic)
Tumors kinking the tube (as broad ligamentary swellings).
Etiology of Tubal Pregnancy
- Functional Tubal factors
Etiology of Tubal Pregnancy
- Functional Tubal factors (Tubal Spasm)
Due to parasympathetic overactivity
Etiology of Tubal Pregnancy
- Functional Tubal factors (Abnormal Peristalisis)
As in IUCD & progesterone only contraceptives use.
Etiology of Tubal Pregnancy
- Ovum factors
Migration theory (wandering ovum)
Uterine Pathology in Ectopic Pregnancy
Uterine Pathology in Ectopic Pregnancy
- Cause
Due to effect of pregnancy hormones.
Uterine Pathology in Ectopic Pregnancy
- Size & Consistency of Uterus
- Enlarged (but not > size of 8 weeks).
- Soft.
Uterine Pathology in Ectopic Pregnancy
- Areas-Stella Reaction
- Areas of hypersecretory endometrium characterized by nuclear pleomorphism & hyperchromatosis (present also in normal pregnancy, GTD & endometriosis).
Uterine Pathology in Ectopic Pregnancy
- Most Importnat Pathology
Absence of chorionic villi.
Tubal Pathology in Ectopic Pregnancy
- Decidual Reaction
Tubal Pathology in Ectopic Pregnancy
- Unditurbed Ectopic Pregnancy
- After implantation, there is picture of undisturbed ectopic pregnancy but pregnancy will not continue due to unfavorable environment (deficient decidual function & thin tubal wall which ruptures easily)
Tubal Pathology in Ectopic Pregnancy
- Disruption of ectopic Pregnancy
- disruption will occur (usually at 6-10 weeks) giving picture of disturbed ectopic pregnancy which have one of the following pathological types (fate) depending on whether disruption occurs towards lumen or towards outer surface:
Tubal Pathology in Ectopic Pregnancy
- If disruption occurs towards lumen, This may lead to:
- Tubal mole
- Tubal abortion
Pathogenesis of Tubal mole
- Repeated attacks of slight Hge → embryo dies but is still attached to tubal wall & becomes surrounded by clotted blood forming mole
Fate of Tubal mole
Shrinkage & absorption, hematosalpinx or pyosalpinx (if infected).
Pathogenesis of Tubal Abortion
- Separation of embryo from tubal wall followed by its expulsion into peritoneal cavity through abdominal ostium.
Incidence of Tubal Abortion
Most common in ampullary or fimbrial pregnancy.
Fate (Types) of Tubal Abortion
Fate (Types) of Tubal Abortion
- Complete Tubal Abortion
Beeding stops & products of conception are absorbed.
Fate (Types) of Tubal Abortion
- Incomplete Tubal Abortion
Fate (Types) of Tubal Abortion
- Incomplete Tubal Abortion may lead to ….
- Hematosalpinx: Blood collects in tube when both tubal ends are closed.
- Peritubal hematocele: Blood collects around abdominal ostium.
- Pelvic hematocele: Blood collects in Douglas pouch.
- Diffuse intraperitoneal Hge.
Hematosalpinx
- Blood collects in tube when both tubal ends are closed.
Peritubal hematocele
- Blood collects around abdominal
ostium.
Pelvic hematocele
Blood collects in Douglas pouch
Tubal Pathology in Ectopic Pregnancy
- If disruption occurs towards Outer Surface, This may lead to:
…
Incidence of Tubal rupture
Occurs in 55% of cases & is more common in isthmic pregnancy.
fate of Tubal rupture
Tubal Pathology in Ectopic Pregnancy
- Tubal Erosion
Tubal Pathology in Ectopic Pregnancy
- Local Signs
- Signs of early pregnancy (present in all clinical types).
- Tender cervical motion (Dodd’s sign): Pain on cervical mobility from side to side.
- Tender adnexal swelling (50%).
CP of Ectopic Pregnancy
Clinical Types of Ectopic Pregnancy
- Subacute disturbed ectopic pregnancy
- Acute disturbed ectopic pregnancy
- Chronic disturbed ectopic pregnancy
- Advanced abdominal pregnancy