Ectopic : means abnormal place or position, normally implantation of the Blastocyst should occur in the uterus, So Ectopic Pregnancy means simply implantation of the Blastocyst outside the uterine cavity.
most commonly, ectopic pregnancy occurs in the oviducts and particularly in the distal ampulla,
what are the causes of Ectopic pregnancy ?
Ectopic pregnancy may occur idiopathically, however the most common cause is tubal scarring and adhesion (i.e. there's simply a mechanical obstruction or disruption in the normal ciliary mechanism that's responsible to deliver the blastocyst to the normal implantation site and therefore would result in abnormal implantation)
and the most common reason for tubal adhesion or scarring is a Pelvic Inflammatory Disease (PID), also tubal surgeries and Intrauterine devices, a previous history of ectopic pregnancy increases Risk factors by 15 %.
in short always exclude a previous PID in a case of ectopic pregnancy.
Ectopic Pregnancy would present in a female in the child bearing period with a classic triad of
1- Unilateral adnexal pain
2- Amenorrhea
3- Vaginal spotting(bleeding) due to unstable trophoblastic changes occuring in the uterus.
On examination , adnexal tenderness with cervical wall motion tenderness would be present, you may or may be not palpate an adnexal mass
In case of Ruptured ectopic pregnancy , it's a medical emergency with tachycardia, hypotension, abdominal tenderness, guarding and rigidity.
How to manage a case of an Ectopic pregnancy ?
First, always remember that any case with Amenorrhea should be initially tested with Beta- HCG test.
Criteria for diagnosis of Ectopic Pregnancy is :
1- B-HCG greater than 1500mIU
2- No uterine mass detected by the VAGINAL US.
IMPORTANT! HCG levels less than 1,500 are inconclusive(before 5th week) and DOES NOT EXCLUDE PREGNANCY , you should follow up regularly HCG levels ! for detection of rising titer.
to understand this diagnostic criteria, it's worth to know that Pregnancy could be visualized using vaginal US on the 5th week of gestation , where HCG would be more than 1500 , also it's visualized using abdominal US after the 6th week of gestation, when HCG levels are more than 6500
http://php.med.unsw.edu.au/embryology/index.php?title=File:Ectopic_01.jpg
How to manage Ectopic Pregnancy ?
Ruptured Ectopic is managed by urgent Laparotomy and SALPINGECTOMY
Unruptured Ectopic Pregnancy is either managed by Methotrexate or Salpingostomy
Criteria to use Methotrexate :
Size is less than 3.5 cm , no heart sounds, no history of folic acid supplementation and HCG less than 6000
most commonly, ectopic pregnancy occurs in the oviducts and particularly in the distal ampulla,
what are the causes of Ectopic pregnancy ?
Ectopic pregnancy may occur idiopathically, however the most common cause is tubal scarring and adhesion (i.e. there's simply a mechanical obstruction or disruption in the normal ciliary mechanism that's responsible to deliver the blastocyst to the normal implantation site and therefore would result in abnormal implantation)
and the most common reason for tubal adhesion or scarring is a Pelvic Inflammatory Disease (PID), also tubal surgeries and Intrauterine devices, a previous history of ectopic pregnancy increases Risk factors by 15 %.
in short always exclude a previous PID in a case of ectopic pregnancy.
Ectopic Pregnancy would present in a female in the child bearing period with a classic triad of
1- Unilateral adnexal pain
2- Amenorrhea
3- Vaginal spotting(bleeding) due to unstable trophoblastic changes occuring in the uterus.
On examination , adnexal tenderness with cervical wall motion tenderness would be present, you may or may be not palpate an adnexal mass
In case of Ruptured ectopic pregnancy , it's a medical emergency with tachycardia, hypotension, abdominal tenderness, guarding and rigidity.
How to manage a case of an Ectopic pregnancy ?
First, always remember that any case with Amenorrhea should be initially tested with Beta- HCG test.
Criteria for diagnosis of Ectopic Pregnancy is :
1- B-HCG greater than 1500mIU
2- No uterine mass detected by the VAGINAL US.
IMPORTANT! HCG levels less than 1,500 are inconclusive(before 5th week) and DOES NOT EXCLUDE PREGNANCY , you should follow up regularly HCG levels ! for detection of rising titer.
to understand this diagnostic criteria, it's worth to know that Pregnancy could be visualized using vaginal US on the 5th week of gestation , where HCG would be more than 1500 , also it's visualized using abdominal US after the 6th week of gestation, when HCG levels are more than 6500
How to manage Ectopic Pregnancy ?
Ruptured Ectopic is managed by urgent Laparotomy and SALPINGECTOMY
Unruptured Ectopic Pregnancy is either managed by Methotrexate or Salpingostomy
Criteria to use Methotrexate :
Size is less than 3.5 cm , no heart sounds, no history of folic acid supplementation and HCG less than 6000
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