Ectopic Pregnancy - Prof Zakaria Sanad
Ectopic Pregnancy - Prof Zakaria Sanad
Ectopic Pregnancy - Prof Zakaria Sanad
Zakaria Sanad , MD
Professor,Obstetrics and Gynecology
Department
Faculty of Medicine , Menoufiya University , Egypt
Ectopic Pregnancy ( Eccyesis )
Tubal : > 95 %
Other : < 5 % ( cervical, ovarian,
cesarean scar, rudimentary horn,
abdominal )
Heterotopic ( combined IU and
ectopic ) : Spontaneous 1/30,000
ART 1/100 – 1/500
Risk factors
Tubal ( PID,tubal surgery, endometriosis,
leiomyoma,anomalies )
Assisted Reproductive Technology
(ART) : 2 – 8 % due to medications, high
E/P levels, damaged tubes, number of
embryos, placement )
Others ( smoking, douching, recurrence )
Contraceptive failure : IUD ( 5-10% )
Pathology and Fate
Tubal implantation is abnormal :
+The tube is less distensible
+ The intra-arterial pressure is high
+ Decidual reaction is minimal
+ Trophoblast is more invasive
Timing of rupture :
= Isthmic ( 6-8 weeks )
= Ampullary ( 8-12 weeks )
= Interstitial / Cornual ( 12-16 weeks )
Rupture may lead to severe IP hge ….
shock …. Death
Rupture into tubal lumen .. tubal abortion
Re-implantation on omentum, intestine or
mesentery …. 2ry abdominal pregnancy
Sometimes, the dead embryo may be
mummified or calcified
Blood collects in the Douglas pouch, broad
ligament, around fimbria , even under the
diaphragm
Spontaneous resolution may occur in 30%
due to early embryonic death and
resorption
Clinical Findings
No specific symptoms or signs are
pathognomonic – many disorders can
present similarly
Normal preg, threatened,or incomplete
abortion, ovarian cyst rupture, ovarian
torsion, gastroenteritis or appendicitis
can all be confused with EP
Early diagnosis is crucial, high index of
suspicion should be maintained ( early
pregnancy with bleeding and/or pain )
Symptoms
Pelvic or abdominal pain :
+ almost 100 % of cases
+unilateral or bilateral
+ localized or generalized
+ sub-diaphragmatic or shoulder pain is
suggestive of intra-abdominal bleeding
+ caused by tubal distension, contraction,
abortion or rupture / phrenic nerve ++
Abnormal uterine bleeding :
+ in 75 % of cases
+ due to decidual sloughing of the endom
( lack of progesterone )
+ usually intermittent light spotting
+ however may be heavier
+ a decidual cast may be passed in 5-10%
+ pathologic ex : decidua without ch villi
2ry amenorrhea is variable :
+ about half of women with EP have some
bleeding at the time of expected menses
and may not realize they are pregnant
Syncope, dizziness, lightheadedness
may occur initially and should raise
suspicion of intra-abdominal bleeding
( rupture or abortion )
Signs
Pelvic/abdominal tenderness :
+ diffuse or localized
+ in the majority of cases
Adnexal and/or cervical motion tenderness
is also a common finding
Adnexal mass :
Type 2 , Exogenous
) In-the-niche (