ECTOPIC PREGNANCY: QUESTIONS AND ANSWERS
LATEST UPDATE (GRADED A+)
Ectopic pregnancy
Implantation of a blastocyst in a location other than in the uterine cavity
Classic triad of ectopic symptoms?
Pain
Amenorrhea
Spotting or bleeding
Three categories of ectopic pregnancies?
Intrauterine, extra uterine, heterotopic
Treatment options for ectopic?
Medical
Surgical
Expectant management
Which is preferable, medical or surgical management of ectopic?
Medical management is preferable to even "conservative" surgical procedures whenever feasible, esp in
asymptomatic women with early unruptured EP
Location might an intrauterine ectopic occur?
Gestation in cervix or cornua
Location might an extrauterine ectopic occur?
Fallopian tube, ovary, abdomen, broad ligament
Location might an heterotopic pregnancy occur?
Implantation in both uterine cavity and in an ectopic site (usually tube)
When are heterotopic pregnancies more likely?
With pregnancy resulting from IVF
Which type of ectopic is most common?
Tubal (97%)
How are tubal ectopics classified?
By location: ampullary, isthmic, fimbrial, cornual/insterstital
What type of tubal ectopic is most common?
, Ampullary
Why is ampullary ectopic so common?
Because it is where fertilization usually occurs
When will a woman with an isthmic ectopic become symptomatic?
Earlier rather than later (6-7w?)
Why will a woman with an isthmic ectopic become symptomatic earlier?
Because it that part of the tube is so narrow
What is the most distal part of the fallopian tube?
Fimbriae
What can happen to the products of conception in a fimbrial ectopic?
They can be expelled into the peritoneal cavity
Why do interstitial ectopics generally rupture later rather than earlier?
Thicker portion of the tube partially surrounded by myometrium
When would rupture generally occur with an interstitial ectopic?
9-12w
What is a possible etiology of ectopic related to implantation?
Mechanical interference with implantation: IUC, hormonal dysfunction, sterilization failure
What are some factors considered high risk for ectopic?
Prior ectopic pregnancy
Tubal pathology & surgery
In utero DES exposure
What is the chance of recurrence with prior ectopic pregnancy?
33%
What kind of infection can result in tubal pathology?
Chlamydia, GC, polymicrobial
What is the relationship between IUDs and ectopic?
Doesn't cause EP but if a pregnancy occurs there's a greater risk that the pregnancy is EP
What type of infertility is of greatest risk for ectopic?
Patients with primary infertility due to tubal factors that prohibit or delay ovum transport
LATEST UPDATE (GRADED A+)
Ectopic pregnancy
Implantation of a blastocyst in a location other than in the uterine cavity
Classic triad of ectopic symptoms?
Pain
Amenorrhea
Spotting or bleeding
Three categories of ectopic pregnancies?
Intrauterine, extra uterine, heterotopic
Treatment options for ectopic?
Medical
Surgical
Expectant management
Which is preferable, medical or surgical management of ectopic?
Medical management is preferable to even "conservative" surgical procedures whenever feasible, esp in
asymptomatic women with early unruptured EP
Location might an intrauterine ectopic occur?
Gestation in cervix or cornua
Location might an extrauterine ectopic occur?
Fallopian tube, ovary, abdomen, broad ligament
Location might an heterotopic pregnancy occur?
Implantation in both uterine cavity and in an ectopic site (usually tube)
When are heterotopic pregnancies more likely?
With pregnancy resulting from IVF
Which type of ectopic is most common?
Tubal (97%)
How are tubal ectopics classified?
By location: ampullary, isthmic, fimbrial, cornual/insterstital
What type of tubal ectopic is most common?
, Ampullary
Why is ampullary ectopic so common?
Because it is where fertilization usually occurs
When will a woman with an isthmic ectopic become symptomatic?
Earlier rather than later (6-7w?)
Why will a woman with an isthmic ectopic become symptomatic earlier?
Because it that part of the tube is so narrow
What is the most distal part of the fallopian tube?
Fimbriae
What can happen to the products of conception in a fimbrial ectopic?
They can be expelled into the peritoneal cavity
Why do interstitial ectopics generally rupture later rather than earlier?
Thicker portion of the tube partially surrounded by myometrium
When would rupture generally occur with an interstitial ectopic?
9-12w
What is a possible etiology of ectopic related to implantation?
Mechanical interference with implantation: IUC, hormonal dysfunction, sterilization failure
What are some factors considered high risk for ectopic?
Prior ectopic pregnancy
Tubal pathology & surgery
In utero DES exposure
What is the chance of recurrence with prior ectopic pregnancy?
33%
What kind of infection can result in tubal pathology?
Chlamydia, GC, polymicrobial
What is the relationship between IUDs and ectopic?
Doesn't cause EP but if a pregnancy occurs there's a greater risk that the pregnancy is EP
What type of infertility is of greatest risk for ectopic?
Patients with primary infertility due to tubal factors that prohibit or delay ovum transport
