ECTOPIC PREGNANCY: QUESTIONS AND ANSWERS
LATEST UPDATE (GRADED A+)
Immediate surgical intervention is indicated for:
a high hCG level,
abdominal pain,
vaginal bleeding,
hemodynamic failure,
hemoperitoneum, and
syncope
Stats of ectopic preg
up to 2.6% of pregnancies
and in 6% to 16% of women who visit the emergency department with pain or bleeding (or both) in early
pregnancy
ektopos
out of place (Greek)
How much has ectopic preg increased?
sixfold since 1970, peaking in the late 1980s, perhaps because of an attendant increase in sexually
transmitted diseases, increased frequency of sterilization procedures, and delayed childbearing
What age does ectopic pregnancy increase?
30 years, especially beyond the age of 35 years.
Ectopic pregnancy and maternal mortality
second leading cause of maternal mortality
leading cause of pregnancy-related death in the first trimester,
representing approximately 6% to 9% of maternal deaths
Risk factors for ectopic preg
all maternal
tubal pathologic conditions and infections (e.g., chlamydia, gonorrhea, or salpingitis),
prior tubal surgery including sterilization,
particularly at younger (<28) age,
prior ectopic gestation,
in vitro fertilization (embryo transfer and assisted hatching),
endometriosis,
irritable bowel syndrome,
, smoking
daughters of mothers who experienced ectopic pregnancy had a 50% higher risk of ectopic gestation
Although intrauterine devices do not increase the risk for ectopic pregnancy, pregnancies that occur
with these devices in place are more likely to be ectopic
Patho for ectopic preg
abnormal embryogenesis (with serious chromosomal aberration in one-third of cases)
ascending Chlamydia trachomatis infection that scars the fallopian tubes,
and luteal phase defects.
most common site of ectopic pregnancy
95% of ectopic pregnancies implant in the distal portion of the fallopian tube and on the ipsilateral side
to the corpus luteal cyst
Cervical pregnancy
is the rarest form of ectopic pregnancy (accounting for <1% of all ectopic pregnancies) and has been
associated with cervicouterine instrumentation.
Ovarian pregnancy
associated with ovulation induction, intrauterine insemination, and vaginal douching
Heterotopic pregnancy (simultaneous intrauterine and extrauterine gestations)
is increasing in incidence, occurring in 0.3% to 0.8% of the general population and 1% to 3% of women
whose pregnancies resulted from assisted reproductive technologies
Persistent ectopic pregnancy
involves residual trophoblastic activity and a β-human chorionic gonadotropin (β-hCG) level that rises or
plateaus
chronic ectopic pregnancy
contains no active trophoblastic tissue and results in an hCG level that is low or absent.
most common symptom of ectopic pregnancy
Abdominal pain, which may manifest in isolation or in combination with vaginal bleeding or spotting,
dizziness, and shoulder pain (which suggests blood irritating the diaphragm)
Other s/s of ectopic preg
between 6 and 12 weeks of gestation.
Amenorrhea for 1 to 2 months and the usual early signs of pregnancy (nausea, fatigue, breast heaviness)
are often part of the initial presentation.
generalized or unilateral pelvic or abdominal pain described as sharp, cramping, continuous, or
intermittent.
Less common presenting symptoms include
LATEST UPDATE (GRADED A+)
Immediate surgical intervention is indicated for:
a high hCG level,
abdominal pain,
vaginal bleeding,
hemodynamic failure,
hemoperitoneum, and
syncope
Stats of ectopic preg
up to 2.6% of pregnancies
and in 6% to 16% of women who visit the emergency department with pain or bleeding (or both) in early
pregnancy
ektopos
out of place (Greek)
How much has ectopic preg increased?
sixfold since 1970, peaking in the late 1980s, perhaps because of an attendant increase in sexually
transmitted diseases, increased frequency of sterilization procedures, and delayed childbearing
What age does ectopic pregnancy increase?
30 years, especially beyond the age of 35 years.
Ectopic pregnancy and maternal mortality
second leading cause of maternal mortality
leading cause of pregnancy-related death in the first trimester,
representing approximately 6% to 9% of maternal deaths
Risk factors for ectopic preg
all maternal
tubal pathologic conditions and infections (e.g., chlamydia, gonorrhea, or salpingitis),
prior tubal surgery including sterilization,
particularly at younger (<28) age,
prior ectopic gestation,
in vitro fertilization (embryo transfer and assisted hatching),
endometriosis,
irritable bowel syndrome,
, smoking
daughters of mothers who experienced ectopic pregnancy had a 50% higher risk of ectopic gestation
Although intrauterine devices do not increase the risk for ectopic pregnancy, pregnancies that occur
with these devices in place are more likely to be ectopic
Patho for ectopic preg
abnormal embryogenesis (with serious chromosomal aberration in one-third of cases)
ascending Chlamydia trachomatis infection that scars the fallopian tubes,
and luteal phase defects.
most common site of ectopic pregnancy
95% of ectopic pregnancies implant in the distal portion of the fallopian tube and on the ipsilateral side
to the corpus luteal cyst
Cervical pregnancy
is the rarest form of ectopic pregnancy (accounting for <1% of all ectopic pregnancies) and has been
associated with cervicouterine instrumentation.
Ovarian pregnancy
associated with ovulation induction, intrauterine insemination, and vaginal douching
Heterotopic pregnancy (simultaneous intrauterine and extrauterine gestations)
is increasing in incidence, occurring in 0.3% to 0.8% of the general population and 1% to 3% of women
whose pregnancies resulted from assisted reproductive technologies
Persistent ectopic pregnancy
involves residual trophoblastic activity and a β-human chorionic gonadotropin (β-hCG) level that rises or
plateaus
chronic ectopic pregnancy
contains no active trophoblastic tissue and results in an hCG level that is low or absent.
most common symptom of ectopic pregnancy
Abdominal pain, which may manifest in isolation or in combination with vaginal bleeding or spotting,
dizziness, and shoulder pain (which suggests blood irritating the diaphragm)
Other s/s of ectopic preg
between 6 and 12 weeks of gestation.
Amenorrhea for 1 to 2 months and the usual early signs of pregnancy (nausea, fatigue, breast heaviness)
are often part of the initial presentation.
generalized or unilateral pelvic or abdominal pain described as sharp, cramping, continuous, or
intermittent.
Less common presenting symptoms include
