Ectopic Pregnancy

Pregnancy in which implantation occurs outside the endometrium and endometrial cavity--ie, in the cervix, uterine tube, ovary, or abdominal or pelvic cavity.

Risk Factors

  • tubal infection - 50%

  • tubal disorder

  • previous ectopic pregnancy

  • exposure to DES

  • induced abortion

  • intrauterine device

Mortality

  • 1in 826 (USA)

Symptoms & Signs

  • shortly after missed period

    • spotting (usually precedes pain)

    • cramping pain

  • pain

  • pelvic pressure

  • hypotension

  • shock

  • uterus enlarged - but small for dates

  • motion tenderness of cervix

  • tender mass in adnexum

  • cul-de-sac may bulge

Rupture

  • tubal at 6-8 weeks

  • cornual at 12-16 weeks

Investigations

  • beta-hCG - urine, serial titres (double about 48-72 hours normally, slower in ectopic)

  • USS

  • aspiration from cul-de-sac

  • laparoscopy

Treatment

  • surgery

    • salpingotomy

    • hysterectomy

  • ? methotrexate 50 mg/m2 IM - if <3.5cm and no foetal heart

 

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