ectopic pregnancy

Disorders of early pregnancy
Ectopic Pregnancy
Any pregnancy occurring outside the uterus
Site of implantation:
1- Tubal, ovarian or other intraabdominal
sites.
2- Abnormal site in the uterus: cornu or
Cervix
Incidence
22 / 1000 live birth
16 / 1000 pregnancy

It is increasing from 4 - 19 /1000 preg. (5 folds)
95-98% in the tubes
Types and of ectopic pregnancy:
1) Fimbrial 2) Ampullary 3) Isthemic 4) Interstitial 5)Ovarian 6) Cervical 7)Cornual 8) Secondary abdominal 9) Broad ligament 10) Primary abdominal

Risk Factors:
Any mechanical or functional obstruction of the tubal patency will increases the risk for tubal pregnancy
• History of infertility
• Pelvic inflammatory disease even subclinical chlamydia and GC
• Pelvic operations { tubal, or appendix }, failed tubal sterilization
• Previous tubal pregnancy
• Assisted conception { particularly IVF if tubes are patent and damaged }
• Failed contraceptive methods (Presence of an intra uterine device)

Clinical presentation of Tubal Pregnancy
Tubes are the Commonest site of ectopic pregnancy,
There are no pathognomonic clinical features for tubal or ectopic pregnancy:

Symptoms:
? Onset occurs ~7 weeks after LMP
? Abdominal pain
? Vaginal bleeding

Signs:
? 1st trimester bleeding
? Abdominal tenderness
? Adnexal tenderness

Signs suggestive of ruptured ectopic pregnancy:

? Usually between 6 and 12 weeks gestation
? Severe abdominal tenderness with rebound, guarding
? Shoulder tip pain due to haemoperitoneum and diaphragmatic irritation
? Orthostatic hypotension, fainting attack, dizziness