Symptoms and signs are include pelvic pain and vaginal bleeding. Transvaginal ultrasound is the diagnostic tool of choice for tubal ectopic pregnancy. There is a describe rupture measure length and width, note associated hemorrhage, blood clot. Ectopic pregnancy is the second major cause of maternal mortality in the united states and a leading cause of maternal morbidity and mortality in the world. Adnexal sonographic findings in ectopic pregnancy and. Please use one of the following formats to cite this article in your essay, paper or report. When a pregnant patient presents with firsttrimester bleeding or abdominal pain, physicians should. Pdf on mar 24, 2014, goran augustin and others published ruptured ectopic pregnancy find, read and cite all the research you need on.
Diagnosis and management of ectopic pregnancy annemarie lozeau, m. Pregnancies in the fallopian tube account for 97 percent of ectopic pregnancies. Purpose and scope the purpose of this guideline is to improve the management of women who may have an ectopic pregnancy. The most common ectopic implantation site is the fallopian tube, though 10 % of ectopic pregnancies implant in the cervix, ovary, myometrium, interstitial portion of the fallopian tube, abdominal cavity or within a cesarean section scar. Risk factors for ectopic pregnancy include a previous ectopic pregnancy, the presence of tubal damage from an infection or prior abdominalpelvic surgery, a history of infertility, treatment for in vitro fertilization, increased maternal age and smoking 5. The prevalence of ectopic pregnancy is 12% and it is an important cause of maternal morbidity and mortality consider ectopic pregnancy in all pregnant women presenting with abdominal pain or vaginal bleeding women with a history of ectopic pregnancy, tubal surgery, or tubal pathology are at. Fertilization of the ovum occurs in the fallopian tube. A ruptured ectopic pregnancy is a surgical emergency because it causes maternal hemorrhage and risk of death. Its incidence is increasing and has been risen from 4. The incidence of ectopic pregnancy is reported most commonly as the number of ectopic pregnancies per conceptions. A ruptured ectopic pregnancy is a surgical emergency, and a prompt diagnosis is essential to prevent maternal hemorrhage and death. Ectopic pregnancy in conakry, guinea world health organization. Alloimmunisation has been reported following ectopic pregnancy and 25% of cases of ruptured tubal ectopic pregnancy are associated with a significant number of fetal cells in the maternal circulation.
Fallopian tube rupture is most often a complication of a tubal ectopic pregnancy where the pregnancy breaks open due to progressive growth. Although this is rare, there is a risk of rupture of ectopic pregnancy during followup even if the titers of betahcg decline. In some cases, the following conditions have been linked with an ectopic pregnancy. An ectopic pregnancy is exceedingly rare if an intrauterine pregnancy is identified on ultrasound. The incidence rates vary among different countries. Women diagnosed with ectopic pregnancy may be categorized into two groups. Diagnosis and management of ectopic pregnancy american. In the uk, ectopic pregnancy remains the leading cause of pregnancy related first trimester death 0. Matt, miz and sam discuss the spectrum of presentation for ectopic pregnancy. The diagnosis and treatment of ectopic pregnancy ncbi. After ectopic pregnancy, couples have not only to face the loss of a child but also fears about future fertility, writes sheila wayman. In a normal pregnancy, the fertilized egg moves from the fallopian tube into the uterus, where the pregnancy develops. Extrauterine pregnancy is a complication of the first trimester of.
In a small percentage of pregnancies, however, the embryo implants in. In developing countries, the incidence rates vary from 1in 44 deliveries to 1 in 21 deliveries 1, 2, 3, while in the developed western countries, the rates are between 1 in 233 and 1 in 280 deliveries 4, 5. University of wisconsin medical schoolmadison, madison, wisconsin e ctopic pregnancy is any. The incidence of ectopic pregnancy has been rising over the last 20 years.
Diagnosis of unruptured ectopic pregnancy is still uncommon. Although rare, molar changes can occur at any site of an ectopic pregnancy. Ectopic pregnancy should be considered when a female presents with vaginal bleeding, usually in the first trimester, pelvic pain and a palpable adnexal mass, although all the signs may not be present every time. An ectopic pregnancy is very dangerous and should be treated immediately. Objective to assess the incidence of ectopic pregnancy ep in hospitals in conakry, the. Surgery is still typically recommended if the tube has ruptured, there is a fetal heartbeat. An ectopic pregnancy is a pregnancy implanted in an abnormal location outside of the uterus.
An ectopic pregnancy is a pregnancy that occurs outside of the uterus. In the left fallopian tube there is an ectopic pregnancy. An ectopic pregnancy occurs in roughly one in 100 pregnancies. Clinical diagnosis of a molar pregnancy is difficult but histopathology is the gold standard for diagnosis. The majority of ectopic pregnancies occur in the fallopian tube 96 percent, but other possible sites include. In the left fallopian tube there is an ectopic pregnancy and bleeding. It implants somewhere else, most often in the fallopian tube. A ruptured ectopic pregnancy should be strongly suspected if a woman has a positive pregnancy test and presents with syncope and signs of. Half of the women with ectopic pregnancies have no identifiable risk factors 6. An ectopic pregnancy most often occurs in one of the tubes that carry eggs from the ovaries to the uterus fallopian tubes. An ectopic pregnancy can cause the fallopian tube to burst rupture. Ruptured ectopic pregnancy diagnosed with computed tomography. If there is no evidence of pregnancy tissue, the presence of and early diagnosis of an ectopic pregnancy must be considered.
Signs and symptoms of ectopic pregnancy typically include abdominal pain, amenorrhea, and abnormal vaginal bleeding. An ectopic pregnancy is when a fertilized egg implants itself outside of the uterus. If you experience any of these symptoms especially if youre in a highrisk category contact your health care provider immediately. When a pregnant patient presents with firsttrimester bleeding or. The majority of ectopic pregnancies occur in the fallopian tubes. Ep, eccyesis, extrauterine pregnancy, eup, tubal pregnancy when in fallopian tube. Ruptured ectopic pregnancy with collapse and or significant free fluid in the abdomen haemoperitoneum. Early treatment reduces morbidity from a ruptured ectopic pregnancy, but risks overtreating an evolving spontaneous abortion or interrupting a. Ectopic pregnancy is a common condition throughout the world. A ruptured ectopic pregnancy is a true medicalemergency. Ectopic pregnancy aftercare instructions what you need. Diagnosis and management of ectopic pregnancy mcgill university. If ectopic pregnancy appears unlikely and patients are stable, serum levels of betahcg can be measured serially on an outpatient basis typically every 2 days. Revised guideline aims to prevent women dying from ectopic.
Epidemiology the overall incidence has increased over the last few decades and is currently thought to affect 12% of pregnancies. Laparotomy, revealed a ruptured left tubal ectopic pregnancy and histopathological examination was suggestive of a molar pregnancy. In a normal pregnancy, a fertilized egg implants and grows in the uterus also called the womb. However, hemorrhage from extrauterine pregnancies remains the leading cause of pregnancy related death in the first trimester and accounts for 410% of all pregnancy related deaths in the us 4. Contraceptive choices after a miscarriage or ectopic pregnancy. Treatment of an ectopic pregnancy the doctor will explain the medical and surgical choices to you. Seethapathy nagar, velacherry, chennai600042 corresponding author abstract introduction ectopic pregnancy is one of the most common gynaecological emergencies. Get a printable copy pdf file of the complete article 999k, or click on a page image below to browse page by page. The mother must be treated to avoid risks and complications, such as rupture, that can be lifethreatening. What links here related changes upload file special pages permanent link page. Risk of rupture in acute phase from sexual intercourse or pelvic exam consider alternative management if indicated e. Trimester bleeding jody steinauer, md, mas july, 2015 disclosures. Pregnancy where location has not been identified but is suspicious for ectopic.
The cause for the rupture is when the pregnancy outgrows the narrow confines of the fallopian tube. Feb 20, 2020 ectopic pregnancy, condition in which the fertilized ovum egg has become imbedded outside the uterine cavity. Links to pubmed are also available for selected references. It may just be that the pregnancy is too early to see on a scan or that a miscarriage might have already occurred, but the diagnosis of ectopic pregnancy cannot be ruled out. Ectopic pregnancy, which is any pregnancy implanted outside the uterine cavity, remains the leading cause of pregnancyrelated. This booklet is designed to provide information on the diagnosis and treatment of ectopic pregnancy.
Diagnosis and management of ectopic pregnancy 2016. Gynecologic pathology grossing guidelines specimen type. University of wisconsin medical schoolmadison, madison, wisconsin e ctopic pregnancy is any pregnancy that occurs outside the uterine cavity. Lab testing includes a urine betahcg and, if positive, a quantitative serum betahcg and a transvaginal ultrasound.
Ectopic pregnancy affects 1% to 2% of all pregnancies and is responsible for 9% of pregnancy related deaths in the united states. Incidence, diagnosis and management of tubal and nontubal. Diagnosis of ectopic pregnancy how is a tubal pregnancy diagnosed. Information for you this leaflet has been updated uptodate information is available on the rcog website. The tubes can only stretch but so much and once the pressure of the growing pregnancy splits the tube, it causes heavy internal bleeding. Ectopic pregnancy united states pdf ppt case reports. How soon can i have sex again after a miscarriage or ectopic pregnancy. The most common sites include the ampulla and isthmus of the fallopian tube. Ectopic pregnancy refers to the implantation of a fertilised ovum outside of the uterine cavity. In an ectopic pregnancy, the fertilized egg does not make it to the uterus. Ectopic pregnancy occurs when a fertilized egg attaches and begins to grow outside of the uterus. Less commonly, the ovaries, cervix or peritoneal cavity can be involved. This book contains the practical methods to early diagnosis of various forms of ectopic pregnancies and their modern management. The management of tubal pregnancy this guideline replaces the management of tubal pregnancies, produced in october 1999.
Factors that raise the risk for a tubal rupture in a given tubal ectopic pregnancy include 24 history of pelvic surgery. Profuse hemorrhage from ruptured ectopic pregnancy. Everything from minor vaginal bleeding to ruptured ectopic. In some cases, however, an ectopic pregnancy occurs in the abdominal cavity, ovary or neck of the uterus cervix. There are 3 main treatments for an ectopic pregnancy.
The etiology of ep concentrated mainly on factor causes delayed transport of the fertilized ovum through the fallopian tube favors implantation in tubal mucosa, thus giving rise to ep. Jun 25, 2017 ectopic pregnancy is the leading cause of maternal death in early pregnancy. If pregnancy tissue is seen, an ectopic pregnancy is very unlikely, although very rarely a double pregnancy, one in the uterus and the other in the fallopian tube called a heterotopic pregnancy can occur. It is widely available, well tolerated, and highly sensitive for ectopic pregnancy. Ectopic pregnancy symptoms symptoms of an ectopic pregnancy are often confused with those of a miscarriage or pelvic inflammatory disease. Contraceptive choices after a miscarriage or ectopic. Ectopic pregnancy is cured througha single injection of methotrexate with. Ectopic pregnancy affects 1% to 2% of all pregnancies and is responsible for 9% of pregnancyrelated deaths in the united states. Purpose and scope there were maternal deaths resulting from ectopic pregnancy in the uk during the period 199799. Other risks even if you have been treated for an ectopic pregnancy, there is always a small risk of severe internal bleeding. The rupture of ectopic pregnancy ep still remains the primary and direct cause of death in the first trimester of pregnancy. Risk increases with prior ectopic pregnancy, tubal surgery, history of sexually transmitted infections, smoking, in vitro fertilisation, or if pregnant despite iud usage. It used to be that about 90% of women with ectopic pregnancies had to have surgery. Jan 08, 2018 the cause of an ectopic pregnancy isnt always clear.
Ectopic pregnancy national womens health auckland district. A typical history of ruptured ectopic pregnancy is of a missed period followed by severe abdominal pain and vaginal bleeding. Your normal fertility returns quickly after a miscarriage or ectopic pregnancy. Blackmores case, may indicate peritoneal irritation. This medication could replace surgery for most cases of ectopic pregnancy and revolutionisecontemporary gynaecological care. In the left fallopian tube there is an ectopic pregnancy and bleeding marked by red. The fallopian tube is very narrow and its wall is thin.
The egg can also implant on the outside of the uterus, on the ovary or cervix, or in the abdomen. A rupture can be life threatening, but fortunately theyre uncommon and treatable, if dealt with quickly. Signs and symptoms of an ectopic pregnancy may include abdominal pain, lack of menstrual period amenorrhea, vaginal bleeding, fainting, dizziness, and low blood pressure. The majority of ectopic pregnancies occur in the fallopian tube. If you suspect you have an ectopic pregnancy, medical care should be sought urgently. The site of implantation most commonly is a fallopian tube. Ectopic pregnancy symptoms, diagnosis and treatment bmj. Suspect ectopic pregnancy in any female of reproductive age with pelvic pain, vaginal bleeding, or unexplained syncope or hemorrhagic shock, regardless of sexual, contraceptive, and. Ectopic pregnancy switzerland pdf ppt case reports. Many factors can increase a womans risk of ectopic pregnancy. Ectopic pregnancy is a common lifethreatenin g emergency in the developing world and its frequency is still high.
History of tubal ligation history of pid contraception failure previous ectopic pregnancy tubal reconstructive surgery history of infertility art particularly if the tubes are patent but damaged iud use. It is for use by all healthcare professionals involved in womens. Sep 28, 2017 ectopic pregnancy is the result of a flaw in human reproductive physiology that allows the conceptus to implant and mature outside the endometrial cavity see the image below, which ultimately ends in the death of the fetus. The most common place for this to happen is in the fallopian tube.
New 2016 b tubal ectopic pregnancies should be positively identi. Management guidelines of ruptured ectopic pregnancy. If you want to delay or avoid another pregnancy you should use contraception. The most common symptoms are abdominal and pelvic pain and vaginal bleeding. Ectopic pregnancy modern diagnosis and management is a comprehensive book which guides the reader through. Ectopic pregnancy diagnosis and management in gynaecology and maternal fetal medicine mfm. Risk increases with prior ectopic pregnancy, tubal surgery, history of sexually transmitted infections, smoking, in vitro fertilization, or if pregnant despite iud usage.
Ectopic pregnancy occurs more in young women who still desire children. Visualized ectopic pregnancy, with yolk sac or fetal pole outside the uterus. Representative sections are submitted describe cassette submission. Fallopian tubal rupture radiology reference article. Ectopic pregnancy is a potentially lifethreatening condition occurring in 12 % of all pregnancies. The most common symptoms of an ectopic pregnancy are abnormal bleeding andor pelvic pain in the first trimester. Since 1970, when the reported rate in the united states was 4. Management guidelines of ruptured ectopic pregnancy 16. Diagnosis and management of ectopic pregnancy ncbi. With an ectopic, no evidence of intrauterine pregnancy would.
Definition ectopic pregnancies account for 1% to 2% of all conceptions. Hemorrhage from ectopic pregnancy is still the leading cause of pregnancyrelated maternal mortality in the first trimester and accounts for 4 percent of all pregnancyrelated deaths, despite improved diagnostic methods leading to earlier detection and treatment 2. Ectopic pregnancy is defined as implantation of a fertilized egg outside the uterine cavity. Ectopic, early pregnancy loss, or normal pregnancy. Ectopic pregnancy occurs when a fertilized egg implants itself in a fallopian tube or outside of the uterus. Secondtrimester ectopic pregnancies carry a significant maternal mortality risk. It is important to know that an ectopic pregnancy is not able to develop into a healthy pregnancy or baby. A ruptured ectopic pregnancy and resulting hemorrhage is one of the leading causes of maternal death in the first trimester. Because of tubal rupture, salpingectomy which leads to tubal loss and reduced reproductive potentials is the commonest. An ectopic pregnancy happens when a fertilized egg grows outside the uterus. Approximately 1%2% of pregnancies in the united states are ectopic 1,2. Isthmic rupture usually occurs at 68 weeks, the ampullary one at 812 weeks and the interstitial one at about 4 months risk factors.
Clinical diagnosis of a molar pregnancy is difficult but histopathology is. A combination therapeutic approach to resolve ectopic. An ectopic pregnancy ep falls within the area of the gynecological emergency andor reproductive management of women, which is the implantation of fertilized ovum outside the endometrial cavity. This type of ectopic pregnancy is known as a tubal pregnancy. Ectopic pregnancy is a complication of pregnancy in which the embryo attaches outside the. Early diagnosis and appropriate treatment of the different types of ectopic pregnancies is essential in further reducing the number of women who lose their lives from the condition, states a revised guideline published today 4 november by the royal college of obstetricians and gynaecologists rcog and the association of early pregnancy units apeu. An ectopic pregnancy is a pregnancy located outside the inner lining of the uterus.
Pain is most severe in cases of tubal rupture, whereas in cases of tubal mole and tubal abortion it is colicky. Typically presents 68 weeks after last normal menstrual period, but can present earlier or later. If the ectopic is ruptured, the patient may present with signs of shock. This is a do not miss diagnosis, and one that depending on your urgent cares resources, must be not be misappropriately handled. Management and outcome of ectopic pregnancy in developing. You may need to wait and have another scan when the pregnancy is bigger. Pdf on dec 20, 2017, talal anwer abdulkareem and others. As the fertilized egg grows in the fallopian tube, it can cause the tube to rupture. Ectopic pregnancy gynecology and obstetrics msd manual. If left alone no treatment, an ectopic pregnancy can rupture and create pain and internal bleeding, and even death. Without timely diagnosis and treatment, ectopic pregnancy can become a lifethreatening situation. Full text full text is available as a scanned copy of the original print version. Ectopic pregnancy occurs when a fertilized ovum implants on any tissue other than the endometrial lining of the uterus.
An ectopic pregnancy is any pregnancy which is implanted at a site outside of the uterine cavity. If you have suffered serious injury as a result of your doctors ectopic pregnancy misdiagnosis and the treatment provided was incorrect andor inappropriate, you may be able to file an ectopic pregnancy claim against your doctor and others who were responsible for your misdiagnosis. Ectopic pregnancy modern diagnosis and management intechopen. Evidence level 2 however, there are no studies evaluating the use of anti. Even with the best equipment, it is hard to see a pregnancy less than 6 weeks and just as difficult to see an ectopic pregnancy.
1212 12 1163 778 84 347 677 1164 807 1148 914 309 791 735 583 1080 908 804 342 1414 656 1064 920 181 844 21 1508 1226 998 135 79 566 572 1386 721 1416 738 934 387