Ectopic Pregnancy Lecture Notes

Definition

• Ectopic: Out of place
• Ectopic Pregnancy: Pregnancy occurring outside the uterine cavity

Process

1. Fertilization: Egg fertilized outside the uterine cavity
2. Implantation: Egg implants on a surface with sufficient blood supply
   • Common sites: Ovaries, intestines, ampulla of the fallopian tube
3. Development: Embryo develops, possibly leading to symptoms similar to normal pregnancy

Outcomes

• Insufficient blood supply: Embryo death
• Sufficient blood supply: Hormonal changes, missed menstrual period, nausea, breast fullness
• Ampullary Ectopic Pregnancy: Can lead to stretching, pain, potential rupture of the fallopian tube
  • Rupture Consequences: Massive hemorrhaging, peritoneal irritation, referred shoulder pain, light vaginal bleeding

Risk Factors

• Smoking
• Pelvic inflammatory disease
• In vitro fertilization
• Gynecologic surgery
• Use of intrauterine devices
• Tubal ligation
• Previous ectopic pregnancy

Symptoms

• Amenorrhea (missed menstrual period)
• Pelvic pain
• Vaginal bleeding
• Palpable mass near uterus (on physical exam)
• Abdominal tenderness

Diagnosis

• Establish hemodynamic stability (vital signs normal: no hypotension, no tachycardia)
• Hemodynamically unstable: Immediate surgery required
• Hemodynamically stable:
  • Serial hCG testing (levels should double every 2 days)
  • Transvaginal ultrasound (checks for intrauterine pregnancy, identifies ectopic pregnancy signs)

Treatment

• Early Diagnosis and Stable HCG: Close monitoring, serial HCG measurements
• Later Diagnosis: Methotrexate to terminate pregnancy
• Unstable Patient: Surgical intervention
  • Salpingostomy: Open and close fallopian tube to remove pregnancy
  • Salpingectomy: Remove fallopian tube entirely

Recap

• Ectopic Pregnancy: Fertilized egg implants outside uterine cavity
• Risk Factors: Smoking, pelvic inflammatory disease, in vitro fertilization, pelvic surgery, intrauterine devices, tubal ligation, previous ectopic pregnancy
• Treatment: Depends on hemodynamic stability, includes monitoring, methotrexate, surgery