It is the leading cause of 1st trimester death and causes 0. Women who underwent ectopic pregnancy are advised to avoid getting pregnant for a year after the incident because there is a 10% to 20% chance of a subsequent ectopic pregnancy. The condition of tubal ectopic pregnancy is presented from diverse points of. Purpose and scope there were maternal deaths resulting from ectopic pregnancy in the uk during the period 199799. Nowadays it represents less than 1% of all ectopic pregnancies, with a reported incidence varying from 1. 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. A little is known about its risk factors and incidence. Signs and symptoms it is important for both the pregnant woman and the health care provider to identify any signs and symptoms of an ectopic pregnancy before rupture. In many cases the symptoms have low specificity, and can be similar to those of other genitourinary and gastrointestinal disorders, such as appendicitis, salpingitis, rupture of a corpus luteum cyst, miscarriage, ovarian torsion or urinary tract infection. The guideline includes guidance on when senior andor specialist advice should be sought in order to avoid errors and unnecessary delay. The rate of increase of hcg in ectopic pregnancy is lower than that of normal pregnancies 21. When a pregnant patient presents with firsttrimester bleeding or. Many factors can increase a womans risk of ectopic pregnancy.
Ectopic pregnancy refers to the implantation of a fertilised ovum outside of the uterine cavity. Cornual ectopic pregnancy radiology reference article. The risk is as high as 18% for first trimester pregnancies with bleeding 14. Learn more from webmd about the symptoms, causes, and treatment of an. Ectopic pregnancy remains common in the western world. Identify features concerning for a possible ectopic pregnancy. To calculate ectopic pregnancy rates, women were grouped into three age categories. Risk increases with prior ectopic pregnancy, tubal surgery, history of sexually transmitted infections, smoking, in vitro fertilization, or if pregnant despite iud usage. 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. Alkatout 20ectopic pregnancy occurs in up to 2% of pregnancies. The site of implantation most commonly is a fallopian tube. If quantitative serum betahcg is p reg n a n cy ashis sau, diana hamiltonfairley laparoscopy is not mandatory for the diagnosis of ectopic pregnancy, which can be diagnosed by the use of transvaginal scan together with colour doppler and estimation of quantitative phuman chorionic gonadotrophin phcg. Further study is necessary to elucidate the cause of ectopic pregnancy, probably in the direction of functional disturbances rather than structural defects.
This booklet is designed to provide information on the diagnosis and treatment of ectopic pregnancy. This type of ectopic pregnancy is known as a tubal pregnancy. The incidence of ectopic pregnancy is reported most commonly as the number of ectopic pregnancies per conceptions. When compared with normal pregnancies, hcg levels increase at different rates in ectopic pregnancies 21. Nowadays it represents less than 1% of all ectopic pregnancies, with a reported incidence varying from. Its incidence is increasing and has been risen from 4. Diagnosis involves a combination of clinical symptoms. 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.
Pathophysiology an ectopic pregnancy is when the fertilized egg zygote attaches, or implants, and begins to grow in an area other than the uterus. Surveillance for ectopic pregnancy united states, 19701989. Get a printable copy pdf file of the complete article 577k, or click on a page. Risk factors most common cause for the tubal ectopic pregnancy is a pathologic fallopian tube. Typically presents 68 weeks after last normal menstrual period, but can present earlier or later. There are new guidelines for hcgdiscriminatory zone, as well as epl ultrasound diagnostic cut.
Currently, the use of systemic methotrexate mtx proved to be a great. 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. If there is no evidence of pregnancy tissue, the presence of and early diagnosis of an ectopic pregnancy must be considered. Ectopic pregnancy is a pregnancy in which the developing blastocyst becomes implanted at a site other than the endometrium of the uterine cavity. Any pregnancy implanted outside the endometrial cavity is defined as an ectopic pregnancy ep. Introduction of ectopic pregnancy guangzhou elizabeth. Currently, the use of systemic methotrexate mtx proved to be a great alternative with similar success rates and. Early symptoms and signs include pelvic pain, vaginal bleeding, and. This guideline will cover the following ectopic pregnancies. Ectopic pregnancy united states pdf ppt case reports. Damage to the fallopian tube impairs its ability to transport gametes the sperm or the egg or embryos, and predisposes the woman to faulty implantation of the fertilized ovum. If quantitative serum betahcg is ectopic pregnancy is excluded. Ectopic pregnancy is a kind of abnormal pregnancy where by the fertilized egg develops outside the womb.
The majority of ectopic pregnancies occur in the fallopian tubes. The guideline covers diagnosis of early pregnancy loss, including the use of ultrasound scanning and biochemical testing. A previous history of ectopic pregnancy can also predispose you to an increased risk of developing. Ectopic pregnancy simple english wikipedia, the free. This most often occurs in the fallopian tube, but can be in other areas as well. Ectopic pregnancy is the leading cause of maternal death in the first trimester of pregnancy. Teal, md, mph department of obstetrics and gynecology, university of colorado at denver and health sciences center, academic o. 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. Expectant management of pregnancy of ectopic pregnancy criteria for selection asymptomatic women with an ultrasound diagnosis of ectopic pregnancy. The dosage of beta fraction of human chorionic gonadotropin betahcg and improvement of the transvaginal ultrasound allowed an earlier diagnosis and a conservative management. Diagnosis and management of ectopic pregnancy american. Embryo implantation outside of the endometrial cavity background. Although sometimes interchangeably used with interstitial pregnancy, cornual pregnancy specifically refers to the presence of a gestational sac within a rudimentary uterine. Current management of ectopic pregnancy liberato v.
Since 1970, when the reported rate in the united states was 4. The most common extrauterine location is the fallopian tube, which accounts for 96 percent of all ectopic gestations picture 1ab 1. Information for you this leaflet has been updated uptodate information is available on the rcog website. Up to 10% of women with ectopic pregnancy have no symptoms, and one third have no medical signs. Nonsurgical diagnosis and management of ectopic pregnancy. Results there were 47 ectopic pregnancies in the 10,685 women. As assisted reproductive technology art procedures are becoming popular the incidence is. Ectopic pregnancy occurs in approximately 2% of ivf cycles.
Most cases occur in the fallopian tube and are thus sometimes called tubal pregnancies. Diagnosing ectopic pregnancy and current concepts in the. Ectopic pregnancy is often associated with risk factors that lead to tubal epithelial damage. Ectopic pregnancy symptoms, diagnosis and treatment bmj. Without timely diagnosis and treatment, ectopic pregnancy can become a lifethreatening situation. Common signs of an ectopic pregnancy lady care health. Ectopic pregnancy affects 1% to 2% of all pregnancies and is responsible for 9% of pregnancy related deaths in the united states. Ectopic pregnancy modern diagnosis and management intechopen. Incidence, diagnosis and management of tubal and nontubal.
Low levels are evidence of a problem, like an ectopic pregnancy. We present a case of a week abdominal pregnancy evaluated with ultrasound and magnetic resonance imaging. Ectopic pregnancy, condition in which the fertilized ovum egg has become imbedded outside the uterine cavity. Full text get a printable copy pdf file of the complete article 577k, or click on a page image below to browse page by page. Ectopic, early pregnancy loss, or normal pregnancy. The incidence of ectopic pregnancy has remained static in recent years 11. A ruptured ectopic pregnancy is a surgical emergency because it causes maternal hemorrhage and risk of death. Diagnosis and management of ectopic pregnancy greentop. Cervical ectopic pregnancy is a rare form of ectopic pregnancy and can be defined as the implantation of the blastocyst in the endocervix, below the internal os 14. In some cases, however, an ectopic pregnancy occurs in the abdominal cavity, ovary or neck of the uterus cervix.
Damage to the fallopian tube impairs its ability to transport gametes the sperm or the egg or embryos, and predisposes the woman to faulty implantation of the fertilized ovum seeber and barnhart, 2008. Foster, dphil, md, am amanda dennis, mbe fiona smith, mph acknowledgements this research was conducted by ibis reproductive health for the national womens law center. 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. Cornual ectopic pregnancies are rare and represent a gestational sac within the cornua of a bicornuate or septate uterus. The incidence of ep varies from 11 to 20 per live births in developed countries centres for disease control, 1995. The diagnosis and management of pregnancy of unknown location will not be covered. In a normal pregnancy, the hgc levels double every day. The majority of ectopic pregnancies occur in the fallopian tube 96 percent, but other possible sites include. An ultrasound can also be used to see if the embryo is implanted in the uterus or not. In vitro fertilisation and fertility treatments sexually transmitted infections e. In most cases a near fatal situation, an ectopic pregnancy is characterized by a pregnancy that develops outside the uterus. Ectopic pregnancy gynecology and obstetrics merck manuals. Nonsurgical diagnosis and management of ectopic p reg n a n cy ashis sau, diana hamiltonfairley laparoscopy is not mandatory for the diagnosis of ectopic pregnancy, which can be diagnosed by the use of transvaginal scan together with colour doppler and estimation of quantitative phuman chorionic gonadotrophin phcg. Ectopic pregnancy is a potentially lifethreatening condition occurring in 12 % of all pregnancies.
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 is a pregnancy that occurs outside of the uterus. Definition ectopic pregnancies account for 1% to 2% of all conceptions. In ectopic pregnancy, implantation occurs in a site other than the endometrial lining of the uterine cavityin the fallopian tube, uterine cornua, cervix, ovary, or abdominal or pelvic cavity. Essentially meaning out of place, an ectopic pregnancy is said to have occurred when the fertilized egg does not implant in the uterus, but somewhere else like the fallopian tubes or the abdomen. This book contains the practical methods to early diagnosis of various forms of ectopic pregnancies and their modern management. Ectopic pregnancies cannot be carried to term and eventually rupture or involute.
The fallopian tubes are not designed to hold a growing embryo. An ectopic pregnancy occurs when an embryo implants somewhere other than the uterus, such as in one of the fallopian tubes. Ectopic pregnancy switzerland pdf ppt case reports. Ectopic pregnancy can be an unintended consequence of assisted reproduction. There is an increased incidence associated with in. A transabdominal ultrasound and magnetic resonance imaging were performed. Pregnancy, ruptured, ectopic ovarian ectopic is a rare and dangerous form of ectopic pregnancy. The overall incidence has increased over the last few decades and is currently thought to affect 12% of pregnancies.
The management of tubal pregnancy this guideline replaces the management of tubal pregnancies, produced in october 1999. If ultrasonography detects an intrauterine gestational sac, ectopic pregnancy is extremely unlikely except in women who have used assisted reproductive techniques which increase risk of heterotopic pregnancy. 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. This also means that if you have a inflammatory process such as salpingitis and salpingitis isthmica nodosa, you will be at an increased risk for developing an ectopic pregancy. Investigations incur costs and the use of serial measurements may delay decision making. Box 6511, aurora, co 80045, usa ectopic pregnancy, which is any pregnancy implanted outside the. An ectopic pregnancy occurs when the fertilized egg attaches itself in a place other than inside the uterus. We present a case of ruptured primary ovarian pregnancy which was a surprise intra operative finding. Ectopic pregnancy modern diagnosis and management is a comprehensive book which guides the reader through. Symptomatic early pregnancy ectopic pregnancy must be ruled out, but we must be careful to not diagnose a desired iup as abnormal. Please use one of the following formats to cite this article in your essay, paper or report. There are two main ways to treat an ectopic pregnancy if it is diagnosed before the fallopian tube ruptures. To analyze deaths resulting from complications of ectopic pregnancy, women were grouped into six age categories. Ectopic pregnancy an overview sciencedirect topics.