Ectopic PregnancyManuel Fonseca Crescioni

MS3Hospital San Lucas Guayma

Ectopic Pregnancy• Implantation of fertilized ovum outside

uterine cavity.

• Most common site is the ampulla of fallopian tube(70-80%)

• Leading cause of maternal death in the 1st trimester

• A=Ampulla 80%

• B=Isthmic 12%

• C=Fimbria 5%

• D=Corneal interstitial 2%

• E= Abdominal1.4%

• F=Ovarian 0.2%

• G= Cervical 0.2%

Risk Factors1.Tubal damage:

a.PID b.Salpingitisc.Previous Abdominal Surgeryd.Endometriosis2.Previous History of Ectopic Pregnancy

3. Decrease Motility of Fallopian Tube

a.Smokingb.IUDc.Maternal Age4. History of Infertility

Classic presentation• Reproductive age female• Unilateral right or left lower quadrant,

abdominal pain or pelvic pain.• weeks after missed period

• +/- Vaginal Bleeding• 50% palpable adnexal mass

Management

• B-hcg

• U/S

Treatment

Medical Treatment

• Reliable patient

• CBC

• CMP

• B-hcg

Medical Treatment• MTX • Exclusion criteria for MTX

-Immunideficiency

-Liver disease

-ectopic is 3.5cm or larger

-fetal heartbeat auscultated

-Bhcg levels less than 5000mlU/ml

-free fluid cul-de-sac

-noncompliant

Medical Treatment

• follow up 4-7 days

• 15% B-HCG decrease

• follow up 4-7 days

Surgical Treatment

• Salpingostomy

Surgical Treatment

• Salpingectomy

25 y/o F presents to ER w/RLQ Pain 8/10, LMP 12 weeks ago, PMH endometriosis , PID , social drinker 10-15 drinks per weekend, smokes 2 packs per week, BHCG is + , u/s show gestational sac outside uterine wall, bp 90/60 hr 105 temp 38, what is the next best step?

a. Give MTX follow up in 4-7 days

b.Order CBC ,CMP, and evaluate for fetal heartbeat

c.Laparoscopic Salpingectomy STAT

d.administer IV fluids, blood products, vassopresors

25 y/o F presents to ER w/RLQ Pain 8/10, LMP 12 weeks ago, PMH endometriosis , PID , social drinker 10-15 drinks per weekend recreational IV drug user, smokes 2 packs per week, BHCG is + , u/s show gestational sac outside uterine wall, bp 90/60 hr 105 temp 38, what is the next best step?

a. Give MTX follow up in 4-7 days

b.Order CBC ,CMP, and evaluate for fetal heartbeat

c.Laparoscopic Salpingectomy STAT

d.administer IV fluids, blood products, vassopresors

Reference

• Medscape

• Fundamentals of Pathlogy 2e Husain A Sattar,MD

• Rapid Review Pathology 4e Edward F. Goljan

• Master the boards USMLE Step 2 ck 3e Conrad Fischer, MD