Chapter 19 – Ectopic Pregnancy

A collection of key vocabulary terms and definitions drawn from Chapter 19 on ectopic pregnancy, covering implantation sites, diagnostic concepts, risk factors, and management options.

Ectopic Pregnancy

Implantation of a fertilized ovum outside the endometrial lining of the uterine cavity.

Tubal Pregnancy

Ectopic implantation within any segment of the fallopian tube; accounts for ~95 % of ectopic pregnancies.

Ampullary Ectopic

Tubal pregnancy located in the ampulla; most common site (~70 %).

Isthmic Ectopic

Tubal pregnancy in the isthmus of the tube (~12 %).

Infundibular (Fimbrial) Ectopic

Tubal pregnancy sited in the fimbrial end of the tube (~11 %).

Interstitial Pregnancy

Implantation within the intramural (interstitial) portion of the tube that traverses the uterine wall.

Cesarean Scar Pregnancy (CSP)

Gestation implanted in the myometrial defect of a previous cesarean-section scar.

Cervical Pregnancy

Ectopic gestation implanted within the cervical canal below the internal os.

Abdominal Pregnancy

Implantation within the peritoneal cavity exclusive of tubes, ovaries, or broad ligament.

Ovarian Pregnancy

Ectopic implantation within the ovary, fulfilling Spiegelberg criteria.

Heterotopic Pregnancy

Co-existing intrauterine and ectopic gestations; incidence rises with assisted reproduction.

Acute Ectopic Pregnancy

Rapidly growing ectopic with high β-hCG levels and higher risk of rupture.

Chronic Ectopic Pregnancy

Ectopic in which trophoblast degenerates early, yielding low or static β-hCG and a complex pelvic mass.

β-hCG (Beta-Human Chorionic Gonadotropin)

Hormone produced by trophoblast; used for pregnancy detection and ectopic surveillance.

Discriminatory Zone

Serum β-hCG level above which an intrauterine gestational sac should be visible on transvaginal sonography (commonly 1 500–2 000 mIU/mL).

Pregnancy of Unknown Location (PUL)

Positive pregnancy test with no intra- or extra-uterine gestation visualized on ultrasound.

Serum Progesterone Test

Single progesterone value helping categorize pregnancies;

Pseudogestational Sac

Cavity-conforming fluid collection within the endometrium, often seen with ectopic pregnancy.

Decidual Cast

Entire sloughed decidualized endometrium expelled intact; may mimic products of conception.

Intradecidual Sign

Early intrauterine gestational sac seen eccentrically within decidua; helps confirm IUP.

Interstitial Line Sign

Echogenic line from endometrial cavity to interstitial gestational sac; specific for interstitial pregnancy.

Ring of Fire

Peripheral high-velocity vascular flow seen on color Doppler around a tubal ectopic mass.

Hemoperitoneum

Free intraperitoneal blood; detected sonographically, indicates possible rupture.

Culdocentesis

Needle aspiration of fluid from rectouterine pouch to detect hemoperitoneum; largely replaced by ultrasound.

Methotrexate (MTX)

Folic-acid antagonist used to medically treat ectopic pregnancy by inhibiting trophoblastic proliferation.

Single-Dose MTX Protocol

50 mg/m² IM on day 1 with β-hCG checks on days 4 & 7; second dose if <15 % decline between days 4–7.

Multidose MTX Protocol

MTX 1 mg/kg on days 1,3,5,7 with leucovorin rescue on alternate days; up to four doses until β-hCG drops ≥15 %.

Leucovorin Rescue

Folinic acid given after MTX in multidose regimens to mitigate cytotoxic side-effects.

Separation Pain

Post-MTX pelvic pain due to detachment of ectopic tissue from tube; usually self-limited.

Salpingostomy

Linear incision on antimesenteric tubal border to remove ectopic tissue while preserving the tube.

Salpingectomy

Surgical removal of the affected fallopian tube, usually from uterotubal junction to fimbria.

Persistent Trophoblast

Continued viable trophoblastic tissue after surgery; indicated by plateauing or rising β-hCG.

Expectant Management

Close observation without immediate intervention for selected early ectopic pregnancies with falling or low β-hCG.

Salpingitis Isthmica Nodosa

Diverticular outpouchings in the isthmic tube musculature; risk factor for ectopic pregnancy.

Hemat​osalpinx

Blood-filled, distended fallopian tube often following tubal abortion.

Angular Pregnancy

Implantation in the uterine corner medial to uterotubal junction; distinguished from interstitial pregnancy.

Cornual Resection

Wedge excision of interstitial gestation and surrounding myometrium with subsequent layered closure.

Cornuostomy

Incision and removal of interstitial gestation with preservation of surrounding myometrium; incision closed afterwards.

Chemoembolization

Combination of uterine artery embolization with intra-arterial or systemic MTX for cervical or scar pregnancies.

Uterine Artery Embolization (UAE)

Radiologic occlusion of uterine arteries to control or pre-empt hemorrhage in ectopic treatment.

Broad-Ligament (Intraligamentous) Pregnancy

Ectopic implantation between the leaves of the broad ligament.

Spiegelberg Criteria

Set of four anatomical/histological requirements that confirm an ovarian pregnancy.