Ectopic Pregnancy

An ectopic pregnancy is?

the implantation of a fertilized ovum at any site except the endometrium

The most common site for an ectopic pregnancy is?

in the ampullary portion of the fallopian tube

An ectopic in the ampullary portion of the fallopian tube happens _______% of the time

90%

Common to Rare locations of ectopics:

- ampullary/isthmus (95%)

- interstitial/intramural

- ovary

- cervix (1:16,000)

- fimbria

Once they have had an ectopic, the risk of recurrence is?

12-18%

Factors that increase the risk of ectopic:

- any tubal abnormality that may prevent the passage of the zygote & will result in delayed transport

- previous tubal pregnancies

- history of tubal reconstruction surgeries

- pelvic inflammatory disease

- maternal factors (age, # of preg, C-sections)

Symptoms of an ectopic pregnancy:

- pain

- bleeding

- palpated adnexal mass

Locations of ectopic implantations:

- adnexal

- uterine

- cervical

- abdominal

Uterine ectopic

when the conceptus implants on any site within the uterus other than the endometrial cavity

Cervical ectopic

a very rare ocurance & very dangerous because of the chance for bleeding

- has a very high mortality rate

Abdominal ectopic

a rare occurance in which the fertilized ovum implants into the peritoneal cavity

Abdominal Ectopic Sonographic Findings:

- absence of myometrium surrounding the pregnancy

- poor viscalization of the placenta

- presence of an empty uterus separate from the developed fetus

- oligohydraminos (low fluid)

- unusual fetal presentation

Heterotopic pregnancy

when intrauterine & extrauterine pregnancies are coexisting

Heterotopic pregnancy occurance:

1:30,000

Heterotopic pregnancies are more common in?

fertility patients

- 1:500

Clinical symptoms of ectopic gestations:

- amenorrhea

- positive pregnancy test

- spotting or bleeding

- adnexal tenderness or mass

- pelvic pain

- shoulder pain

Ectopic Sonographic Findings:

- live extrauterine embryo

- empty uterus

- sliding sac sign

- presence of an adnexal mass

- free fluid — usually blood

- presence of an endometrial decidual reaction or pseudo-sac in the endometrial lining

Transvaginally, we should be seeing a gestational sac when the BhCG reaches?

1,000-2,000 mIU/mL

Transabdominally, we should be seeing a gestational sac when the BhCG reaches?

6,5000 mIU/mL

Sonographic Pitfalls:

- the presence of fluid in the endo cavity known as pseudo-gestational sac

- misidentification of a corpus luteum cyst as an adnexal ectopic

- misidentification of an acornual/interstitial ectopic as an IUP

The sonographic sign “ring of fire” occurs with?

both ectopics & corpus luteum cysts

For identificaiton of an acornual pregnancy, there is _________________ of myometrium surrounding any side of the gestational sac

less than 5 mm

Using color doppler, a “ring of fire” surrounding the gestational sac represents?

a metabolically active trophoblastic flow

A high velocity, low resistance spectral waveform indicates?

typical trophoblastic flow patterns, but this may be mimicked by flow at the margins of a corpus luteum cyst

______________________ cannot be used to exclude ectopic pregnancy

the absence of doppler signal

Treatment of ectopic pregnancy:

- methotrexate administration (MTX)

- laparoscopy

- exploratory laparoscopy

- expectant management

Methotrexate Administration (MTX)

a cancer treating medication that does something with the development of the cells, it stops cells from dividing

Laparoscopy

when they surgically go in & try to find it

Exploratory Laparoscopy

when they open the patient up and dig around & try to find it

Expectant Management

a “wait & see” approach that may be used to manage an ectopic when 5 criteria are met

5 criteria for “wait & see”

- decreasing serum hCG levels

- general health appears to be stable

- pain levels are considered to be acceptable

- no fetal heartbeat

- ultrasound shows small ectopic with no worrying of rupur