Ectopic pregnancy (mechanism of disease)

This is a flowchart on ectopic pregnancy, covering the etiology, pathophysiology, and manifestations of ectopic pregnancy.

ADDITIONAL TAGS:
Previous ectopic pregnancy
Fallopian surgery (tubectomy)
Endometriosis
Ruptured appendix
Kartagener syndrome
(ciliary dyskinesia)
Exposure to diethylstilbestrol
Bicornuate uterus
Risk factors / SDOH
Cell / tissue damage
Structural factors
Ectopic pregnancy
Medicine / iatrogenic
Infectious / microbial
Biochem / metabolic
Immunology / inflammation
Signs / symptoms
Tests / imaging / labs
Flow physiology
Reproductive pathology
Growth / neoplastic
Pathophysiology
Etiology
Manifestations
Inflammation damages fallopian tubes
Ectopic pregnancy: a pregnancy in which the fertilized egg attaches outside the uterine endometrium
Such as in fallopian tube (95%: ampulla [70%], isthmus [15%], fimbriae [8%], cornual [2%]); ovary (3%), abdomen (1%), cervix (1%)
History of PID (salpingitis)
Smoking
Advanced maternal age (35)
Intrauterine device
In vitro fertilization
Hormone therapy
Hormone dysregulation
Slows down the transport of fertilized eggs
Signs and symptoms typically begin 4-6 weeks after last menstrual period
Lower abd pain and guarding
+/- vaginal bleeding
Tenderness in ectopic area
Cervical motion tenderness
Sometimes mistaken for appendicitis
Sometimes mistaken for (delayed) menstruation
Enlarged uterus
Amenorrhea
Nausea
But with closed cervix (so it’s not PID)
Breast tenderness
Frequent urination
Normal signs and symptoms of pregnancy
Upregulation of pro-inflam cytokines
Disruption of smooth muscle contraction and ciliary beat within tubes that assists transport of oocyte or embryo
Promotes embryo implantation, invasion, and angiogenesis
Tubal rupture
Acute course with sudden symptoms
Severe lower abdominal pain
Hemorrhagic shock
Shoulder pain
Phrenic nerve irritation → hiccups
Bleed into abd cavity
Irritate peritoneum
Tachycardia
Hypotension
Syncope
Best initial test for imaging, transvaginal ultrasound: empty uterine cavity,
+/- embryo in ectopic site
Anatomic alteration of fallopian tubes