Ectopic pregnancy

This is a brief video on ectopic pregnancies, or a pregnancy occurring outside the uterus.

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ADDITIONAL TAGS:
Ectopic pregnancy
Ectopic pregnancy in open Fallopian tube, ~7 weeks gestational age
By Ed Uthman, MD (Flickr, Wikipedia) - (2014). "Tubal pregnancy with embryo". WikiJournal of Medicine 1 (2): 7. DOI:10.15347/wjm/2014.007., Public Domain,https://commons.wikimedia.org/w/index...
Pregnancy outside of the uterus
Definition: embryo attaches outside the uterus
Most commonly occur in the ampulla of fallopian tube, but can occur in other parts of tube, ovary, cervix, myometrium or within the abdomen
Ectopic embryos can grow and create pressure or invade surrounding tissues
Overview
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Symptoms:
Classic symptoms: abdominal/pelvic pain, vaginal bleeding
Pain can be sharp, dull, and/or crampy, often mimicking appendicitis
Bleeding 6 weeks after last menstrual period
Tender cervix, adnexal mass, or adnexal tenderness
Symptoms of pregnancy: nausea, vomiting, urination, fatigue, breast tenderness

Destruction / rupture of fallopian tubes:
Rupture: abdominal distention, generalized tenderness, peritonitis, and hypovolemic shock (low BP, high HR, feeling cold)
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Damage to Fallopian tubes and/or hair-like cilia in internal surface of tubes

Pelvic inflammatory disease / salpingitis resulting in scarring (most common)
Infertility
IUD use
Exposure to DES
Tubal surgery (ligation)
Intrauterine surgery (D&C)
Smoking
Previous ectopic pregnany
Endometriosis
Causes / risk factors
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Overview
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Causes
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Management
By Mikael Häggström, from original by BruceBlaus - File:Blausen 0602 Laparoscopy 02.png, CC BY 3.0, https://commons.wikimedia.org/w/index...

Overview
Presentation
Causes
Diagnosis
Management
A "blob sign", which consists of the ectopic pregnancy. The ovary is distinguished from it by having follicles, whereof one is visible in the field. This patient had an intrauterine device (IUD) with progestogen, whose cross-section is visible in the field, leaving an ultrasound shadow distally to it.

By Mikael Häggström.When using this image in external works, it may be cited as:Häggström, Mikael (2014). "Medical gallery of Mikael Häggström 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.008. ISSN 2002-4436. Public Domain.orBy Mikael Häggström, used with permission. - Own work, CC0, https://commons.wikimedia.org/w/index...

Perform transabdominal/transvaginal ultrasound:
↪ If intrauterine gestational sac present in uterus → not ectopic pregnancy
↪ If gestational sac present elsewhere (ring of fire with color Doppler d/t increased vascular flow to adnexa) → ectopic pregnancy
↪ If no gestational sac seen, perform quantitative serum hCG:
↪ If serum hCG 1500-2000 → treat like ectopic pregnancy (should be able to see intrauterine pregnancy)
↪ If serum hCG 1500-2000 → too soon to tell → perform serial hCG:
↪ Repeat hCG in 48 hours:
↪ If hCG doubles → intrauterine pregnancy → routine care, evaluate other causes of symptoms
↪ If hCG fails to double → ectopic pregnancy
Ruptured ectopic pregnancy:
Stabilize with fluids, blood, pressors
OR for salpingectomy (remove tube)
Unruptured ectopic pregnancy:
Stabilize, OR for salpingostomy (unblock tube)
If hCG 3000, gestational size 3.5 cm, no fetal heart tones
Medical management: methotrexate +/- leucovorin
Management
Overview
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Causes
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Management
Uterus in blue arrows
Bleeding ectopic pregnancy in red arrows
By Mikael Häggström - File:Ectopic pregnancy1981.jpg by Urskalberer81, CC BY-SA 3.0, https://commons.wikimedia.org/w/index...
By Urskalberer81 - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index...
Salpingectomy