Edneisha Hillard Ectopic Pregnancy 9/16/2024

Ectopic Pregnancy

1. ECTOPIC PREGNANCY ANJANA.B.S. 6 TH SEM 2016 BATCH

2. DEFINITION An ectopic pregnancy is defined as a pregnancy where implantation occurs in a site other than the uterine cavity. The most common site is the fallopian tube.

3. AETIOLOGY Any factor that causes delayed transport(or entrapment) of the fertilized ovum through the fallopian tube favours implantation in the tube And can give rise to a tubal pregnancy

4. Pelvic inflammatory disease most important cause of ectopic pregnancy 1 episode leads to a 12% chance of ectopic , incidence rising with each episode. Chlamydial infection usually subclinical -most likely cause Endosalpingitis causes agglutination of tubal mucosal folds with formation of blind pockets

5. In addition, there is reduced ciliation and impaired tubal peristalsis. All this can lead to ovum entrapment & implantation in the tube. Pelvic tuberculosis – another cause of ectopic. Post abortal or puerperal sepsis also causes peritubal adhesions, leading to kinking & narrowing of the lumen.

6. 2. Congenital factors Tubal tortuosity, accessory ostia, diverticula , partial stenosis & in uterine exposure to diethyl stilboestrol predisposes to these abnormalities. 3. Salpingitis isthmica nodosa In this condition, tubal epithelium invades the myosalpinx forming diverticulum. Aetiology unknown- probably caused by ovum entrapment in the diverticula

7. 4. Previous surgery on the tube This includes tubal recanalization procedures & tubal sterilisation. One third of pregnancies which following tubal sterilisation turn out to be ectopic. Tubal sterilisation using electrocoagulation is associated with a higher risk of ectopic.

8. 5. Assisted reproductive technology (ART) In vitro fertilisation- increased the incidence of ectopic pregnancies Ectopic pregnancies constitute upto 5% of pregnancies following ART. The incidence of heterotropic pregnancy (coexisting intrauterine and extrauterine pregnancy) has also gone up with these procedures. Ovulation induction also contributes.

9. 6. Intrauterine devices IUDs do not cause ectopic gestations, but they prevent intrauterine pregnancy than a tubal pregnancy. If a pregnancy occurs with an IUD in situ, it is more likely to be an ectopic. IUD may also increase chance of infection. 7. Cigarette smoking Has an increased risk- impaired immunity in smokers – predisposes to pelvic infections. 8. Previous ectopic Recurrence risk is 12% after one ectopic & 28% after two ectopics .

10. INCIDENCE Epidemiological trends show incidence is rising due to increase in predisposing factors & due to increased detection. SITES Fallopian tube(95%) Extratubal (rare) Ampulla (80%) Intraligamentous Isthmus(12%) Abdominal Infundibulum(6%) Ovarian Interstitial (2%) Cervical Cornual

11. NATURAL HI STORY Tubal Abortion Most commonly seen in ampullary pregnancy. If the process is complete, the products may be expelled through ostium resulting in a complete abortion. Sometimes the dead ovum may remain in the tubal lumen enclosed in clotted blood similar to a missed abortion & can present as a chronic or old ectopic.

12. B. TUBAL RUPTURE Usually presents as intraabdominal bleeding & shock. If the ectopic is in isthmus- rupture occur at 6-8 weeks. ampulla-rupture bit later – widest part. interstitial region- much later- greater distensibility & haemorrhage excessive.

13. C. Abdominal Pregnancy After tubal rupture or abortion, if the fetus is still alive, it can very rarely result in a secondary abdominal pregnancy or a secondary intraligamentous pregnancy.

14. D. Changes in the Uterus Uterus – slightly enlarged due to myohyperplasia & hypertrophy. Endometrium shows a histological pattern called ARIAS STELLA PHENOMENON Hyperplasia of glandular cells with hyperchromatic nuclei, cytoplasmic vacuolation & loss of cell polarity.

15. Arias Stella reaction along with absence of chorionic villi- highly suggestive of ectopic. Due to low levels of hormones & failing pregnancy, decidua may be shed intermittently, giving rise to intermittent bleeding in an ectopic. Sometimes, decidua may be passed as a flat, reddish brown piece of tissue called a decidual cast.