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    Ectopic Pregnancy - Ob Patho

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    Norman Vryne Cadua
    The document discusses ectopic pregnancy, defining it as implantation outside the uterine cavity. It covers epidemiology, types based on location, risk factors, clinical manifestations, pathophysiology, differentials, diagnostics including beta-hCG, progesterone, ultrasound and laparoscopy, pathologic findings, and management approaches like expectant management, methotrexate, and surgical options of salpingostomy, salpingotomy, and salpingectomy.

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    Ectopic Pregnancy - Ob Patho

    Uploaded by

    Norman Vryne Cadua
    25 views32 pages
    The document discusses ectopic pregnancy, defining it as implantation outside the uterine cavity. It covers epidemiology, types based on location, risk factors, clinical manifestations, pathophysiology, differentials, diagnostics including beta-hCG, progesterone, ultrasound and laparoscopy, pathologic findings, and management approaches like expectant management, methotrexate, and surgical options of salpingostomy, salpingotomy, and salpingectomy.

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    ECTOPIC PREGNANCY - OB PATHO

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    The document discusses ectopic pregnancy, defining it as implantation outside the uterine cavity. It covers epidemiology, types based on location, risk factors, clinical manifestations, pathophysiology, differentials, diagnostics including beta-hCG, progesterone, ultrasound and laparoscopy, pathologic findings, and management approaches like expectant management, methotrexate, and surgical options of salpingostomy, salpingotomy, and salpingectomy.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    25 views32 pages

    Ectopic Pregnancy - Ob Patho

    Uploaded by

    Norman Vryne Cadua
    The document discusses ectopic pregnancy, defining it as implantation outside the uterine cavity. It covers epidemiology, types based on location, risk factors, clinical manifestations, pathophysiology, differentials, diagnostics including beta-hCG, progesterone, ultrasound and laparoscopy, pathologic findings, and management approaches like expectant management, methotrexate, and surgical options of salpingostomy, salpingotomy, and salpingectomy.

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    ECTOPIC

    PREGNANCY
    BAUTISTA, C. | CADUA | CAMACHO
    TABLE OF CONTENTS
    INTRO TO ECTOPIC DIFFERENTIALS
    PREGNANCY 04
    01 Definition, Epidemiology, Types
    of Ectopic Pregnancy based on
    You can describe the topic of the
    section here
    Location, Risk Factors
    DIAGNOSTICS
    CLINICAL 05
    02 MANIFESTATIONS
    You can describe the topic of the
    section here

    06 PATHOLOGY
    Gross and Microscopic Findings
    03 PATHOPHYSIOLOGY
    You can describe the topic of the
    MANAGEMENT
    section here
    06
    01
    INTRO to
    ECTOPIC
    PREGNANCY
    ECTOPIC
    PREGNANCY
    ● Implantation of a fertilized egg
    outside the uterine cavity
    EPIDEMIOLOGY
    Rate of Diagnosis
    ~2% 2.7% increases with age:

    AGE RATE
    15-19 0.29%
    20-24 0.50%
    25-29 0.58%
    US: approximately Pregnancy-related
    2% of all mortalities related 30-34 0.70%
    pregnancies are to ruptured ectopic
    ectopic pregnancy 35-44 0.89%
    TYPES of BASED ON LOCATION
    ● Transit of fertilized ovum is blocked thus implanting along the fallopian tube
    Tubal
    ○ Ampulla (70%), Isthmus (12%), fimbria (11%), interstitial tubal portions (2%)

    Interstitial ● Within the proximal intramural portion of the fallopian tube

    Heterotropic ● Ectopic + Intrauterine pregnancies

    Cervical ● Within the endocervix, at or below the cervical os

    ● Spielberg Criteria:
    ○ Intact tube on the ipsilateral side
    Ovarian ○ Ovary occupied by the ectopic pregnancy
    ○ Ectopic pregnancy attached to the uterus by the utero-ovarian ligament
    ○ Ovarian tissue identified histologically amid placental tissue

    Cesarean Scar ● Blastocyst implants on the scar tissues within the myometrial defect of a previous CS

    Abdominal ● Within the peritoneal cavity, excluding tubal, ovarian, or intraligamentary implantations
    RISK FACTORS

    PRIOR PRIOR TUBAL SMOKING >20


    ECTOPIC SURGERY CIGARETTES
    PREGNANCY PER DAY
    RISK FACTORS

    PID >3 PRIOR >40 YEARS


    CONFIRMED MISCARRIAGES OLD
    or
    CHLAMYDIA
    INFECTION
    RISK FACTORS

    PRIOR >1 YEAR OF >5 LIFELONG


    MEDICAL OR INFERTILITY SEXUAL
    SURGICAL PARTNERS
    ABORTION
    RISK FACTORS

    Abnormal Fallopian ● Retarded passage of the fertilized ovum into the uterine cavity
    Tube Anatomy

    ● From previous ectopic surgery


    Prior Tubal Surgery
    ● From surgery on the tubes for ligation and tubal reconstruction

    ● Causes agglutination of mucosal folds (present in fallopian tube lumen) and reduced
    Salpingitis
    ciliation (from scarring due to infection)

    ● Causes tubal kinking and narrowing of the lumen


    Peritubal adhesion ● May also be caused by previous surgeries, pelvic endometriosis, and other abdominal
    infections
    02
    CLINICAL
    MANIFESTATIONS
    TRIAD OF SYMPTOMS

    AMENORRHEA
    01
    ABDOMINAL PAIN
    02 95% Sign of diaphragmatic irritation and hypovolemia

    VAGINAL BLEEDING/SPOTTING
    03 60-80%
    CLINICAL SIGNS

    UTERINE ADNEXAL
    VITAL SIGNS
    ENLARGEMENT MASS
    Slightly enlarged and Normal (Unruptured)
    Often tender
    may be pushed to one Hypotensive (Ruptured)
    side

    BULGING
    SMALL CERVICAL POSTERIOR
    CORPUS MOTION VAGINAL FORNIX
    In comparison to AOG
    TENDERNESS Accumulation of blood
    in the cul-de-sac
    03

    PATHOPHYSIOLOGY
    FOUR CAUSES OF ECTOPIC
    PREGNANCY
    ANATOMIC
    ABNORMAL
    OBSTRUCTION
    CONCEPTUS
    Prevents migration of the zygote

    ZYGOTE
    TUBAL MOTILITY
    TRANSPERITONEAL
    ABNORMALITIES
    MIGRATION
    04

    DIFFENTIALS
    1. Abortion
    2. Corpus luteum cyst
    3. Cystic ovarian masses
    4. Appendicitis (due to exquisite pain
    especially when pain is on the right
    lower quadrant)
    5. Pelvic inflammatory disease (pain
    and wiggling tenderness)
    05

    DIAGNOSTICS
    DIAGNOSTICS
    ● B-HCG: LOWER if ectopic
    BETA-HCG (URINE ● Doubling time in b-HCG level not observed in ectopic pregnancies
    OR SERUM) ● Lower limits of detection: 20-25mIU/ mL (urine); </5 mIU/ mL (serum)

    SERUM ● LOWER if ectopic pregnancy


    PROGESTERONE ● Normal intrauterine pregnancies: >25 ng/mL; Ectopic pregnancies: </= 25 ng/mL

    ● Complex adnexal mass separate from the ovary and fluid in cul-de-sac
    ● Pseudogestational sac: fluid collection seen in th midline within the endometrial
    ULTRASOUND cavity
    ● Absent intrauterine gestational sac (BHCG level of >/= 1,500 mIU/mL) (except in
    heterotropic pregnancies)

    ● GOLD STANDARD for diagnosis


    ● Direct visualization of the pelvic organs
    ● Done only in hemodynamically stable patients
    LAPAROSCOPY
    ● Can detect pregnancy even in massive hemoperitoneum
    ● Operative laparoscopy may be doe once diagnosis is confirmed resulting in shorter
    hospitalization and less blood loss
    ULTRASOUND FINDINGS:
    05
    PATHOLOGIC
    FINDINGS
    GROSS FINDINGS:
    GROSS FINDINGS:
    GROSS FINDINGS:
    GROSS FINDINGS:
    GROSS FINDINGS:
    MICROSCOPIC FINDINGS:
    07

    MANAGEMENT
    MANAGEMENT
    EXPECTANT MANAGEMENT

    - Observation
    - B-HCG monitoring every 48 hours
    - Done if minimal risk for tubal rupture:
    - Hemodynamically stable
    - Minimal abdominal pain
    - Initial B-HCG <1000 IU/L
    - No gestational sac or extrauterine mass suspicious
    for an ectopic pregnancy
    MANAGEMENT
    METHOTREXATE
    - Folic acid antagonist
    - Binds to dihydrofolate reductase which reduces dihydrofolate to
    tetrahydrofolate; leads to arrest in DNA, RNA, and protein synthesis
    - Indicated if:
    - Pregnancy is < 6 weeks
    - Asymptomatic
    - Hemodynamically stable
    - Compliant to follow-up check-ups and medications
    - Low initial b-HCG
    - Small ectopic pregnancy size (<3.5cm)
    - No cardiac activity
    MANAGEMENT
    SURGICAL MANAGEMENT
    - SALPINGOSTOMY
    - For removing unruptured pregnancy that is <2 cm in size
    - Linear incision (10-15mm) made at the antimesenteric border then
    products of conception are flushed out
    - Incision left to heal by secondary intention
    - Bipolar cauterization: for hemostatic control
    - SALPINGOTOMY
    - Same as with salpingostomy but incision is sutured
    - More tubal scarring and adhesion formation thus not done anymore
    - SALPINGECTOMY
    - Complete excision of the fallopian tube
    Thank you
    for
    listening!

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