Ectopic Pregnancy
Ectopic Pregnancy is a life-threatening condition characterised by the implantation of an embryo outside
the uterine cavity, usually in the fallopian tube.
Epidemiology
The incidence of ectopic pregnancy is increasing in the UK and currently stands at 1 in 100 pregnancies.
Risk Factors

Increased maternal age

Smoking

Previous tubal surgery

Prior recurrent spontaneous miscarriages

Prior surgical termination of pregnancy

Pelvic inflammatory disease

Previous use of an intrauterine device

History of infertility
Prior oral contraception use can reduce the risk of ectopic pregnancy.
Etiology and Pathogenesis
When the ovum is released by the ovary, it travels along the fallopian tube (where it is fertilized) in the
direction of the uterus. The resulting embryo does not reach its destination, however, as it implants into the
wall of the fallopian tube. The subsequents trophoblastic proliferation causes erosion and bleeding. Unlike
the uterus, the fallopian tube's muscle layer does not undergo hypertrophy, so rupture into the lumen and
peritoneal and retroperitoneal cavities occurs.
Clinical Features
History

Severe lower abdominal colicky pain

Vaginal bleeding after a missed period

Shoulder tip pain

Dysuria

Shock
Examination

Signs of early pregnancy

Mass on vaginal examination

Soft, enlarged uterus

Cervical excitation

Abdominal tenderness
Investigations

Pregnancy test and serum β-hCG

Ultrasound scan - trans-vaginal
Treatment
Treat these patients as resuscitation patients. Give oxygen and gain IV access. Cross-match blood and
request Rhesus status. Surgery is avoided initially using IV methotrexate and hCG monitoring. If the
pregnancy continues, surgical intervention is required.
References
Why women die. Report on confidential enquiries into maternal deaths in the United Kingdom 1994-1996.
Norwich: Stationery Office, 1998. The risk factors for an ectopic pregnancy are:
Bouyer J et al. Risk Factors for Ectopic Pregnancy: A Comprehensive Analysis Based on a Large CaseControl, Population-based Study in France. Am J Epidemiol 2003 157;185-194
O'Connor, J. Pathology 2nd ed. Mosby. Edinburgh. 2002.
McCarthy, A & Hunter, B (2003) Master Medicine: Obstetrics and Gynaecology (2nd ed.) Philadelphia:
Elsevier Saunder
http://www.gpnotebook.co.uk