Ectopic Pregnancy.

Ectopic Pregnancy

Define Ectopic Pregnancy : It may be defined as when implantation of the fertilized ovum occurs at any site others than the normal uterine cavity.

We have described:

What are the type of ectopic pregnancy?

Site of ectopic pregnancy.

How will you manage a case of ectopic pregnancy?

Risk factor of ectopic pregnancy :

Why ectopic pregnancy is increasing day by day?

Ectopic Pregnancy

Types of ectopic pregnancy: Clinically 3 distinct types :

  1. Acute (tubal rupture or abortation)
  2. Unruptured
  3. Subacute.

Site of ectopic pregnancy :

  1. Fallopian tube:





  1. Ovary
  2. Abdominal cavity
  3. Broad ligament
  4. Uterus
  5. Cervix

Risk factor of ectopic pregnancy : 

  1. Pelvic inflammatory disease (6 folds increased risk)
  2. Use of IUCD’s (3-5% increased risk)
  3. Smoking (2.5% increased risk)
  4. ART pregnancies. (3-5% increased risk)
  5. Tubal  damage ( surgical occlusions or cilial damage)
  6. Tubal surgery (5.8% Increased risk.)
  7. Salpingitis isthmica nodusa (3.5% increased risk)
  8. Prior ectopic pregnancy. (10 folds increased risk)
  9. Age 35-44 years women have 3 fold greater risk than age 18-24 years.
  10. Nonwhite race (1.5 folds increased risk).
  11. Endometriosis.
  12. Development errors.
  13. Overdevelopment of ovum and external genitalia

Symptoms of rupture ectopic pregnancy :

  1. Short period of amenorrhoea.
  2. Sudden severe lancinating lower abdominal pain.
  3. Per vaginal bleeding.
  4. Patients may go into collapse and shock.

Sign of rupture ectopic pregnancy

A. General Examination : 

  1. Anaemia
  2. Low blood pulse
  3. Rapid thready pulse
  4. Cold clammy skin.

B. Per abdominal examination : 

  1. Lower abdominal tenderness, rigid and distended.
  2. Shifting dullness may be elicited.
  3. Gut may be distended

 C. Per vaginal examination

  1. Extreme tenderness on palpation of the fornix.
  2. No mass usually felt through the cervix

Investigations of rupture ectopic pregnancy :

1. Blood:


          .HB%- fall

          .ESR – raised

         .Blood grouping, cross matching, Rh typing

  1. USG of uterus.
  2. Pregnancy test: Positive in 50% cases.
  3. Colpometry or colpopuncture.
  4. Curettage: Reveal only decidual tissue, no chorionic tissue.
  5. Laparoscopy : Confirmatory

Treatment of rupture ectopic pregnancy

  • General treatment : 

  • Immediate hospitalization
  • Wide bore IV channel opening.
  • Blood is sent for grouping and cross matching.
  •  IV infusion: Hartman solution
  •  Blood transfusion if needed
  • Catheterization
  •  Analgesics: Inj. Pethidine 100 mg IM.
  •  Antibiotics

B. Specific Treatment :

  • .If the family is complete : Salpingectomy + Other sided tubectomy.
  • .IF family is incomplete and other sided tube healthy : Salpingectomy
  • .If family is incomplete and other sided tube unhealthy : partial salpigectomy if the   tube is ruptured and anastomosis done in later sitting .
  • .If tube is intact:
  • .Salpingotomy
  • .Salpingostoy
  • .MIlking.

Cause of ectopic pregnancy in developing country:

Ectopic pregnancy is common is developing country because of the following reasons:

1.Increased prevalence of chronic pelvic inflammatory disease (PID).

2.Contraceptive failure : 

.IUCD : It prevents intrauterine pregnancy effectively. Thus there is relative increase of tubal pregnancy.

.Sterilization operation.

.Use of progesterone only pill

. post coital oestrogen pill.

3. Prior induced abortion.

4. Previous ectopic pregnancy.

5.Intra-pelvic adhesion following pelvic surgery.

6.Developmental defects of tube.

7. Use of ovulation inducing drugs.

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