Summary of "Ectopic Pregnancy"

Summary of Key Points on Ectopic Pregnancy

Definition and Location

Ectopic pregnancy is the abnormal implantation of a fertilized ovum outside the uterus. Approximately 90-95% of ectopic pregnancies occur in the fallopian tube (tubal ectopic pregnancy). Other possible locations include the ovary and cervix. These pregnancies are typically non-viable due to the inability of the site to stretch and support fetal growth.

Risk Factors

History of sexually transmitted infections (STIs)
Use of an intrauterine device (IUD)
Previous tubal surgery
Previous ectopic pregnancy

Signs and Symptoms

Positive pregnancy test and morning sickness (common pregnancy symptoms)
Abdominal or pelvic pain
Abnormal dark red or brown vaginal bleeding
Severe abdominal pain with possible bending over or wincing (may indicate rupture)
Referred shoulder tip pain due to irritation of the diaphragm and phrenic nerve (sign of rupture)
Signs of internal bleeding/hemorrhage in rupture cases:
- Hypotension (low blood pressure)
- Tachycardia (rapid heart rate)
- Pallor
- Dizziness or lightheadedness
- Altered mental status

Assessment and Diagnosis

Consider ectopic pregnancy in any woman of childbearing age with abdominal pain, abnormal bleeding, or positive pregnancy test.
Urine pregnancy test to confirm pregnancy.
Ultrasound (transvaginal or abdominal) to check for presence or absence of intrauterine pregnancy.
Elevated serum HCG and progesterone levels can support diagnosis.
An empty uterus on ultrasound with a positive pregnancy test suggests ectopic pregnancy.

Treatment Options

Medical Management

Methotrexate to inhibit embryo growth, used if the patient is stable and diagnosed early.

Surgical Management

Salpingostomy: Removal of ectopic pregnancy while preserving the fallopian tube (if unruptured).
Salpingoectomy: Removal of the entire fallopian tube (typically if ruptured or damaged).

Surgery carries risks and may affect future fertility.

Additional Considerations

Ectopic pregnancy is fatal for the fetus.
Emotional support is important; referral to pregnancy loss support groups is recommended.
The primary goal is to preserve the life and health of the mother.