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Ectopic pregnancy

  • Definition: A pregnancy that occurs outside the uterine cavity, most commonly in the fallopian tube.
Etiology/ Risk Factors
  • Pelvic inflammatory disease (PID), often due to Chlamydia trachomatis.
  • Previous ectopic pregnancy.
  • Previous tubal surgery.
  • Infertility and its treatments.
  • Endometriosis.
  • Smoking.
  • Advanced maternal age.
  • History of pelvic or abdominal surgery.
  • Intrauterine device (IUD), especially if pregnancy occurs with IUD in place.
  • Tubal ligation ā€“ rare but possible.
Clinical Features
  • Amenorrhoea: Absent menstrual periods.
  • Vaginal bleeding: often darker and less than a normal period.
  • Unilateral pelvic pain.
  • Shoulder tip pain due to blood irritating the diaphragm (Kehr’s sign).
  • Signs of pregnancy: breast tenderness, nausea.
  • Signs of shock: tachycardia, hypotension, especially if tube ruptures.
  • Beta-hCG: Serial measurements. Levels may rise slower than expected or decline abnormally.
  • Transvaginal ultrasound: To identify location of pregnancy.
  • Laparoscopy: Diagnostic and potentially therapeutic.
  • Culdocentesis: Aspiration of blood from the pouch of Douglas.
  • Methotrexate: For unruptured ectopic pregnancy, used to inhibit growth of the embryo.
  • Laparoscopic surgery: Salpingostomy or salpingectomy.
  • Laparotomy: For unstable patients or where laparoscopic expertise is not available.
  • Rh(D) immune globulin: Given to Rh-negative women to prevent Rh sensitisation.
  • Rupture: Leading to haemorrhage and shock.
  • Infertility: Especially if a tube is removed.
  • Recurrence: Risk of another ectopic pregnancy.
Key Points
  • Ectopic pregnancy is a life-threatening condition and a leading cause of maternal mortality in the first trimester.
  • Any woman of reproductive age with abdominal pain and/or vaginal bleeding should be evaluated for ectopic pregnancy.
  • Early diagnosis and management can help in preserving future fertility.

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