An ectopic pregnancy is a pregnancy outside of the uterine cavity. Ectopic pregnancies are those implanted outside of the uterine cavity, the. Ectopic pregnancies cannot be carried to term and eventually rupture or involute. Early diagnosis is the key to less invasive treatment. This report summarizes the investigation results, which identified 11 ectopic pregnancy deaths from 20092010 and.
Since many ectopic pregnancies are now treated in an outpatient setting, true current numbers are hard to obtain. Seethapathy nagar, velacherry, chennai600042 corresponding author abstract introduction ectopic pregnancy is one of the most common gynaecological emergencies. This paper provides advice for clinicians in obtaining consent of women undergoing laparoscopic salpingectomy or salpingotomy for ectopic pregnancy. Ectopic pregnancy occurs when an embryo attaches outside of the uterus, most commonly in the fallopian tubes. Figure 1 is an algorithm for the evaluation of acute pelvic pain. Ectopic pregnancy rates in the medicaid population american. Current knowledge of the aetiology of human tubal ectopic pregnancy. Incidence of ectopic pregnancy is rising while maternal mortality from it is falling. In the united kingdom nearly 12 000 ectopic pregnancies are diagnosed each year, which gives a prevalence of 1. Without timely diagnosis and treatment, ectopic pregnancy can become a lifethreatening situation.
Ectopic pregnancy occurs when implantation of the blastocyst takes place in a site other than the endometrium of the uterine cavity. The epidemiological risk factors for tubal ectopic pregnancy are well. This study assessed the rate of ectopic pregnancy among medicaid. The aetiology of ectopic pregnancy remains uncertain although a number of risk factors have been identified. The site of implantation most commonly is a fallopian tube. Ectopic pregnancy an overview sciencedirect topics. To estimate the association between maternal age and fetal death spontaneous abortion, ectopic pregnancy, stillbirth, taking into account a womans reproductive history. This is to study the incidence, clinical presentation, risk factors and the management of cases that presented in our centre over a five year period. Two other varying cases of failed methotrexate treatment for similar diagnosis are discussed. Some ectopic pregnancies resolve spontaneously, but others continue to grow and can lead to. Ectopic pregnancy ep presents a major health problem for women of childbearing age. Incidence, diagnosis and management of tubal and nontubal ectopic. Diagnosis and management of ectopic pregnancy 2016 bjog. Ectopic pregnancy symptoms, diagnosis and treatment.
Ectopic pregnancy gynecology and obstetrics msd manual. Ectopic pregnancy is the result of a flaw in human reproductive physiology that allows the conceptus to implant and mature outside the endometrial cavity see the image below, which ultimately ends in the death of the fetus. Uncommon implantation sites of ectopic pregnancy include the cervix, interstitial segment of the fallopian tube, scar from a prior cesarean delivery, uterine myometrium, ovary, and peritoneal cavity. Ectopic pregnancy mortalityflorida, 20092010 pregnancy. The difficulties associated with the diagnosis and the surgical skill required for treatment make management of interstitial ectopic pregnancies extremely challenging. Ectopic pregnancy modern diagnosis and management is a comprehensive book which guides the reader through. Definition ectopic pregnancies account for 1% to 2% of all conceptions. Signs and symptoms of ectopic pregnancy typically include abdominal pain, amenorrhea, and abnormal vaginal bleeding. Ectopic pregnancy refers to the implantation of a fertilised ovum outside of the uterine cavity. An ectopic pregnancy occurs when the fertilized egg attaches itself in a place other than inside the uterus.
Ectopic pregnancy affects 1% to 2% of all pregnancies and is responsible for 9% of pregnancyrelated deaths in the united states. Royal college of obstetricians and gynaecologists consent advice no. This prevents the fertilized egg from passing through to the uterus, instead causing it to attach to the tube itself. If ectopic pregnancy appears unlikely and patients are stable, serum levels of betahcg can be measured serially on an outpatient basis typically every 2 days. Most early ectopic pregnancies can be successfully. Purpose and scope the purpose of this guideline is to improve the management of women who may have an ectopic pregnancy. Ectopic pregnancy is the second major cause of maternal mortality in the united states and a leading cause of maternal morbidity and mortality in the world. Ectopic pregnancies can also happen on your ovary, or somewhere else in your belly. Highlights of prescribing information provera contraceptive injection depoprovera ci. Adenofibroma and ectopic pregnancy of left fallopian tube. Ectopic pregnancy is a potentially lifethreatening condition occurring in 12 % of all pregnancies. Ectopic pregnancy is when a pregnancy grows outside of your uterus, usually in your fallopian tube. Daniela carusi md, msc, in decision making in medicine third edition, 2010. In current practice, in developed countries, diagnosis.
The majority of ectopic pregnancies occur in the fallopian tube 96 percent, but other possible sites include cervical, interstitial also referred to as cornual. The information provided by ultrasound can be of great value in guiding management decisions and improving outcome. Ectopic pregnancy, condition in which the fertilized ovum egg has become imbedded outside the uterine cavity. In pursuit of understanding interstitial pregnancies. A rare coexistence of an adenofibroma and ectopic pregnancy in the left fallopian tube is reported. Most cases occur in the fallopian tube and are thus sometimes called tubal pregnancies. A case of retroperitoneal ectopic pregnancy located very close to large retroperitoneal blood vessels and treated with methotrexate is presented.
The most common ectopic implantation site is the fallopian tube, though 10 % of ectopic pregnancies implant in the cervix, ovary, myometrium, interstitial portion of the fallopian tube, abdominal cavity or within a cesarean section scar. Ep refers to the pregnancy occurring outside the uterine cavity that constitutes 1. Fewer than 50 percent of affected women have both of these symptoms. Management of ectopic pregnancy 29 advanced facilities. The choice today is laparoscopic treatment of unruptured ectopic pregnancy. Implantation of an embryo in the interstitial portion of the fallopian tube leads to an ectopic pregnancy that has an alarming mortality rate of 2. Ectopic pregnancy occurs when a fertilized ovum implants on any tissue other than the endometrial lining of the uterus. An ectopic pregnancy occurs when a fertilised ovum implants outside the normal uterine cavity. It is important for both the pregnant woman and the health care provider to identify any signs and symptoms of an ectopic pregnancy before rupture. Women who underwent ectopic pregnancy are advised to avoid getting pregnant for a year after the incident because there is a 10% to 20% chance of a subsequent ectopic pregnancy. If the ectopic pregnancy has ruptured and hemorrhage has occurred, the patient may have signs and symptoms of hypovolemic shock. To estimate trends in the rates of diagnosis and treatment of ectopic pregnancy in the united states.
The presented patient failed methotrexate treatment and eventually underwent surgical excision. When a pregnant patient presents with firsttrimester bleeding or. An ectopic pregnancy, or eccysis, is a complication of pregnancy occurs when the site of implantation is outside of the womb uterine cavity either in the tubes,ovaries or abdominal cavity, with rare exceptions, ectopic pregnancies are not viable, pregnancy can even occur in both the womb and the tube. Ectopic pregnancy affects 1% to 2% of all pregnancies and is responsible for 9% of pregnancy related deaths in the united states. Signs and symptoms classically include abdominal pain and vaginal bleeding. Blackmores case, may indicate peritoneal irritation. Evaluation of acute pelvic pain in women american family. The estimated prevalence of ectopic pregnancy is 12% worldwide. In other words, doctors tend to diagnose an ectopic pregnancy by saying. Summary key points incidence of ectopic pregnancy is rising while maternal mortality from it is falling. Information for you this leaflet has been updated uptodate information is available on the rcog website. Incidence, diagnosis and management of tubal and nontubal.
Ectopic pregnancy ep is defined as the extrauterine implantation of a fertilised ovum. A fertilized ovum implanting and maturing outside of the uterine endometrial cavity, with the most common site being the fallopian tube 97%, followed by the ovary 3. Ectopic pregnancy knowledge for medical students and. Ectopic pregnancy is a common lifethreatenin g emergency in the developing world and its frequency is still high. Diagnosis and management of ectopic pregnancy bmj sexual.
Adenofibroma is a rare benign neoplasm of the fallopian tube, and the fallopian tube is the most common site of ectopic pregnancies. Ectopic pregnancy is a complication of pregnancy in which the embryo attaches outside the uterus. Ruptured ectopic pregnancy continues to be a common life threatening emergency in our environment as well as a public health problem. We analyzed data from a large administrative claims database of more than 200 u. Trends in the diagnosis and treatment of ectopic pregnancy. The purpose of this study was to determine the incidence and some risk factors of ectopic pregnancy in hamadan province during 20002010. Diagnosis and management of ectopic pregnancy the bmj.
Epidemiology the overall incidence has increased over the last few decades and is currently thought to affect 12% of pregnancies. A left tubal ectopic pregnancy at laparoscopy and b tubal ectopic pregnancy has been removed by salpingectomy 7. Approximately 1%2% of pregnancies in the united states are ectopic 1,2. Some studies have reported a potentially small increased risk of ectopic pregnancy in past users of an iud, but more current, wellcontrolled research indicates there is no increased risk with previous iud use 9. This guideline replaces the management of tubal pregnancy, which was. It is for use by all healthcare professionals involved in womens. The pain may be described as sharp, dull, or crampy.
This was a retrospective descriptive study carried out at hospitals in hamadan provience, iran. Pain may also spread to the shoulder if bleeding into the abdomen has occurred. This booklet is designed to provide information on the diagnosis and treatment of ectopic pregnancy. Ectopic pregnancy can be diagnosed early before it ruptures with recent advances in immunoassay to detect shcg, high resolution usg, and dignostic laparoscopy. Ectopic pregnancy remains a major gynaecologyical problem in contemporary gynaecological practice. This book contains the practical methods to early diagnosis of various forms of ectopic pregnancies and their modern management. This is a retrospective study of cases of ectopic gestations managed in the. It is frequently associated with pelvic inflammatory disease, which may lead to stenosis of the fallopian tubes. In ectopic pregnancy, implantation occurs in a site other than the endometrial lining of the uterine cavityin the fallopian tube, uterine cornua, cervix, ovary, or abdominal or pelvic cavity.
125 426 263 492 1370 922 760 88 697 522 1461 562 1104 438 697 842 472 745 1025 135 999 1506 1038 1238 724 18 1060 1106 1394 627 1477 429 611 369 856 1327 994 1178 737 983 665 555 518 883 549 267