Page 1 of 1: Ectopic Pregnancy

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Ectopic Pregnancy

Incidence Increasing ( 1:66 Pregnancies)
Mortality Decreasing With Better Detection
Surgical and Medical Treatment Available
Recurrence Rate ~ 15%

Risk Factors

Previous Ectopic Pregnancy
PID
Tubal Surgery
Infertility
???IUD Use (Probably Not)
IVF
Kartegener’s Syndrome

Sites
Ampulla (95%)
Isthmus (8%)
Cornua (< 2%)
Ovary (< 2%)
Abdomen (< 2%)
Cervix (< 2%)

Symptoms
Amenorrhea
Abdominal Pain
Vaginal Bleeding
Syncope
Pelvic Mass

Evaluation and Diagnosis

History and Physical Exam
CBC, T+S
Serial Quantitative ß-hCG (BSU)
Ultrasound
Progesterone Level?
Culdocentesis
Laparoscopy

Serial BSU’s
ß-hCG Levels Double Every 48 Hrs
< 66% Rise / 48 Hrs Consistent With Ectopic
Single Determination Not Helpful
Best If Done Within Same Laboratory
Never Rules Out Ectopic

Ultrasound
May or May Not Be Helpful
Discriminatory Zone:
TV: 1500-2000 mIU/ml
TA: 6500 mIU/ml
+IUP: Generally Excludes Ectopic

Culdocentesis

Highly Specific if Interpreted Correctly: Presence of Free-Flowing, NON-Clotting Blood
Negative Tap Inconclusive
May Obviate U/S
Most Helpful in Emergent Situations to Confirm Diagnosis, But Remains Controversial

Progesterone Levels

> 15 ng/ml a/w IUP
< 15: SAb or Ectopic
May Take Several Days for Result
Clinical Use Not Yet Widespread

Treatment
Observation
Laparoscopy
Laparotomy
MTX
Hyperosmolar Glucose

Laparoscopy

Allows Diagnosis and Treatment
Salpingostomy
Salpingectomy (Total / Partial)
Cornual Resection
Minimally Invasive, Unlike Laparotomy
Few Contraindications: Unstable Patient (Possibly)

MTX
Toxic to Trophoblast Cells
Minimal Side Effects
May Preserve Fertility in Cases of Cervical Pregnancy
Requires Compliant Patient, Time
Pain Not Uncommon
BSU May Rise Initially

Summary

Ectopic Pregnancy is a Common, Treatable Problem
Sensitive BSU Assays Allow Early Detection
Surgical and Medical Options Exist
Ruptured Ectopics Should be Unusual with Compliant Patients and Appropriate Medical Care

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