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Ectopic Pregnancy : Etiology, Clinical features, Diagnosis, Treatment and Complications : Gynecology

The most common location of ectopic pregnancy is the ampulla of the fallopian tube.

The term ectopic pregnancy refers to a pregnancy that implants at a site other than the uterus. While an ectopic pregnancy can occur anywhere, 95% of all ectopic pregnancies occur within the fallopian tubes. Of these, 70% occur at the ampulla, 12% are isthmic, 11% are fimbrial, and 2% are interstitial (see illustration). The remainder generally occurs on the ovaries or within the abdominal cavity.

Risk factors for tubal pregnancies include prior ectopic pregnancy, previous tubal surgery or tubal pathology, diethylstilbestrol exposure, or prior upper genital tract infection (ie, pelvic inflammatory disease). An infection or inflammation of the fallopian tube can cause it to become partially or entirely blocked. Scar tissue or adhesions from surgical procedures or a previous infection in the tube may also impede the egg’s movement. Also, abnormal growths or a birth defect can result in an abnormality in the tube’s shape. In contrast, ovarian pregnancies appear to be a random event and are not associated with a history of infertility, pelvic inflammatory disease, or prior extrauterine pregnancy.

The most common clinical presentation of ectopic pregnancy is vaginal bleeding and/or abdominal pain in the first trimester. Ectopic pregnancy may also be asymptomatic. Clinical manifestations of ectopic pregnancy typically appear six to eight weeks after the last normal menstrual period but may occur later, especially if the pregnancy is at an extrauterine site other than the fallopian tube. The diagnosis of ectopic pregnancy is based upon a combination of measurement of human chorionic gonadotropin in serum and findings on transvaginal ultrasonography. Tubal ectopic pregnancy may be treated medically (methotrexate), surgically, or with expectant management.

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