Ectopic Pregnancy: Any pregnancy where fertilised ovum gets implanted and develops
at a site other than normal uterine cavity, commonly in the fallopian tubes.
Sites of Ectopic Pregnancy
ectopic


• Ectopic pregnancies can occur in various places in a woman’s reproductive organs.
• The most common site is an ampullary tubal pregnancy. Roughly 85% of ectopic
pregnancies occur at this site.
1. Fimbrial
2. Ampullary >85%
3. Isthmus 8%
4. Interstitial
5. Ovarian <2%
6. Cervical <2%
7. Cornual-Rudimentary horn <2%
8. Secondary abdominal <2%
9. Broad Ligament
10. Primary abdominal
Risk Factors of Ectopic Pregnancy
• History of pelvic inflammatory disease (PID)
• Past or present Intrauterine Contraceptive Device (IUCD) use
• Previous lower abdominal surgery
• Previous ectopic pregnancy
• Uterine or adnexal mass
• Endometriosis
• Assisted reproductive techniques
• Smoking
• Advanced maternal age
Clinical Features of Ectopic Pregnancy
• Intact ectopic pregnancy
o May be asymptomatic or may present with lower abdominal pain.
• Ruptured ectopic pregnancy
o May present in two variations, acute or subacute (slow leaking).
Acute Features
• Amenorrhea
• Abdominal pain that is generalized, often radiating to the shoulder
• Syncope (fainting attacks)
• Vaginal bleeding that is intermittent
• Pelvic mass
Physical Findings
• Pallor
• Unstable vital signs (shock); low BP, high PR ( >100 beats/minute), cold skin
• Abdominal swelling
• Guarding
• Rebound tenderness
• Cervical excitation test (Pain on moving the cervix) – positive
• Bulging posterior fornix
Sub-Acute Symptoms
• It is a salient feature of a slow or unruptured ectopic pregnancy
• Normally presents with history of lower abdominal pain with features of pregnancy
• Acute symptoms may develop when the gestation sac ruptures
• Investigation includes urine for pregnancy test (UPT), haemoglobin (Hb) and pelvic ultra
sound.
Management of Ectopic Pregnancy
• Resuscitate with intravenous fluids
o Ringer’s lactate or normal saline, 3 L. or more using a wide bore cannula
• Insert urethral catheter
• Obtain blood for blood grouping and cross match
• Refer for urgent laparotomy
References
• Baker, P. & Monga, A. (2006). Obstetrics by Ten Teachers (18th Ed.). London: Hodder
Arnold.
• DeCherney, A.H. & Nathan, L. (2002). Current Obstetrics and Gynaecology (9th Ed.).
McGraw Hill.
• MOHSW. (2005). Advanced LSS Trainee Manual. Dar es Salaam, Tanzania: Ministry of
Health and Social Welfare.
• Oats, J., Abraham, S. (2005) Llewellyn-Jones Fundamentals of Obstetrics and
Gynaecology. (8th Ed.). Edinburgh: Mosby.