Ectopic pregnancy occurs when an egg implants outside of the uterus, presenting as pelvic pain and bleeding. It is diagnosed with beta-hCG level and pelvic ultrasound. It is treated with methotrexate or surgery.
Pathophysiology
- Egg implantation outside of the uterus
- Non-viable pregnancy
Locations
| Location | Probability (%) |
|---|---|
| Ampullary | 80 |
| Isthmus | 12 |
| Fimbria | 5 |
| Abdomen | 1.4 |
| Ovary | < 3 |
| Cervix | < 1 |
Contextual Factors
- Prior ectopic pregnancy
- Prior abdominal or pelvic surgery (due to scar tissue)
- Tubal abnormalities
- IUD use
- History of chlamydia
- Infertility
- Cigarette smoking
- Prior abortion
Clinical Manifestation
- Can be asymptomatic until rupture
- Pelvic pain
- Vaginal bleeding
Pelvic Exam
- Cervical motion tenderness
- Adnexal tenderness
- Adnexal mass
Complications
- Ectopic pregnancy rupture
- Sudden evere pain
- Hemorrhagic shock
- Peritonitis
Diagnosis
- Urine beta-human chorionic gonadotropin (beta-hCG)
- Quantitative serum beta-hCG
- Discriminatory zone: 2000 mlU/mL - indicates (possibly ectopic) pregnancy
- Might have to repeat every 2 days outpatient if not confirmed as ectopic
- Pelvic ultrasonography to confirm no intrauterine pregnancy
Treatment
- Methotrexate if criteria met
- Surgical resection if methotrexate criteria not met or ectopic rupture
- Rho(D) immune globulin if patient is Rh-negative
Methotrexate Criteria (Must meet all)
- Hemodynamically stable with no current/ impending rupture
- CBC, renal, and liver function tests normal
- Pregnancy < 3-4 cm
- No fetal heart activity
- beta-hCG <= 5000 mlU/mL
- Patient will comply with post-treatment follow-up