Ectopic Pregnancy and Its Diagnosis
- Patient serum for Beta- HCG level may be done.
- Biopsy of the fallopian tube or ovarian tissue for surgical pathology will show placental villi and trophoblastic cells.
- This is defined as the product of conception implanted outside the uterine cavity.
- Or implantation of the fertilized ovum other location than the uterus.
- This is the implantation of the fetus out of the normal place of the uterine cavity.
- This may be seen in 1% of pregnancies.
- The most common site is:
- The ampullary part of the fallopian tube is 80%.
- The isthmic portion of the fallopian tube is 12%.
- The fimbria of the fallopian tube is 5%.
- The abdominal is 1.4%.
- Ovary is 0.2%.
- Cervix is 0.2%.
- The most common site is the fallopian tubes and these are also called a tubal pregnancy.
- There are chances of ectopic pregnancy 1 out of 50 pregnancies.
- The hormonal changes are the same as a normal pregnancy.
- There is the cessation of the menstrual cycle.
- There is the elevation of the serum and urinary placental hormone.
- 50% of the cases show hypersecretory and decidual changes.
- In the surgical biopsy material take many sections particularly from the blood clot.
- Try to find the placental villi to confirm the ectopic pregnancy.
- The ectopic pregnancy is caused by:
- Infection or the scar formation of the fallopian tubes which blocks the tube is almost seen in 50% of the cases.
- Due to previous surgery which may cause scarring.
- Adhesion due to previous surgery on the fallopian tubes or in the pelvic area.
- Endometriosis may also block the passage of the ovum.
- If the diagnosis is not made in time, it leads to the death of the fetus and endangers the life of a pregnant lady.
- Complications of ectopic pregnancy are:
- Intratubal hematoma also called hematosalpinx.
- There may be an intraperitoneal hemorrhage.
- Death of the ovum.
- The tubal rupture and hemorrhage of the ectopic pregnancy lead to a fatal outcome.
- There severe abdominal pain.
- The patient may go into shock.
- Immediate surgery can save a life.
- 13% of these ectopic pregnancies may lead to maternal death.
- Ectopic pregnancy is the most common cause of death in the first trimester of pregnancy.
- The majority of the cases > 95% occur in the fallopian tubes.
- Rest occurs in the ovary, cornua, and abdomen.
Sign and Symptoms
- Most of the time its diagnosis is missed.
- Usually, there is abdominal pain.
- Or there may be vaginal bleeding (spotting).
- The following signs and symptom suggest emergency surgical procedure:
- Severe tenderness.
- If there is abdominal rigidity or guarding.
- If there is a hypovolemic shock.
- 25% of the ectopic pregnancy patients shows three classic presentations:
- Lower abdominal pain.
- vaginal bleeding.
- Adnexal mass.
- Advise beta-HCG to confirm the pregnancy.
- Follow the normal dynamics of the HCG level. This will be disturbed in the ectopic pregnancy.
- Normally it increases every 48 to 72 hours until it reaches 10,000 to 20,000 IU/mL
- Serial HCG levels are estimated to differentiate ectopic pregnancy from the normal.
- If the HCG level does not rise at least 66% in 48 hours or HCG level falls in this period.
- But you can see the normal rate of rising by 15% of the ectopic pregnancy.
- Ultrasound is the most helpful tool.
- Progesterone and HCG both predict the abnormal pregnancy than advising a single test of HCG.
- Ectopic pregnancy:
- 97% of cases have Progesterone <12.6 ng/mL and HCG <3000 IU/L.
- Normal pregnancy has progesterone >12.6 ng/mL and HCG >3000 IU/L.
- Progesterone level > 25 ng/ mL, will assure the intrauterine pregnancy and no need for further laboratory tests.
- Progesterone level < 5 ng/mL strongly suggest abnormal pregnancy.
- The first line of management is surgical by laparoscopy.
- Medically gives methotrexate I/M.
- After removal of the ectopic pregnancy HCG level normally remains a detectable level for 4 weeks.
- Monitor the HCG level to be sure that there is no leftover of trophoblastic tissue.