Ectopic pregnancy - misc.

Question 1

What % of ectopic pregnancies occur in the fallopian tube/oviduct?

Answer 1

90%

Question 2

What condition are 1/2 of ectopic pregnancies associated with?

Answer 2

Chronic salpingitis

Question 3

What is chronic salpingitis?

Answer 3

Underlying pathology in the fallopian tubes itself.

Chronic inflammation in fallopian tube which disturbs the movement of the fertilised ovum

• Ovum implants while still in fallopian tubes.
• Grow within narrow tube.
• –> Increased pressure
• –> causes fallopian tube to burst open
• ~ –> lead to major haemorrhage.

Question 4

Where should a normal fertilised ovum implant?

what is the term for when a fertilised ovum implants outside this structure?

Answer 4

uterine fundus

ectopic pregnancy

Question 5

Per 150 pregnancies, how many implant outside the normal place of implantation?

Answer 5

normal location of implantation = uterine fundus

1 per 150

Question 6

Which location outside the physiologically normal place can a fertilised ovum implant and still survive?

Answer 6

Tubal ectopic pregnancy (extrauterine site)

Question 7

What are the negative implications of a tubal ectopic pregnancy?

Answer 7

• pregnancy continues for a couple of weeks
• increased pressure in the fallopian tube –> rupture
• –> acute, life-threatening haemmorhage

Question 8

When does acute haemmorhage due to tubal ectopic pregnancy usually occur?

Answer 8

6 weeks post previous menstrual period

Question 9

What are the causes all ectopic pregnancies?

Answer 9

1/2 due to identifiable lesions e.g.

• chronic salpingiits
  
  • due to pelvic inflammatory disease
• adhesions ​
  
  • due to appendicitis, endometriosis, or previous laparotomy

1/2 no cause is found

Question 10

What is a cause of chronic salpingitis causing a lesion?

Answer 10

pelvic inflammatory disease

Question 11

What is a cause of adhesions causing an abdominal lesion?

Answer 11

• appendicitis
• endometriosis
• previous laparotomy

Question 12

Why does an ectopic pregnancy

a) present as a medical emergency?
b) should be considered as a differential for women of childbearing age?

Answer 12

• a) because of the sudden rupture with hemoperitoneum
• b) can be a cause of acute abdominal pain

Question 13

How is an ectopic pregnancy diagnosed?

Answer 13

• positive pregnancy test (presence of human chorionic gonadotropin)
• ultrasound
• culdocentesis w presence of blood

are all helpful

Question 14

What is culdocentesis?

Answer 14

the extraction of fluid from the pouch of Douglas through a needle.

Useful in diagnosing:

• pelvic inflammatory disease
• ruptured ectopic pregnancies that cause hemoperitoneum

Question 15

What structures can be recovered following a rupture of an ectopic pregnancy?

Answer 15

• blood clot
• chorionic villi

Question 16

What are some other sites of ectopic pregnancy?

Answer 16

• ovary
• abdominal peritoneum
• cornual (uterine) portion of fallopian tube

Question 17

What is the clinical presentation of an ectopic pregnancy?

Answer 17

Normal symptoms of pregnancy:

• morning sickness
• amenorrhoea
• breast swelling
• positive pregnancy test

Intermittent lower abdominal pain before sudden onset severe pain

Question 18

What is acute salpingitis?

Answer 18

• ascending infection
• 1/2 caused by: Neisseria gonorrhoeae
• may involve ovary
• can –> in abscess formation (localised tissue necrosis w neutrophil infiltration)