1. Ectopic Pregnancy
Manuel Fonseca Crescioni
MS3
Hospital San Lucas Guayma

2. Ectopic Pregnancy
• Implantation of fertilized ovum outside uterine cavity.
• Most common site is the ampulla of fallopian
tube(70-80%)
• Leading cause of maternal death in the 1st trimester

3. • A=Ampulla 80%
• B=Isthmic 12%
• C=Fimbria 5%
• D=Corneal interstitial 2%
• E= Abdominal1.4%
• F=Ovarian 0.2%
• G= Cervical 0.2%

4. Risk Factors
1.Tubal damage:
a.PID
b.Salpingitis
c.Previous Abdominal Surgery
d.Endometriosis
2.Previous History of Ectopic Pregnancy
3. Decrease Motility of Fallopian Tube
a.Smoking
b.IUD
c.Maternal Age
4. History of Infertility

5. Classic presentation
• Reproductive age female
• Unilateral right or left lower quadrant, abdominal pain
or pelvic pain.
• weeks after missed period
• +/- Vaginal Bleeding
• 50% palpable adnexal mass

6. Management
• B-hcg
• U/S

7. Treatment

8. Medical Treatment
• Reliable patient
• CBC
• CMP
• B-hcg

9. Medical Treatment
• MTX
• Exclusion criteria for MTX
-Immunideficiency
-Liver disease
-ectopic is 3.5cm or larger
-fetal heartbeat auscultated
-Bhcg levels less than 5000mlU/ml
-free fluid cul-de-sac
-noncompliant

10. Medical Treatment
• follow up 4-7 days
• 15% B-HCG decrease
• follow up 4-7 days

11. Surgical Treatment
• Salpingostomy

12. Surgical Treatment
• Salpingectomy

14. 25 y/o F presents to ER w/RLQ Pain 8/10, LMP 12 weeks
ago, PMH endometriosis , PID , social drinker 10-15 drinks
per weekend, smokes 2 packs per week, BHCG is + , u/s
show gestational sac outside uterine wall, bp 90/60 hr 105
temp 38, what is the next best step?
a. Give MTX follow up in 4-7 days
b.Order CBC ,CMP, and evaluate for fetal heartbeat
c.Laparoscopic Salpingectomy STAT
d.administer IV fluids, blood products, vassopresors

15. 25 y/o F presents to ER w/RLQ Pain 8/10, LMP 12 weeks
ago, PMH endometriosis , PID , social drinker 10-15 drinks
per weekend recreational IV drug user, smokes 2 packs per
week, BHCG is + , u/s show gestational sac outside uterine
wall, bp 90/60 hr 105 temp 38, what is the next best step?
a. Give MTX follow up in 4-7 days
b.Order CBC ,CMP, and evaluate for fetal heartbeat
c.Laparoscopic Salpingectomy STAT
d.administer IV fluids, blood products, vassopresors

16. Reference
• Medscape
• Fundamentals of Pathlogy 2e Husain A Sattar,MD
• Rapid Review Pathology 4e Edward F. Goljan
• Master the boards USMLE Step 2 ck 3e Conrad
Fischer, MD