An ectopic pregnancy is a pregnancy outside of the uterine cavity. Diagnosis and management of ectopic pregnancy the bmj. The condition is the leading cause of pregnancy related death in the first trimester. Ectopic pregnancy, also known as a tubal pregnancy, is a potentially lifethreatening form of pregnancy in which implantation of the fertilized egg occurs outside the uterus. Ectopic pregnancy is defined as implantation of a fertilized egg outside the uterine cavity. Ectopic pregnancy after tubal sterilization is not rare, particularly among women sterilized before the age of 30, and all women undergoing this procedure should be informed that ectopic pregnancy.
Although over 70% of ectopic pregnancies occurred among currently married females, the ectopic pregnancy rates were highest for previously married females. Ectopic pregnancy symptoms, diagnosis and treatment. In patients with a vital extrauterine pregnancy, the human chorionic. Overall, there was a reduced rate of any pregnancy event when comparing the ectopic pregnancy group with the control groups.
Diagnosis and management of ectopic pregnancy american. Incidence, diagnosis and management of tubal and nontubal. Ectopic pregnancy, condition in which the fertilized ovum egg has become imbedded outside the uterine cavity. Ectopic pregnancy may be the only lifethreatening disease in which prevalence has increased as mortality has declined1. The most common ectopic implantation site is the fallopian tube, though 10 % of ectopic pregnancies implant in the cervix, ovary, myometrium, interstitial portion of the fallopian tube, abdominal cavity or within a cesarean section scar. Ectopic pregnancy is a highrisk condition that occurs in 1. Risk increases with prior ectopic pregnancy, tubal surgery, history of sexually transmitted infections, smoking, in vitro fertilisation, or if pregnant despite iud usage. The new england journal of medicine 380 n engl j med 361. A fertilized ovum implanting and maturing outside of the uterine endometrial cavity, with the most common site being the fallopian tube 97%, followed by the ovary 3. In a normal pregnancy, the fertilized egg moves from the fallopian tube into the uterus, where the pregnancy develops. Extrauterine pregnancy is a complication of the first trimester of pregnancy that carries major morbidity and mortality. Ectopic pregnancy affects 1% to 2% of all pregnancies and is responsible for 9% of pregnancyrelated deaths in the united states. An ectopic pregnancy, or eccysis, is a complication of pregnancy occurs when the site of implantation is outside of the womb uterine cavity either in the tubes,ovaries or abdominal cavity, with rare exceptions, ectopic pregnancies are not viable, pregnancy can even occur in both the womb and the tube.
Ectopic pregnancy gynecology and obstetrics msd manual. Assessing normal and abnormal pregnancy from 410 weeks. Any pregnancy implanted outside the endometrial cavity is defined as an ectopic pregnancy ep. Diagnosing ectopic pregnancy and current concepts in the. Definition ectopic pregnancies account for 1% to 2% of all conceptions. Left untreated, ectopic pregnancy is a life threatening condition. The crude rate of ectopic pregnancy per reported pregnancies rose from 5. The incidence of ep varies from 11 to 20 per live births in developed countries centres for disease control, 1995. Diagnostic criteria for nonviable pregnancy early in the first trimester. The power and limits of classification a 32yearold man with. Most cases of tubal ectopic pregnancy that are detected early can be treated successfully either with minimally invasive surgery or with medical management using. For either an intrauterine pregnancy of uncertain viability or a pregnancy. Mark julie ectopic pregnancy 2019 clinical ultrasound. There is an increased incidence associated with in.
Oct 09, 2015 ectopic pregnancy is generally associated with a rise in hcg by no more than 66%, or a fall by no more than % from the baseline level, in 48 hours. In the united kingdom nearly 12 000 ectopic pregnancies are diagnosed each year, which gives a prevalence of 1. Gynecology service university of alabama at birmingham diagnosis of ectopic pregnancy cont. In the uk, one in 90 pregnancies result in an ectopic pregnancy, with an estimated 11,000 ectopic pregnancies diagnosed each year. Nice has released its 2019 guidelines on diagnosis and initial management of ectopic pregnancy and miscarriage. Imaging confirmed an abdominal ectopic pregnancy, with no uterine wall visible surrounding the fetus. Without timely diagnosis and treatment, ectopic pregnancy can become a lifethreatening situation. The site of implantation most commonly is a fallopian tube. Diagnosis involves a combination of clinical symptoms. Ectopic pregnancy remains common in the western world. This is especially important when we try to limit the number of people going to the emergency department or urgent care center so that they wont either transmit or be exposed to covid19. Information for you this leaflet has been updated uptodate information is available on the rcog website. Ectopic pregnancy, in which the gestational sac is outside the uterus, is the most common lifethreatening emergency in early pregnancy.
When a pregnant patient presents with firsttrimester bleeding or. Ectopic pregnancy ep occurs in around 12% of all pregnancies, and is associated with significant morbidity and mortality. The average length of hospital stay for ectopic pregnancy decreased from 7. Pain described as midline in location decreased the likelihood. Diagnosis and management of ectopic pregnancy greentop guideline no. In a small percentage of pregnancies, however, the embryo implants in.
Findings from the history that were predictive of ectopic pregnancy included pain described as moderate to severe, sharp, or lateral, and history of iud use, infertility, pelvic surgery, or tubal ligation. The condition is the leading cause of pregnancyrelated death in the first trimester. Fallopian tube damage commonly results from prior pelvic infection, such as gonorrhea, chlamydia, or other sexually transmitted infections stis. Jun 10, 2011 the estimated prevalence of ectopic pregnancy is 12% worldwide. Nov 01, 2005 ectopic pregnancy is a highrisk condition that occurs in 1. Even today, it accounts for as much as 6% of pregnancyassociated mortality 1, 2.
Visualized ectopic pregnancy, with yolk sac or fetal pole outside the uterus. Sep 28, 2017 ectopic pregnancy is the result of a flaw in human reproductive physiology that allows the conceptus to implant and mature outside the endometrial cavity see the image below, which ultimately ends in the death of the fetus. Aug 19, 20 ectopic pregnancy is a lifethreatening gynecological emergency, and a significant cause of maternal morbidity and mortality in nigeria. The majority of ectopic pregnancies occur in the fallopian tube 96. It is the leading cause of death in the first trimester of pregnancy and the fourth leading cause of all maternal deaths in the united kingdom. Ectopic pregnancy ectopic pregnancies ep refer to implantation of an embryo outside of the uterus. Jun 21, 20 ectopic pregnancy ep presents a major health problem for women of childbearing age. Ectopic pregnancy affects 1% to 2% of all pregnancies and is responsible for 9% of pregnancy related deaths in the united states. This guideline covers diagnosing and managing tubal ectopic pregnancy and miscarriage in women with complications, such as pain and bleeding, in early pregnancy that is, up to completed weeks of pregnancy. Women of reproductive age presenting acutely with gastrointestinal symptoms, particularly diarrhoea, as well as those presenting with abdominal pain andor vaginal bleeding should have a urinary hcg test.
Ectopic pregnancy is a lifethreatening gynecological emergency, and a significant cause of maternal morbidity and mortality in nigeria. The overall incidence has increased over the last few decades and is currently thought to affect 12% of pregnancies. A healthy 29yearold woman who has been trying to conceive presents with vaginal spotting for the past 5 days and intermittent crampy abdominal pain in her left lower quadrant for the past 3 days. This is especially important when we try to limit the number of people going to the emergency department or urgent care center so. Typically presents 68 weeks after last normal menstrual period, but can present earlier or later. Tubal scarring pid, prev ep iud assisted fertilization 25% of pregnancies occuring in pts w iud or tl are ectopic. Women with risk factors, or early pregnancy symptoms of abdominal pain or vaginal bleeding are assessed by early pregnancy assessment services. Ep refers to the pregnancy occurring outside the uterine cavity that constitutes 1. Downloaded from by elizabeth roberts on may 15, 2019. The majority of ectopic pregnancies occur in the fallopian tube 96 percent, but other possible sites include cervical, interstitial also referred to as cornual. Ectopic pregnancy is a potentially lifethreatening condition occurring in 12 % of all pregnancies. The most prominent theory to explain this phenomenon involves technological. Ectopic location complicates as many as 2% of pregnancies. The risk of ectopic pregnancy after tubal sterilization nejm.
Objective the aim of this work was to determine and evaluate the incidence, clinical presentation, risk factors, and management outcomes of ectopic pregnancies at ebonyi state university teaching hospital. This booklet is designed to provide information on the diagnosis and treatment of ectopic pregnancy. The risk is as high as 18% for first trimester pregnancies with bleeding 14. Compared with women with a first miscarriage, women with an ectopic pregnancy experienced a relative risk of 0.
The condition of tubal ectopic pregnancy is presented from diverse points of. Diagnostic criteria for nonviable pregnancy early in the. Elson cj, salim r, potdar n, chetty m, ross ja, kirk ej on behalf of the royal college of obstetricians and gynaecologists. The incidence in the united states has increased greatly in the last few decades, from 4. The estimated prevalence of ectopic pregnancy is 12% worldwide. Revised guideline aims to prevent women dying from ectopic.
The new england journal of medicine n engl j med 369. Pdf a case of tubal ectopic pregnancy researchgate. Miscarriage, ectopic, haemorrhage ruptured corpus luteum cyst, ovarian torsion. Jul 27, 2006 ectopic pregnancy ep is a major complication of pregnancy and a cause of considerable morbidity and mortality among women of reproductive age. Ectopic pregnancy is the result of a flaw in human reproductive physiology that allows the conceptus to implant and mature outside the endometrial cavity see the image below, which ultimately ends in the death of the fetus. Improved diagnostic and therapeutic methods have made maternal death from extrauterine pregnancy rare as a global phenomenon 0. Ectopic pregnancy refers to the implantation of a fertilised ovum outside of the uterine cavity. Ectopic pregnancies and future reproductive outcomes. Ectopic pregnancy is a pregnancy in which the developing blastocyst becomes implanted at a site other than the endometrium of the uterine cavity. An ectopic pregnancy is a pregnancy that grows outside the womb.
Ectopic pregnancy nejm 2009 frates ectopic pregnancy 95% occur in fallopian tube 2% 8% 90% cervical 0. Ectopic pregnancy is also a leading cause of early pregnancy death in australia. The ectopic pregnancy mortality ratio in the united states decreased from 1. The most common extrauterine location is the fallopian tube, which accounts for 96 percent of all ectopic gestations picture 1ab 1. In fact, 50% of ectopic pregnancies are associated with some degree of tubal disease. Ectopic pregnancy ep presents a major health problem for women of childbearing age. In a casecontrol study, investigators used a database of all women who presented to a single university hospital with pain or bleeding in early pregnancy to identify risk factors for ep. If ectopic pregnancy appears unlikely and patients are stable, serum levels of betahcg can be measured serially on an outpatient basis typically every 2 days.
The diagnosis and treatment of ectopic pregnancy ncbi. Jun 25, 2017 ectopic pregnancy is the leading cause of maternal death in early pregnancy. Clinical practice guideline the diagnosis and management of ectopic pregnancy 3 key recommendations 1. A ratio lying within this range, along with an absolute hcg value above 1500 iul in the absence of any visualizable intrauterine pregnancy, can be taken as evidence for a probable ectopic pregnancy. In the 200305 period, there were two women who died directly as a result of pregnancy in the first. The etiology of ep concentrated mainly on factor causes delayed transport of the fertilized ovum through the fallopian tube favors implantation in tubal mucosa, thus giving rise to ep. Overall ep is 12% of conceptions increased with artificial reproductive technologies e.