Ectopic pregnancy

Published on 09/03/2015 by admin

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Last modified 09/03/2015

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Chapter 9 Ectopic pregnancy

Michael Flynn

Definition. An ectopic pregnancy is implantation of a pregnancy outside the uterine cavity.

Incidence. Incidence varies with geographical location, from 1 in 28 to 1 in 300 pregnancies; 65% occur in the age group 25–34 years. In developed countries, incidence remains static at approximately 11 in 1000 pregnancies. Heterotrophic pregnancy (coexisting intrauterine and ectopic pregnancies) occurs in 1 in 30,000 spontaneous conceptions and in at least 1% of technically assisted conceptions.

Site. 97% of ectopic pregnancies occur in the fallopian tubes; the remainder are abdominal, ovarian or cervical.

Tubal ectopic pregnancy

Aetiology and risk factors

• pelvic inflammatory disease: associated with a seven-fold increased incidence of ectopic pregnancy
• tubal surgery
• past history of ectopic pregnancy: a 10%–15% chance of recurrence, rising to 50% if the contralateral tube is abnormal
• contraception associated with a risk of ectopic pregnancy

• progesterone-only pill
• postcoital pill
• intrauterine contraceptive device (users who fall pregnant have a higher risk of ectopic pregnancy than oral contraceptive users)

• assisted reproductive techniques: 5% of pregnancy cycles
• endometriosis
• abnormal embryo

Presentation

• amenorrhoea
• small amount of vaginal bleeding, often after the onset of pain
• lower abdominal pain, shoulder-tip pain
• cervical motion tenderness, adnexal tenderness/mass

Investigations

Quantitative serum human chorionic gonadotrophin (hCG)

From 10 days postfertilisation, the hCG level doubles every 48 hours. If there is an apparently inadequate rise in hCG levels, suspect a failed pregnancy or ectopic pregnancy. Up to 1% of ectopic pregnancies have hCG levels <25 IU/L.

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