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APGO topic 15 ectopic
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pregnancy ectopic pregnancies are
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abnormal implantations outside of the
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endometrial cavity they account for 1.5
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percent of reported pregnancies in the
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United States 98 percent of ectopic
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pregnancies are in the fallopian tube 70
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to 80 percent are located in the ampulla
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a portion of the tube less common
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locations include the ovary cervix and
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abdomen ectopic pregnancy is a leading
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cause of maternal morbidity and
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mortality early diagnosis and management
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may prevent serious adverse outcomes and
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preserve future fertility the objectives
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of this video are to one develop a
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differential diagnosis for bleeding and
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abdominal pain in the first trimester to
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list risk factors for ectopic pregnancy
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three described the diagnosis and
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treatment for our topic pregnancy when a
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patient presents with first trimester
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vaginal bleeding and abdominal pain it
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is essential to determine the location
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of the pregnancy this could be a
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non-viable intrauterine pregnancy that
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could be either a spontaneous abortion
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or a molar pregnancy or this could still
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be a viable intrauterine pregnancy with
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physiologic implantation bleeding or a
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sub chorionic hemorrhage it is very
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important to consider ectopic pregnancy
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as a possible cause for missing an
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ectopic pregnancy can lead to maternal
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morbidity and mortality let’s discuss
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ectopic pregnancy risk factors as we
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discussed earlier
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98% of ectopic pregnancies are located
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in the fallopian tube here’s a nice and
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normal fallopian tube what risk factors
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would result in this fallopian tube
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becoming scarred and damaged like this
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illustration here having a history of an
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ectopic pregnancy would be the highest
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risk factor any other tubal surgery such
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as a tubal ligation will also put her at
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high risk chlamydial infection causes
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tubal scarring via intraluminal
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inflammation and subsequent fibrin
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deposition if a patient has had three
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episodes of pelvic inflammatory disease
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her ratio of ectopic pregnancy and
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intrauterine pregnancy is one to three
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smoking is also a risk factor because it
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slows the cilia and the fallopian tube
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don’t forget however that 50% of
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patients with atopic pregnancy will not
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have any risk factors the diagnosis of
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ectopic pregnancy involves a high index
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of suspicion the classic symptoms
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associated with ectopic pregnancy
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or amenorrhea vaginal bleeding and
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abdominal pain diagnostic testing
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involves serum beta HCG measurements and
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transvaginal ultrasound serial beta HCG
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measurements are made at 48 hour
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intervals to help determine if this is a
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viable intrauterine pregnancy or a
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non-viable uterine or ectopic pregnancy
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the beta HCG should increase by at least
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50 percent over a 48-hour interval when
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the beta HCG is above approximately
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1,500 to 2,000 and intrauterine
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pregnancy should be seen on transvaginal
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ultrasound treatment for an ectopic
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pregnancy is either medical with
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methotrexate or surgical with either a
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sailfin joste me or a self injected me
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usually performed laparoscopically
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medical management with methotrexate can
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be used if it is safe and there is a
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high chance for success the absolute
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contraindications to methotrexate
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addressed the safety issue and these are
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hemodynamic instability liver or kidney
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abnormalities active lung disease
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breastfeeding and inability to comply
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with the required follow-up beta HCG
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testing if the methotrexate therapy is
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not going to be successful and she still
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ultimately needs surgery then she is
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likely not the best candidate so
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relative contraindications include fetal
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cardiac activity high beta HCG level and
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a large ectopic pregnancy size greater
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than 3.5 centimeters there are two main
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options for surgical management of an
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ectopic pregnancy
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ASAP injected me involves removal of the
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entire fallopian tube there is no need
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for beta HCG follow-ups as the entire
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pregnancy is removed with the fallopian
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tube the other surgical option is a cell
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pin joste me a small hole is made in the
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fallopian tube and the pregnancy is
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removed beta HCG levels have to be
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followed after a South and jaws to me to
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ensure that the entire ectopic pregnancy
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has been removed this concludes the
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aapko video on a topic pregnancy we have
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discussed the differential diagnosis of
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vaginal bleeding and abdominal pain in
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the first trimester ectopic pregnancy
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risk factors and diagnosis and treatment
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remember to always have a high index of
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suspicion in women presenting with
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vaginal bleeding and abdominal pain in
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the first trimester