ECTOPIC PREGNANCY

Group 14, 2D-MT

Cruz, James Christopher
Nuqui, Rowena
Tomas, Danica
Faculty of Pharmacy
Department of Medical Technology
University of Santo Tomas
España, Manila
INTRODUCTION
Pregnancy- fertilization of egg


which normally occurs in the

uterus


EP- abnormal development of



embryo outside the uterus



•
• Greek word ektopos: out of
place
• Occurrence:
 *Fallopian tube- 97%
 55% in the ampulla,
 25% in the isthmus
 17% in the fimbia


 *abdomen, cervix
 and ovary-3%

Parts of the Fallopian Tube
• 1970: EP increased six fold occurring in
 22% of all pregnancies
• 11th Century: primitive methods
 starvation
 bleeding
 injection of strychnine
 administration of electricity in
growing gestational sac


• 1800s: surgery- resulted to more than 80% of

death



• Previous researches: save mothers life
 Recent researches: saving the woman’s
fertility


• Cause of morbidity in first world countries

as well as in third world countries


• 40-50% of ectopic pregnancies are

misdiagnosed
• Diagnosing EP: physical treatment
 progesterone measurement
 beta-hCG measurement
 ultrasonography


• Treating EP: Medical management

 Surgery
 Expectant method
THE STUDIES
 FAILING PREGNANCIES OF UNKWON LOCATION: A
PROSPECTIVE EVALUATION OF THE HUMAN
CHORIONIC GONADOTROPHIN RATIO
(a report)
Bourne et. al (2006)

PUL Ectopic pregnancy

behave like ectopic pregnancy vs failing beta- hCG

ultrasonically represent EP blob sign

bagel sign

gestational sac

PUL is different from ectopic pregnancy. For a pregnancy to be

considered ectopic, it should meet the necessary requirements in terms
of the elevation or demotion of chemical markers present in the human
body and the unusual presence of signs.
ECTOPIC PREGNANCY COMPLICATED BY AN AVM OF
THE FALLOPIAN TUBE
Henrich, Blasi, Stupin, Joachin & Dudenhausen
(2008)
CAUSES OF ECTOPIC PREGNANCY
Chronic Salpingitis
STD (gonorrhea and Chlamydia)
pelvic inflammatory disease
previous abortion
bitubal ligation
IUD
assited preoperative techniques
late primiparity
previous surgery
AVM
 DIAGNOSING ECTOPIC PREGNANCY

Transvaginal Sonography
2D transvaginal scanning

color Doppler imaging

3D transvaginal scanning

angiography

Chronic salpingitis is the most common finding

associated with ectopic pregnancy. However, AVM is
another factor to be considered; it causes abdominal
pregnancy but can be diagnosed as early as possible
with angiography.
 DIAGNOSING AND TREATMENT OF ECTOPIC
PREGNANCY
Table1 : Risk factors for ectopic pregnancy
(a review)
Baakdah, Bardell, Murray & Tulandi (2005) OR (and
95% CI)
Factor Ankum et al 17
Mol et al 18 Dart et al 9
Previous tubal surgery 21 (9.3-4.7)
--- ---
Previous ectopic pregnancy 8.3 (6.0-11.5) ---
---
in uteroDES exposure 5.6 (2.4-1.3)
--- ---
History of PID 2. 5 ( 2. 1- 3. 0)
--- ---
History of Infertility 2.5-21*
--- 5.0 (1.1-28)
History of chlamydial or
Gonococcal Cervicitis 2.8-3.7*
--- ---
Documented tubal abnormality 3.5-25* ---
---
Tubal ligation ---
9.3 (4.9-18) 18 (3.0-139)
Current IUD use ---
Among the 4.2-known
45* risk factors for
5.0ectopic
(1.1-28pregnancy,
) previous tubal surgery
Note : ORfound
was =oddstoratio , CImost
be the – confidence
common.interval, DES =diethylstilbestrol, PID =pelvic
inflammatory disease, IUD =intrauterine device.
*Range; summary OR not calculated owing to significant heterogeneity between studies .
Table 2 : Performance of serum levels of β human chorionic
gonadotropin ( β - hCG ) in identifying ectopic pregnancy and
abnormal intrauterine pregnancy ( IUP

Predictive value ( 95% CI ),

%
Outcome Sensitivity
Specificity Likelihood ratio (+)
26
Kohn et al ; serum β - hCG level < 1500 IU / L
Ectopic pregnancy 42 (32-52) 81 (78-82)
2. 4
Ectopic pregnancy or
abnormal IUP 38 (33-43) 93 (91-
96) 5.8
Kaplan et al ; 23 serum β - hCG level < 1000 IU / L
Ectopic Pregnancy 38 (26-51) 90 (87-93)
3. 8
Ectopic pregnancy or
abnormal IUP 25 (20-31) 97 (95-
99) 9.5
Serum beta-hCG is sensitive in detecting Ectopic
pregnancy but not specific in differentiating ectopic
pregnancy from abnormal intrauterine pregnancy
Table 3 : Performance of progesterone levels in identifying
ectopic pregnancy and abnormal IUP
Predictive value ( 95% CI
), %
Outcome Sensitivity
Specificity Likelihood ratio (+)
Dart et al ; 31 serum progesterone level ≤ 5 ng / mL *
Ectopic pregnancy 88 (69-97) 40 (32-
49) 1.47
Ectopic pregnancy or
abnormal IUP 84 (77-89) 97
(87-99) 28
Buckley et al ; 29 serum progesterone level ≤ 22ng / mL *
Ectopic Pregnancy 100 (94-100) 27 (23-
30) 1.36
*All patients had β-hCG concentration < 3000 IU/L and indeterminate ultrasound
findings.

Progesterone level measurement is sensitive in detecting

ectopic pregnancy but not specific.
( LS ) for the treatment of ectopic pregnancy [ abridged *]
Treatment success rate, %
Difference
Study (no. of patients) MTX LS in rate Other outcomes Comments
Hajenius et al, 199756 82 72 NS No difference in rates All patients
(100) of tubal preservation
underwent laparoscopy for diagnosis or treatment.
Four doses of MTX
Fernandez et al, 199857 88 96 NS Higher rate of future One of a few
(100) pregnancy in MTX
centres using

group (96% v. 62p < a scoring

0.05 but not of system and
recurrent ectopic
local MTX
pregnancy) injection for ectopic pregnancy)
Sarah et al, 199858 95 91 NS No difference in rates The study
(75)
of tubal patency or was under-
future pregnancy powered
Sowter et al, 200159 65 93 95% CI Less time till β-hCG This study
(62) 10-47 clearance in LS
represents
group: 15 (5-49) the
general
v. 28 (14-71) d
clinical management
of ectopic pregnancy
Note: NS = not significant
Laparoscopy, CI =and
confidence interval were the known methods of treating
methotrexate
*An abridged version of this table is available at www.cmaj.ca/cgi/content/full/173/8/905/DC1.
ectopic pregnancy. However, choosing the more effective method of
treatment is still uncertain.
MANAGEMENT OF ECTOPIC PREGNANCY: A TWO-
YEAR STUDY
(experimental method)
Mabooh & Mazhar (ND)

Fig 1 . Occurrence of ectopic pregnancy

It was found out that ectopic pregnancy accounts for 1% of the entire
pregnancy in Islamabad.
 Fig 2. Treatment administered to patients with ectopic
pregnancy

Laparotomy was found to be the best method in treating an ectopic

pregnancy
Fig 3. The success rate of conservative management
Fig 4. The success rate of methotrexate management
 Other findings
Ectopic pregnancy (Islamabad) 1%

Women mostly affected 28 yrs old

Abdominal pain as the most common symptom 100%

Young women are mostly affected by this condition.

Abdominal pain is the most common symptom
experienced by the patients with ectopic pregnancy.
 (experimental method)
Archibog, Eskandar, Sadek & Sabonde (2002)

There is an increasing occurrence of ectopic pregnancy

 Seasonal variation affects the occurrence of ectopic
pregnancy.
CONCLUSION
• Causes, treatment and diagnosis of ectopic
pregnancy are still being develop by experts
•
• The causes of ectopic pregnancy:
 *AVM


 *Chronic salpingitis caused by sexually

transmitted diseases (gonorrhea and Chlamydia),
pelvic inflammatory diseases, previous
abortions, bitubal ligations , IUD, assisted
preoperative techniques, late primarity and
previous surgery, previous ectopic pregnancy and
infertility


 *seasonal variation and geographical

location

•Mahbooh & Mazhar found out that ectopic
pregnancy frequently occurs at age 28 while
Sepillian & Wood stated that the highest rate of
ectopic pregnancy occurs at age 35- 44.
•
•The diagnosis of ectopic pregnancy can be
done through the use of chemical marker termed
as ß-hCG and by monitoring the level of
progesterone; Ultrasound imaging is mostly
favored by patients with ectopic pregnancy
regardless of its higher cost compared to any
other method.
•Among the three identified methods of treating
an ectopic pregnancy, the surgical management is
preferred over medical and expectant
management because of its minimal drawbacks;
however, there were recorded cases of
recurrences of ectopic pregnancy among patients
who undergone this method.
•
•Despite of the rampant occurrence of ectopic
pregnancy among first world countires, third
world countries, like the Philippines, are not
gravely affected