A 34-year-old woman, without risk factors for multiple pregnancies, presented with a spontaneous hypertopic pregnancy to a military facility. The ectopic pregnancy was successfully treated via laparoscopic surgery. [ncbi.nlm.nih.gov]

Objective: To report a case the seldomness in the way in that it is presented the combination of the two pregnancies and the emergency of when one is broken. [pesquisa.bvsalud.org]

• Pain

  CASE 1: Pelvic pain and few signs of intrauterine pregnancy A 24-year-old woman, para 1-0-0-1, visits the hospital emergency department complaining of pelvic pain. [mdedge.com]

  Signs of ectopic pregnancy include Abdominal pain Shoulder pain Vaginal bleeding Feeling dizzy or faint Get medical care right away if you have these signs. Doctors use drugs or surgery to remove the ectopic tissue so it doesn't damage your organs. [icdlist.com]

  In addition to signs of pregnancy, symptoms include abdominal pain and vaginal bleeding. [amboss.com]

  Signs and symptoms Early signs include: Pain in the lower abdomen, and inflammation (Pain may be confused with a strong stomach pain, it may also feel like a strong cramp) Pain while urinating Pain and discomfort, usually mild. [slideshare.net]

  In ectopic pregnancy, pain usually comes first and if vaginal bleeding occurs it is of much less significance. The differential diagnosis is also as for left iliac fossa pain or right iliac fossa pain. [patient.info]

• Infertility

  Here we report on a 38-year-old women (gravida 3, para 1) with a history of infertility who presented to our infertility clinic for evaluation. Hysterosalpingography revealed bilaterally patent Fallopian tubes and stricture of the cervical canal. [ncbi.nlm.nih.gov]

  […] may be due to: A history of PID Previous ectopic pregnancy Past surgeries involving the fallopian tubes Endometriosis Exposure to DES ( diethylstilbestrol ) in utero Bicornuate uterus Non‑anatomical risk factors Intrauterine device ( IUD ) History of infertility [amboss.com]

  The woman should be aware of the risks of future infertility, recurrent ectopic and persistent ectopic if her tube is saved. [advancedfertility.com]

  De Sutter P (2006) Rational diagnosis and treatment in infertility. Best Pract Res Clin Obstet Gynaecol 20(5):647–664 CrossRef PubMed Google Scholar 19. [link.springer.com]

• First Trimester Pregnancy

  9/17/12 - This week we are excited to have our first guest IOW presenter, advance ultrasound rockstar, Dr. Patrick Thomas providing us with some education on transvaginal ultrasound to evaluate first trimester pregnancy. Enjoy! [em.emory.edu]

  Ectopic pregnancy should be suspected when no intra uterine pregancy (IUP) is found on preliminary scanning (2).Ectopic pregnancy remains the leading cause of death in first trimester pregnancy. [criticalcare-sonography.com]

  Heterotopic pregnancy (IUP + Ectopic) is very rare. 1:5,000 pregnancies without fertility agents. First Trimester Pregnancy Ultrasound: Management of Ectopic Pregnancy : Ectopic Pregnancy can be managed surgically or medically. [60secondem.com]

  First trimester diagnosis and management of pregnancies implanted into the lower uterine segment cesarean section scar. Ultrasound Obstet Gynecol. 2003;21:220–7. [fertilityresearchandpractice.biomedcentral.com]

• Collapse

  In rare instances, collapse may be the first sign of an ectopic pregnancy. This is an emergency situation and should seek urgent medical attention. Urinary symptoms. Rectal pressure or pain on defecation. [aimu.us]

  The possibilities include an abnormal intrauterine pregnancy with a collapsed sac or an ectopic pregnancy. [thenewjerseyectopicpregnancycenter.com]

• Pallor

  SIGNS • Pallor: moderate to severe • Shock signs: • Low BP 90/60 mmHg • Weak pulse • Raised pulse rate 110/min • Raised RR> 20 • Sweating • Cold skin • Tender distended abdomen with rebound tenderness • Signs of intraperitoneal fluid i.e. fluid thrill [slideshare.net]

  Pallor. Abdominal distension. Enlarged uterus. Tachycardia and/or hypotension. Shock or collapse. [patient.info]

• Tachypnea

  […] show some of these findings: Pelvic mass (either from the enlarged ectopic, or from the corpus luteum cyst that accompanies many early pregnancies of all types) Pelvic tenderness, localized or geeralized Abdominal distension Hypotension, tachycardia, tachypnea [brooksidepress.org]

• Abdominal Pain

  In addition to signs of pregnancy, symptoms include abdominal pain and vaginal bleeding. [amboss.com]

  Abdominal pain and bleeding are common with ectopic pregnancy, but many patients do not exhibit these symptoms. "Fewer than half of the women with an ectopic pregnancy have the classically described symptoms of abdominal pain and vaginal bleeding. [medpagetoday.com]

  Signs of ectopic pregnancy include Abdominal pain Shoulder pain Vaginal bleeding Feeling dizzy or faint Get medical care right away if you have these signs. Doctors use drugs or surgery to remove the ectopic tissue so it doesn't damage your organs. [icdlist.com]

  Abdominal pain is the most common symptom, but there are many potential causes of abdominal pain. Often, women will experience vaginal bleeding unrelated to an ectopic pregnancy. [andresberger.com]

  The fallopian tube is the most common ectopic site and may cause abdominal pain with bleeding and can be life-threatening. The location of a pregnancy can be determined with an ultrasound scan. [fertilitysmarts.com]

• Abdominal Tenderness

  Approximately 5 weeks after tubal embryo transfer, the patient presented with lower abdominal tenderness and shock due to internal bleeding. She underwent an emergency laparotomy under the impression of HP. [ncbi.nlm.nih.gov]

  Examination Common signs: Pelvic or abdominal tenderness. Adnexal tenderness. Other possible signs: Rebound tenderness. Cervical tenderness. Pallor. Abdominal distension. Enlarged uterus. Tachycardia and/or hypotension. Shock or collapse. [patient.info]

  The patient was haemodynamically stable without abdominal tenderness or peritoneal signs. A mass, around 15 cm in diameter, was palpable between the umbilicus and the pubic bone on the right side of the abdomen. [southsudanmedicaljournal.com]

  Findings such as hypotension and marked abdominal tenderness with guarding and rebound tenderness suggest a leaking or ruptured ectopic pregnancy. (b)Speculum and bimanual examination have a limited diagnostic value and findings may be nonspecific. [aimu.us]

  Significant abdominal tenderness suggests ruptured ectopic pregnancy, especially in a patient with hypotension who presents with guarding and rebound tenderness. [aafp.org]

• Acute Abdomen

  Tubal rupture Acute course with sudden and severe lower abdominal pain ( acute abdomen ) Signs of hemorrhagic shock : e.g., tachycardia, hypotension, syncope More common in interstitial pregnancy References: [10] [11] [12] Diagnostics Positive pregnancy [amboss.com]

  A patient with spotting, no abdominal pain, and a low initial beta–human chorionic gonadotropin (β-HCG) level that is falling may be managed expectantly, whereas a patient who presents with hemodynamic instability, an acute abdomen, and high initial β-HCG [emedicine.medscape.com]

  DIAGNOSIS Patients clinically suspected of having ectopic pregnancy fall into two major categories: those who have an acute abdomen and in whom immediate surgery is indicated, and those who are clinically stable and in whom adjunctive diagnostic procedures [glowm.com]

• Abdominal Cramps

  Light vaginal bleeding and pelvic pain are usually the first symptoms, but others could include: Nausea and vomiting with pain Sharp abdominal cramps Pain on one side of your body Dizziness or weakness Pain in your shoulder, neck, or rectum Ectopic pregnancy [webmd.com]

• Tachycardia

  Tubal rupture Acute course with sudden and severe lower abdominal pain ( acute abdomen ) Signs of hemorrhagic shock : e.g., tachycardia, hypotension, syncope More common in interstitial pregnancy References: [10] [11] [12] Diagnostics Positive pregnancy [amboss.com]

  Tachycardia and/or hypotension. Shock or collapse. [patient.info]

  […] however, may show some of these findings: Pelvic mass (either from the enlarged ectopic, or from the corpus luteum cyst that accompanies many early pregnancies of all types) Pelvic tenderness, localized or geeralized Abdominal distension Hypotension, tachycardia [brooksidepress.org]

• Osteoporosis

  Stenosis Lumbar Puncture Malaria Malnourishment, Adult Medical Decision-Making Capacity Melanoma Meningitis, Adult Menopause Migraine Mononucleosis Murmur, Diastolic Murmur, Systolic Myasthenia Gravis Myocardial Infarction Opiates and Abdominal Pain Osteoporosis [jamaevidence.mhmedical.com]

• Pelvic Pain

  pain Cervicitis : lower abdominal or pelvic pain PID : fever, menorrhagia and metrorrhagia, dyspareunia, purulent cervical discharge Cervicitis : intermenstrual bleeding, vaginal discharge, dyspareunia, usually no fever Endometriosi s Chronic pelvic [amboss.com]

  CASE 1: Pelvic pain and few signs of intrauterine pregnancy A 24-year-old woman, para 1-0-0-1, visits the hospital emergency department complaining of pelvic pain. [mdedge.com]

  Emergency Ultrasound > Pelvic Pain > Ectopic Pregnancy Pelvic Pain - Ectopic Pregnancy Clinical An ectopic pregnancy is implantation of a fertilized ovum outside of the fundus or body of the uterine cavity.Usually bleeding or pain in a patient with a [med-ed.virginia.edu]

  More severe internal bleeding may cause: Lower back, abdominal, or pelvic pain. Shoulder pain. This is caused by free blood tracking up the abdominal cavity and irritating the diaphragm, and is an ominous sign. [slideshare.net]

  Vaginal bleeding and pelvic pain are common complaints in first trimester pregnancy. When formulating a differential, always have ectopic pregnancy at the front of your mind. [em.emory.edu]

• Adnexal Mass

  The combination of adnexal mass and echogenic cul-de-sac fluid makes this patient very high risk for ectopic pregnancy. Transvaginal image of a cornual ectopic pregnancy (red arrow). The uterus is demonstrating a decidual reaction (red arrowhead). [med-ed.virginia.edu]

  Picture of uterus without a fetal pole and a complex adnexal mass consistent with ectopic pregnancy. [emedicine.medscape.com]

  The history of a left adnexal mass, which in all probability was a tubal ectopic pregnancy; which subsequently ruptured resulting in left abdominal ectopic pregnancy. These findings were confirmed on surgery. [ultrasound-images.com]

  Unruptured ectopic pregnancy with an adnexal mass No intrauterine pregnancy seen on ultrasound scan. [patient.info]

  Transvaginal ultrasound with visualization of intrauterine pregnancy less than 6 weeks and right adnexal mass. Source: Document obtained during the course of the study. [revistas.unal.edu.co]

• Cesarean Section

  Monitoring of the patient resulted in elective uncomplicated cesarean section delivery at 38 weeks following an uneventful pregnancy. [ncbi.nlm.nih.gov]

  section was performed obtaining a female infant, weighing 2280 g without complications. [acronyms.thefreedictionary.com]

  […] scar Back to top Gestation sac in Lower segment Myometrium Back to top Gestation sac in Cesarean section scar Back to top Ultrasound image of scar pregnancy This is yet another case of Cesarean section scar pregnancy. [ultrasound-images.com]

  section o Previous cervical or uterine surgery o In vitro fertilization-embryo transfer (3,4). · Diagnosis of cervical pregnancy requires visualization of an intracervical ectopic gestational sac or trophoblastic mass. · Transvaginal ultrasound improves [fetalultrasound.com]

  Cesarean section EP Risk for cesarean scar implantation is not clearly correlated to the number of prior cesarean sections [ 64 ]. [fertilityresearchandpractice.biomedcentral.com]

• Enlarged Uterus

  Benign neoplasms (e.g., adenomyosis, uterine leiomyoma ) Adenomyosis : chronic pelvic pain Uterine leiomyoma : back or pelvic pain /discomfort Adenomyosis : dysmenorrhea, menorrhagia, uniformly enlarged uterus Uterine leiomyoma : menorrhagia, dysmenorrhea [amboss.com]

  Enlarged uterus. Tachycardia and/or hypotension. Shock or collapse. [patient.info]

  uterus, vaginal bleeding, pelvic pain with manipulation of the cervix, and a palpable adnexal mass significantly increase the likelihood of an ectopic pregnancy. [aafp.org]

• Metrorrhagia

  Endometrial polyp Irregular menstrual bleeding, spotting, menorrhagia Malignant neoplasms (e.g., cervical cancer, endometrial cancer ) Cervical cancer : menometrorrhagia, postcoital spotting, abnormal vaginal discharge Endometrial cancer : metrorrhagia [amboss.com]

After workup the diagnosis of right ruptured ectopic pregnancy with possible hemoperitoneum was established. Ultrasound performed in the ED confirmed ruptured tubal pregnancy. There were no gestation products noted in the uterus. [blr.hcpro.com]

A workup will generally be ordered, including beta hCG levels and ultrasound examinations to determine the location and viability of the pregnancy. [wehavekids.com]

Because of its rarity, there are no universal treatment guidelines to manage this condition. [ncbi.nlm.nih.gov]

The case of a patient following a homologous intrauterine insemination treatment, resulting in live birth of both twins, is also described. [link.springer.com]

Follow-up testing after treatment During the week after treatment for an ectopic pregnancy, your hCG (human chorionic gonadotropin) blood levels are tested several times. [northshore.org]

Medical treatment of ectopic pregnancy has largely replaced surgical treatment in clinically stable patients, using the drug called Methotrexate (MTX). [laivfclinic.com]

Often, the HCG levels will fall, meaning that the pregnancy is being reabsorbed by the body on its own and no treatment is needed. Medical treatment is also possible. [drmalpani.com]

Treatment and prognosis An ultrasound-guided ablation or laparoscopic removal of the extra-uterine fetus can be considered in patients who have a known heterotopic pregnancy to permit the intrauterine pregnancy to continue normally. [radiopaedia.org]

Prognosis [ edit ] Extrauterine pregnancies are non-viable and can be fatal to the mother if left untreated. The mortality rate for the extrauterine pregnancy is approximately 35%. [en.wikipedia.org]

Both abnormally large or small yolk sacs are associated with poor prognosis and usually end in embryonic demise. No embryo was visualized in this case. [ultrasound-images.com]

Two thirds of these maternal deaths are associated with substandard care. [ 2 ] Women who are less likely to seek medical help have a worse prognosis. [patient.info]

The prognosis for the fetus is poor if pregnancy progress. Few angular pregnancies develop into a normal uterus will rupture, but many of these pregnancies abort. Approximately a quarter results into a live birth. [ispub.com]

Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10coded.com]

Very little is known about the etiology of ectopic pregnancy. What obstacles are inhibiting this research? Andrew W. [clinchem.aaccjnls.org]

Etiology Localization Fallopian tube (96% of cases): ampulla >> isthmus > fimbriae > interstitial pregnancy : e.g., cornual pregnancy Ovary (3% of cases) Abdomen (1% of cases) Cervix (very rare) Risk factors Anatomic alteration of the fallopian tubes [amboss.com]

PID is considered a major etiologic factor in ectopic pregnancy. [glowm.com]

Cesarean scar ectopic pregnancies: etiology, diagnosis, and management. Obstet Gynecol. 2006;107:1373–81. PubMed View Article Google Scholar Maymon R, Halperin R, Mendlovic S, Schneider D, Herman A. [fertilityresearchandpractice.biomedcentral.com]

Epidemiology [ edit ] The prevalence of heterotopic pregnancy is estimated at 0.6‑2.5:10,000 pregnancies. [3] There is a significant increase in the incidence of heterotopic pregnancy in women undergoing ovulation induction. [en.wikipedia.org]

Ectopic pregnancy: History, incidence, epidemiology, and risk factors. Clin Obstet Gynecol; 55 (2): 376-386. Cissé CAT, De Bernis L, Faye EO, Diadhiou F. 2002. Grossesse extra-utérine au Sénégal. Carnets de Santé; 12 (2): 271-274. [southsudanmedicaljournal.com]

Epidemiology [ 1 ] The rate of ectopic pregnancy in the UK is 11 per 1,000 pregnancies. Although the mortality from ectopic pregnancies in the UK is decreasing, around 0.2 per 100 ectopic pregnancies result in maternal death. [patient.info]

While there is an epidemiologic study assessing risk factors for ectopic pregnancy, it is difficult to identify causal factors. [clinchem.aaccjnls.org]

Clinical epidemiology: a basic science for clinical medicine. 2nd ed. Boston: Little, Brown, 1991. To the Editor Transvaginal ultrasonography provides a definitive diagnosis in approximately 90 percent of women at risk for ectopic pregnancy 1. [nejm.org]

This bleeding will be both vaginal and internal and has two discrete pathophysiologic mechanisms: External bleeding is due to the falling progesterone levels. [slideshare.net]

A clinician who understands the pathophysiology of ectopic pregnancy can appropriately follow a woman, and intervention and misdiagnosis can be minimized. Tom Bourne: Clearly, avoiding the risk factors would be a move in the right direction. [clinchem.aaccjnls.org]

The site of implantation was also important, as interstitial and nontubal ectopic pregnancies account for only 5–10% of all ectopic pregnancies, but for 20% of all fatalities. 22 PATHOPHYSIOLOGY The mechanisms responsible for ectopic implantation are [glowm.com]

The role of estrogen in the pathophysiology of tubal ectopic pregnancy. Am J Transl Res. 2012;4:269–78. PubMed PubMed Central Google Scholar Shaw JL, Horne AW. The paracrinology of tubal ectopic pregnancy. Mol Cell Endocrinol. 2012;358:216–22. [fertilityresearchandpractice.biomedcentral.com]

Early intervention and thorough inspection of the peritoneal cavity in patients with haemodynamic instability can prevent jeopardizing the life of the mother as well as the ongoing pregnancy. [ncbi.nlm.nih.gov]

Occurrence of ectopic pregnancy cannot be prevented but complications can be reduced/ prevented with early diagnosis and treatment. [aimu.us]

Prevention You cannot prevent ectopic pregnancy, but you can prevent serious complications with early diagnosis and treatment. [northshore.org]

Therefore, high index of suspicion is recommended to prevent morbidity and mortality after failed induction. The life-threatening complication is rupture of the horn. [omicsonline.org]

Early treatment may prevent fertility problems as well as future health complications. Ectopic pregnancy is one of the most serious dangers women face in early pregnancy. [andresberger.com]