Obstetrics & Gynecology
Ectopic Pregnancy
자궁외임신
Implantation of fertilized ovum outside uterine cavity (95% in fallopian tube)
- How common
- 1–2% of all pregnancies
- Typical age
- Reproductive age
What is it?
Tubal damage impairs ovum transport → tubal implantation → trophoblast invades wall → rupture and hemorrhage.
Commonly affected: Fallopian tube (95%), cornua, ovary, abdomen
How it develops
- Tubal damageScarring from PID, prior ectopic, tubal surgery
- Abnormal implantation95% in tubal ampulla; rarely cornual, ovarian, abdominal
- Trophoblastic invasionTrophoblast erodes thin tubal wall and vessels
- Rupture & hemoperitoneumMassive hemoperitoneum can cause shock
Symptoms
- Abdominal painUnilateral lower abdominal, progressive
- ShockTachycardia, hypotension, syncope on rupture
- Shoulder tip painDiaphragmatic irritation from hemoperitoneum (Kehr sign)
- Vaginal bleedingLight to moderate, dark brown
- Amenorrhea4–12 weeks
How it is examined
- Transvaginal USNo intrauterine sac at hCG >1500–2000 IU/L; adnexal mass
- Serial β-hCG<50% rise in 48 hours raises suspicion
- Abd/pelvic examAdnexal tenderness, cervical motion tenderness
Imaging
X-ray unhelpful; US is key.
- Nonspecific
TVUS shows adnexal mass, free fluid in cul-de-sac, possible tubal sac with cardiac activity.
- Tubal gestational sac
- Free pelvic fluid
- Empty uterus
Non-surgical care
- MethotrexateFor hCG <5000, mass <3.5 cm, no cardiac activity, stable: 50 mg/m² IM
- hCG follow-upDays 4 and 7; expect ≥15% decline
- Expectant managementSelected: hCG <200 and falling
- Rest/pain controlAvoid strenuous activity/intercourse; NSAIDs contraindicated
- Anti-D immunoglobulinFor Rh-negative mothers
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Rupture, hemodynamic instability, MTX failure/contraindication, cardiac activity present
Procedures that may be discussed
- Laparoscopic salpingectomy
- Laparoscopic salpingostomy (conservative)
- Emergency laparotomy (severe shock)
Outlook
Good prognosis with early diagnosis; 30–50% risk of recurrence/infertility.