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Pathology - Ectopic Pregnancy
Ectopic means any implantation outside of the uterine cavity. The incidence of ectopic pregnancy is 2% of first time pregnancy.
Ninety-five percent of instances occur in the uterine tube, although implantation can also occur in the cervix, cesarean section scars, peritoneum, or ovary. Approximately 70% of tubal implantations occur in the dilated ampulla, which is the most common location of fertilization. Prior tubal injury is the most important risk factor for ectopic pregnancy.
Six percent of maternal deaths are attributable to ectopic pregnancy and occur from tubal rupture and bleeding. The patient in the vignette is hemodynamically stable at this moment and is unlikely to develop a rupture. The absence of a uterine pregnancy in the presence of serum hCG, which is produced from trophoblast tissue, implies an ectopic implantation. The finding of only slowly increasing hCG levels, which would ordinarily double every 2 days early in pregnancy, together with low levels of progesterone secretion, offers a sensitive and specific diagnosis. Treatment may be surgical to remove the products of conception, or alternatively a pharmacological technique to induce abortion can be utilized; methotrexate is a folate antagonist that interrupts rapid cell division to produce abortion of the pregnancy.
Ectopic means any implantation outside of the uterine cavity. The incidence of ectopic pregnancy is 2% of first time pregnancy.
Ninety-five percent of instances occur in the uterine tube, although implantation can also occur in the cervix, cesarean section scars, peritoneum, or ovary. Approximately 70% of tubal implantations occur in the dilated ampulla, which is the most common location of fertilization. Prior tubal injury is the most important risk factor for ectopic pregnancy.
Six percent of maternal deaths are attributable to ectopic pregnancy and occur from tubal rupture and bleeding. The patient in the vignette is hemodynamically stable at this moment and is unlikely to develop a rupture. The absence of a uterine pregnancy in the presence of serum hCG, which is produced from trophoblast tissue, implies an ectopic implantation. The finding of only slowly increasing hCG levels, which would ordinarily double every 2 days early in pregnancy, together with low levels of progesterone secretion, offers a sensitive and specific diagnosis. Treatment may be surgical to remove the products of conception, or alternatively a pharmacological technique to induce abortion can be utilized; methotrexate is a folate antagonist that interrupts rapid cell division to produce abortion of the pregnancy.
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