| Keywords | URL |
| NEET PG preparation | https://www.diginerve.com/courses/undergrad/digineet/ |
| Ultrasound training for gynaecologists | https://www.diginerve.com/courses/postgrad/advance-course-in-ultrasound-and-infertility/ |
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Ectopic pregnancy is a critical topic in obstetrics and gynecology, both for clinical understanding and NEET PG preparation. It’s also a life-threatening condition that requires early diagnosis and timely management. Understanding its pathophysiology, clinical presentation, and diagnostic approach is vital for both medical students and practising gynaecologists.
What is an Ectopic Pregnancy?
An ectopic pregnancy occurs when a fertilised egg implants outside the uterine cavity, most commonly in the fallopian tube.
In simple terms, it means the embryo attaches in a location that cannot support normal fetal growth, leading to potential rupture and internal bleeding if untreated.
An ectopic pregnancy is the implantation of a fertilised ovum at a site other than the endometrial lining of the uterine cavity.
Common Sites of Ectopic Pregnancy
- Tubal (95%)- Most common, usually in the ampullary or isthmic region.
- Ovarian (3%)
- Abdominal (1%)
- Cervical (rare)
The term tubal pregnancy is often used interchangeably with ectopic pregnancy because the fallopian tube is the most frequent site of implantation.
Reasons for Ectopic Pregnancy
Understanding the causes is essential for both prevention and early detection. The main reasons include:
- Pelvic Inflammatory Disease: It can damage or block the fallopian tubes.
- Previous Tubal Surgery: Can cause scarring or narrowing.
- Use of an Intrauterine Device Slightly increases ectopic pregnancy if conception occurs.
- Assisted Reproductive Techniques: Such as IVF or ICSI.
- Endometriosis: Leads to adhesions or altered tubal anatomy.
- Smoking: Reduces tubal motility and ciliary function.
- Previous Ectopic Pregnancy: Increases recurrence risk.
Signs and Symptoms of Ectopic Pregnancy
Early Ectopic Symptoms
- Missed menstrual period (amenorrhea)
- Mild lower abdominal pain or discomfort
- Light vaginal spotting or bleeding
Classic Triad of Ectopic Pregnancy
- Amenorrhea
- Abdominal pain
- Vaginal bleeding
These are the hallmark signs and symptoms of tubal pregnancy, but they may not always appear together.
Diagnosis of Ectopic Pregnancy
- Clinical Examination
Pelvic tenderness, cervical motion tenderness and adnexal mass may be detected.
- Ultrasound (Transvaginal Sonography)
- No intrauterine gestational sac when β-hCG is >1500 mIU/mL
- Adnexal mass or gestational sac with yolk sac/embryo outside the uterus
- Free fluid in the pouch of Douglas (suggesting rupture)
- Serum β-hCG Levels
- An abnormally slow rise of β-hCG over 48 hours suggests ectopic gestation.
- Serial measurements help in diagnosis and monitoring after treatment.
Treatment of Ectopic Pregnancy
- Medical Management
- Methotrexate is the drug of choice in stable patients without rupture.
- Criteria: Unruptured ectopic β-hCG < 5000 mIU/mL, size < 3.5 cm, no fetal cardiac activity.
- Surgical Management
- Laparoscopic salpingostomy or salpingectomy (depending on the condition of the tube and the patient’s fertility desire).
- Indicated in ruptured ectopic, contraindications to methotrexate or failed medical therapy.
Prevention and Follow-up
- Early treatment of pelvic infections
- Avoid smoking
- Careful monitoring during IVF or ART
- Regular follow-up ultrasounds after treatment to ensure complete resolution
Ectopic Pregnancy in NEET PG Preparation
Ectopic pregnancy is a high-yield topic in NEET PG and other postgraduate medical entrance exams. Questions are frequently tested:
- Site and causes of ectopic pregnancy
- Classic triad of symptoms
- Ultrasound findings
- Management protocols
Ectopic pregnancy remains one of the most critical emergencies in obstetrics. Early diagnosis through ultrasound and β-hCG monitoring can prevent life-threatening complications. For medical students and gynaecologists, mastering this topic enhances both clinical acumen and exam performance.
Whether you’re preparing for NEET PG or advancing your ultrasound training for a gynaecologist, understanding ectopic pregnancy thoroughly is a must.
