Ruptured ectopic pregnancy with a negative urine pregnancy. We report an extremely rare case of chronic ectopic pregnancy with decreasing low levels of serum. A case of chronic ectopic pregnancy manifested by rectal bleeding. The majority of ectopic pregnancies occur in the fallopian tube 96 percent, but other possible sites include cervical, interstitial also referred to as cornual. The typical patient will have subacute or chronic pain and a low. Many ectopic pregnancies will follow a relatively chronic course and transvaginal ultrasonography.
When a pregnant patient presents with firsttrimester bleeding or. The condition is the leading cause of pregnancy related death in the first trimester. The clinical presentation and the sonographic patterns of chronic tubal ectopic pregnancy may be similar to those of a pelvic abscess. Chronic ectopic pregnancy should be considered in the differential diagnosis of patients with adnexal mass. Ectopic pregnancy journal of obstetric, gynecologic. In a small percentage of pregnancies, however, the embryo implants in. Any pregnancy implanted outside the endometrial cavity is defined as an ectopic pregnancy ep. The diagnostic conundrum of chronic ectopic pregnancy. Ectopic pregnancy resulting in perforation of the rectum and rectal bleeding is clinically rare. The incidence of ep varies from 11 to 20 per live births in developed countries centres for disease control, 1995. Transvaginal sonographic findings of chronic ectopic pregnancy. Pdf transvaginal sonographic findings of chronic ectopic.
This type of ectopic pregnancy is called a tubal pregnancy. Three methotrexate protocols, fixed multidose, singledose and. Preoperative diagnosis of chronic ectopic pregnancy is often impossible. Chronic ectopic pregnancy cep is a variant of ectopic pregnancy ep characterized by low or absent serum human chorionic gonadotropin. The etiology of ep concentrated mainly on factor causes delayed transport of the fertilized ovum through the fallopian tube favors implantation in tubal mucosa, thus giving rise to ep. In ectopic pregnancy, implantation occurs in a site other than the endometrial lining of the uterine cavityin the fallopian tube, uterine cornua, cervix, ovary, or abdominal or pelvic cavity. This occurs when the fertilized egg from the ovary does not reach or implant itself in the uterus. Ectopic pregnancy gynecology and obstetrics merck manuals. Early symptoms and signs include pelvic pain, vaginal bleeding, and. Nov 01, 2005 ectopic pregnancy is a highrisk condition that occurs in 1. There is an increased incidence associated with in. Chronic ectopic pregnancy is a form of tubal pregnancy in which salient minor ruptures or abortions of an ectopic pregnancy, instead of a single episode of bleeding, incites an inflammatory response often leading to the formation of a pelvic mass.
Ct scan showed a left pelvic mass compatible with a tuboovarian abscess. An ectopic pregnancy occurs in about 1 in 60 pregnancies. Jun 25, 2017 ectopic pregnancy is the leading cause of maternal death in early pregnancy. Chronic ectopic pregnancy after clinically successful. Diagnosing ectopic pregnancy and current concepts in the. A rare with features of a chronic ectopic pregnancy, which followed successful methotrexate medical treatment of a persistent ectopic pregnancy, is presented. Typically presents 68 weeks after last normal menstrual period, but can present earlier or later. Horrow, md, facr acute ectopic pregnancy is a common clinical problem, usually diagnosed by a combination of clinical, sonographic, and laboratory findings. Lee, md, mph, gino farina, md, and helene lhamon, md the incidence of ectopic pregnancy is estimated to be 19.
In a normal pregnancy, the fertilized egg moves from the fallopian tube into the uterus, where the pregnancy develops. Most of the time, an ectopic pregnancy happens within the. Discussion the incidence of chronic ectopic pregnancies varies from% 6. Jul 31, 2014 chronic ectopic pregnancy may present with a negative urinary pregnancy test and very low or even negative serum bhcg levels. However, they can occur in other locations, such as the ovary, cervix, and abdominal cavity. The term chronic ectopic pregnancy was in itially used to describe the clinical complication of an expectantly managed ectopic pregnancy. Md a chronic ectopic pregnancy is a form of tubal pregnancy in which there is gradual disintegration of the tubal wall with slow andor repeated episodes of hemorrhaging leading to the formation of a pelvic mass. An ectopic pregnancy also termed tubal pregnancy is a pregnancy that develops outside of the uterus. Chronic ectopic pregnancy is often an enigma and a correct diagnosis is.
Signs and symptoms classically include abdominal pain and vaginal bleeding. If ectopic pregnancy appears unlikely and patients are stable, serum levels of betahcg can be measured serially on an outpatient basis typically every 2 days. Medical management of tubal pregnancy medical therapy should be offered to suitable women, and units should have treatment and followup protocols for the use of methotrexate in the treatment of ectopic pregnancy. Acute and chronic presentation of ectopic pregnancy may be.
The risk is as high as 18% for first trimester pregnancies with bleeding 14. The diagnosis of unruptured ep uses a combination of. Fewer than 50 percent of affected women have both of these symptoms. Chronic ectopic pregnancy masquerading as a pyosalpinx. A chronic ectopic pregnancy is not a very rare entity and hence should be kept in the differential diagnosis of any complex adnexal mass.
It is the leading pregnancyrelated cause of death in the. Chronic ectopic pregnancy is an uncommon form of tubal pregnancy manifested as a pelvic mass with minimal symptoms and a low or absent titer of human chorionic gonadotropin. Its clinical features are often confusing, and laboratory evaluations are often misleading. Ectopic pregnancies cannot be carried to term and eventually rupture or involute. The incidence of chronic ectopic pregnancy was found to be 20. Dec 04, 2018 the first person to use ectopic in a medical context was the english obstetrician robert barnes 18171907 who applied it to an extrauterine pregnancy. Ectopic pregnancies are frequently due to an inability of the fertilized egg to make its way through a fallopian tube into the uterus. Chronic ectopic pregnancy may present with a negative urinary pregnancy test and very low or even negative serum bhcg levels. This variation of the definition of chronic ectopic pregnancy depends on how accepted by the author. Chronic ectopic pregnancy request pdf researchgate. The most common signs and symptoms of an ectopic pregnancy are abdominal andor pelvic pain and vaginal bleeding. Of these 62 cases of chronic ectopic pregnancy, 55 had preoperative transvaginal sonographic examination. Initial symptoms are like a normal pregnancy, but in a few days you may experience abdominal cramps on one side, vaginal bleeding, and pain in the shoulder tips. A case of chronic ectopic pregnancy manifested by rectal.
Ectopic pregnancy, hcg, acute ectopic, chronic ectopic ectopic pregnancy ep accounts for 2% of all pregnancies in the united states 1. The large majority 95% of ectopic pregnancies occur in the fallopian tube. Approximately 6% of ectopic pregnancies are chronic. Casereport a case of chronic ectopic pregnancy manifested by rectal bleeding ninavukasradulovic,mariabullarbo,anderlingekerhovd departmentofobstetricsandgynecology. Acute ectopic pregnancy is a common clinical problem, usually diagnosed by a combination of clinical, sonographic, and laboratory findings. Chronic ectopic pregnancy is a more unusual situation, resulting from minor ruptures that develop into a hematocele. Ectopic pregnancy affects 1% to 2% of all pregnancies and is responsible for 9% of pregnancy related deaths in the united states. The pain may be described as sharp, dull, or crampy. Chronic ectopic pregnancy is a different entity which may be seen after expectant management of ectopic pregnancy and contains no active trophoblast with low or absent hcg titers. Diagnosis and management of ectopic pregnancy american. With appropriate and prompt management, maternal mortality due to ectopic pregnancy can be prevented. An ectopic pregnancy occurs when a fertilized egg implants itself outside of the uterus. This may be due to endometriosis, scar tissue from previous abdominal surgeries, inflammation or infection such as chlamydia, use of an iud, or following ivf treatments.
The overall incidence has increased over the last few decades and is currently thought to affect 12% of pregnancies. An ectopic pregnancy is a pregnancy outside of the uterine cavity. Ectopic pregnancy affects 1% to 2% of all pregnancies and is responsible for 9% of pregnancyrelated deaths in the united states. Chronic ectopic pregnancy is often an enigma and a correct diagnosis is frequently not made until exploratory laparotomy. Singledose versus twodose administration of methotrexate. Chronic ectopic pregnancy after clinically successful methotrexate. A chronic ectopic pregnancy is a form of tubal pregnancy in which there is gradual disintegration of the tubal wall with slow andor repeated episodes of hemorrhaging leading to the formation of a pelvic mass. Chronic ectopic pregnancy is a term used more commonly in the past to describe an. Case of chronic ectopic in presence of fibroid uterus. Chronic ectopic pregnancy is extremely rare in developed countries, such as the uk, due to the presence of a robust earlypregnancy care service. Chronic ectopic pregnancy cep is a rare condition caused by implantation of trophoblastic tissue in the fallopian tube, which causes. Most cases of tubal ectopic pregnancy that are detected early can be treated successfully either with minimally invasive surgery or with medical management using. Risk increases with prior ectopic pregnancy, tubal surgery, history of sexually transmitted infections, smoking, in vitro fertilisation, or if pregnant despite iud usage.
Pdf chronic ectopic pregnancy diagnosed incidentally in an. Md a chronic ectopic pregnancy is a form of tubal pregnancy in which there is gradual disintegration of the tubal wall with slow andor repeated episodes of hemorrhaging leading to. An ectopic pregnancy happens when the egg, traveling from the ovary to the uterus, gets stuck. Serum human chorionic gonadotropin hcg is a reliable marker used to manage ectopic pregnancy.
In this period, surgery was per formed on a total of 305 cases of ectopic pregnancy. Clinical practice guideline the diagnosis and management of ectopic pregnancy 3 key recommendations 1. One out of every 100 to 300 pregnancies is ectopic, and the prevalence is increasing. You wont need to stay in hospital after treatment, but regular blood tests will be carried out.
Information you can trust from the leading experts in womens health care. Pain may also spread to the shoulder if bleeding into the abdomen has occurred. Cep may complicate the course of patients with ep and is difficult to diagnose. Its given as a single injection into your buttocks. Ectopic pregnancy remains the leading cause of death in early trimester of pregnancy. Women of reproductive age presenting acutely with gastrointestinal symptoms, particularly diarrhoea, as well as those presenting with abdominal pain andor vaginal bleeding should have a urinary hcg test. An ectopic pregnancy most often occurs in a fallopian tube, which carries eggs from the ovaries to the uterus. Theyre also called tubal pregnancies because most of them happen in the fallopian tubes. Hemodynamically stable patients with ectopic pregnancies are commonly treated with systemic methotrexate lipscomb et al.
If an ectopic pregnancy is diagnosed early but active monitoring isnt suitable, treatment with a medicine called methotrexate may be recommended. Ectopic pregnancy is a complication of pregnancy in which the embryo attaches outside the uterus. Sometimes, an ectopic pregnancy occurs in other areas of the body, such as the ovary, abdominal cavity or the lower part of the uterus cervix, which connects to the vagina. The fertilized egg settles and grows in any location other than the inner lining of the uterus. The classic triad of symptoms, amenorrhea, abdominal pain, and abnormal bleeding, varies greatly among individuals, and ectopic pregnancies frequently are confused with other conditions, such as ovarian cyst, pelvic. Chronic ectopic pregnancy cep is a variant of ectopic pregnancy ep characterized by low or absent serum human chorionic gonadotropin hcg levels, resistance to methotrexate mtx, and an adnexal mass with fibrosis, necrosis, and blood clots due to repeated and gradual fallopian tube wall disintegration. Pelvic organ prolapse pev001 zika virus and pregnancy pev002 english spev002 spanish patient education infographics. Chronic ectopic pregnancy is extremely rare in developed countries, such as the uk, due to the presence of a robust early pregnancy care service. An ectopic pregnancy ep falls within the area of the gynecological emergency andor reproductive management of women, which is the implantation of fertilized ovum outside the endometrial cavity. Ectopic pregnancy is defined as implantation of a fertilized egg outside the uterine cavity. The diagnosis of ectopic pregnancy ep is often confirmed at presentation acute, but often requires serial.
In more than 90% of cases, the egg implants in a fallopian tube. The clinical presentation and the sonographic patterns of chronic tubal ectopic pregnancy may be similar to. The purpose of this study is to analyze whether these clinical presentations represent a spectrum of disease. The clinical presentation can be mild, with absent or subtle symptoms. Chronic ectopic pregnancy may present with a negative urinary pregnancy test and very low or. Acute and chronic presentation of ectopic pregnancy may be two. Ectopic pregnancy refers to the implantation of a fertilised ovum outside of the uterine cavity. The products of this conception in most instances do not survive. Hemodynamic stability, chronicity of symptoms, and a high incidence of falsenegative pregnancy tests and culdocentesis results are clinical characteristics distinguishing it from the more common acute ectopic pregnancy. Jul 23, 2019 chronic ectopic pregnancy cep is a variant of ectopic pregnancy ep characterized by low or absent serum human chorionic gonadotropin hcg levels, resistance to methotrexate mtx, and an adnexal mass with fibrosis, necrosis, and blood clots due to repeated and gradual fallopian tube wall disintegration.