Ectopic pregnancy

358,598views

00:00 / 00:00

High Yield Notes

9 pages

Flashcards

Ectopic pregnancy

of complete

Questions

USMLE® Step 1 style questions USMLE

of complete

A 25-year-old woman comes to the office due to vaginal bleeding and abdominal pain for the past 2 days. The patient’s last menstrual cycle was 6 weeks ago. She is sexually active with her male partner of 2 years, and they have been using the withdrawal method as contraception. Medical history is unremarkable other than an episode of pelvic pain 2 years ago that resolved spontaneously without treatment. Temperature is 37.0°C (98.6°F), pulse is 80/min, and blood pressure is 135/85 mmHg. Serum hCG is positive, measuring 1200 mIU/mL. Transvaginal ultrasound shows an empty, normal-appearing uterus and no other abnormalities. Physical examination shows mild lower right adnexal tenderness but is otherwise unremarkable. Which of the following is the underlying cause of this patient’s presentation?

External References

First Aid

2024

2023

2022

2021

Abdominal pain

ectopic pregnancy p. NaN

Amenorrhea

ectopic pregnancy and p. NaN

Ectopic pregnancy p. NaN

appendicitis differential diagnosis p. 390

Chlamydia trachomatis p. , 147

hCG in p. 652

Kartagener syndrome p. 47

methotrexate for p. 444

salpingitis and p. 182

hCG

ectopic pregnancy p. NaN

Infertility

ectopic pregnancy p. NaN

Pelvic inflammatory disease (PID) p. 182

ectopic pregnancy p. 659

Salpingitis

ectopic pregnancy and p. NaN

Transcript

Watch video only

In ectopic pregnancy, ectopic means “out of place,” so an ectopic pregnancy means that a pregnancy occurs somewhere other than in the uterine cavity.

In order for an ectopic pregnancy to take place, a couple of things need to happen differently from the normal process of a pregnancy.

First, following ovulation, the egg must be fertilized and come to rest somewhere other than the endometrium of the uterine cavity.

Next, when it arrives at this destination, it must implant on a surface with a rich enough blood supply to support a developing embryo.

Ectopic pregnancies have been known to occur on various surfaces, including the ovaries, intestines, and most commonly, in the ampulla of the Fallopian tube.

After implantation, the embryo begins developing and growing just like it would in a normal pregnancy.

Over time, a few different things can happen. Sometimes the tissue can no longer provide a sufficient blood supply for the embryo, leading to its death.

On the other hand, if the tissue can supply the embryo with sufficient blood, then hormones from the corpus luteum and placenta can lead to a missed menstrual period and other body changes like nausea and fullness of breasts, which are typically seen in early pregnancy.

If the ectopic pregnancy occurs in the ampulla of the fallopian tube, it eventually runs out of space.

Slowly the ectopic pregnancy stretches the nerve fibers within the wall of the fallopian tube, causing lower abdominal pain.

Eventually, the expansion causes damage to the wall of the ampulla, potentially rupturing the fallopian tube.

A ruptured ectopic can also lead to massive hemorrhaging into the abdominal cavity, and the blood can irritate the peritoneum which can cause referred pain to the shoulder.

Occasionally, there can be light vaginal bleeding as well.

The combination of internal bleeding, severe pain, and damage to the fallopian tube make an ectopic pregnancy a medical emergency.

The cause of an ectopic pregnancy in any individual case is often unknown, but there are well known risk factors.

These include smoking, a history of pelvic inflammatory disease, conception by in-vitro fertilization, gynecologic surgery, current use of intrauterine devices, tubal ligation, or a previous ectopic pregnancy.

Sources

  1. "Robbins Basic Pathology" Elsevier (2017)
  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
  4. "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)
  5. "Does This Woman Have an Ectopic Pregnancy?" JAMA (2013)
  6. "Diagnosing ectopic pregnancy and current concepts in the management of pregnancy of unknown location" Human Reproduction Update (2013)
  7. "Ectopic pregnancy" The Lancet (2005)
Elsevier

Copyright © 2024 Elsevier, its licensors, and contributors. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Cookies are used by this site.

USMLE® is a joint program of the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME). COMLEX-USA® is a registered trademark of The National Board of Osteopathic Medical Examiners, Inc. NCLEX-RN® is a registered trademark of the National Council of State Boards of Nursing, Inc. Test names and other trademarks are the property of the respective trademark holders. None of the trademark holders are endorsed by nor affiliated with Osmosis or this website.

RELX