Ectopic Pregnancy

Abstract

Ectopic pregnancy was responsible for 5.5% of maternal mortality in the UK (1994–6) and is the major cause of maternal mortality in the first trimester in the Western world. It may occur in the tube (95%), the uterus (intramural, angular, cervical or in a rudimentary horn), the ovary, the broad ligament or elsewhere in the peritoneal cavity. The extratubal sites are usually secondary to extrusion from the tube. In the tube, the commonest site is the ampulla, followed by the isthmus. In the ampulla the conceptus is often extruded, whereas in the isthmus the tube is usually ruptured. Rupture of an ectopic in the interstitial part of the tube, though rare, is associated with particularly severe haemorrhage. Heterotopic pregnancy, a combined intrauterine and extrauterine pregnancy occurs rarely in spontaneous conceptions, but in up to 3% of clinical pregnancies after in vitro fertilisation (IVF).