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Ectopic pregnancy (mechanism of disease)

This is a flowchart on ectopic pregnancy, covering the etiology, pathophysiology, and manifestations of ectopic pregnancy. ADDITIONAL TAGS: Previous ectopic pregnancy Fallopian surgery (tubectomy) Endometriosis Ruptured appendix Kartagener syndrome (ciliary dyskinesia) Exposure to diethylstilbestrol Bicornuate uterus Risk factors / SDOH Cell / tissue damage Structural factors Ectopic pregnancy Medicine / iatrogenic Infectious / microbial Biochem / metabolic Immunology / inflammation Signs / symptoms Tests / imaging / labs Flow physiology Reproductive pathology Growth / neoplastic Pathophysiology Etiology Manifestations Inflammation damages fallopian tubes Ectopic pregnancy: a pregnancy in which the fertilized egg attaches outside the uterine endometrium Such as in fallopian tube (95%: ampulla [70%], isthmus [15%], fimbriae [8%], cornual [2%]); ovary (3%), abdomen (1%), cervix (1%) History of PID (salpingitis) Smoking Advanced maternal age (35) Intrauterine device In vitro fertilization Hormone therapy Hormone dysregulation Slows down the transport of fertilized eggs Signs and symptoms typically begin 4-6 weeks after last menstrual period Lower abd pain and guarding +/- vaginal bleeding Tenderness in ectopic area Cervical motion tenderness Sometimes mistaken for appendicitis Sometimes mistaken for (delayed) menstruation Enlarged uterus Amenorrhea Nausea But with closed cervix (so it’s not PID) Breast tenderness Frequent urination Normal signs and symptoms of pregnancy Upregulation of pro-inflam cytokines Disruption of smooth muscle contraction and ciliary beat within tubes that assists transport of oocyte or embryo Promotes embryo implantation, invasion, and angiogenesis Tubal rupture Acute course with sudden symptoms Severe lower abdominal pain Hemorrhagic shock Shoulder pain Phrenic nerve irritation → hiccups Bleed into abd cavity Irritate peritoneum Tachycardia Hypotension Syncope Best initial test for imaging, transvaginal ultrasound: empty uterine cavity, +/- embryo in ectopic site Anatomic alteration of fallopian tubes