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What is Ectopic Pregnancy?
An ectopic pregnancy or eccysis, is a complication of pregnancy occurs when the site of implantation is
outside of the womb (uterine cavity) either in the tubes, ovaries or abdominal cavity , with rare
exceptions, ectopic and the tube at the same time (heterotopic pregnancy.
Isa ang ectopic pregnancy sa mga condition na nararanasan ng mga babae pag dating sa pagbubuntis.
Ito po ay isang abnormal na kung saan po ang fetus ay nabuo po sa labas ng matres na sa loob nito.
Ang matres o ang uterus lamang po ang nagsisislbing bahay bata sa pagbubuntis. Kaya naman ang
pagbubuntis sa labas nito ay maituturing na unsuccessful pregnancy na may kaakibat na peligro sa
babaeng nagdadala nito. According to the American academy of family physcians ectopic pregnancies
occur in about 1 out of every 50 pregnancies (20 out of 1000)
Classification:
1. Tubal pregnancy - Tubal pregnancy is when the egg is implanted in the fallopian tubes. Hair-
like cilia located on the internal surface of the fallopian tubes carry the fertilized egg to the
uterus.
The vast majority of ectopic pregnancies 95-98% implant in the Fallopian tube among
these:
80% in the ampulla
10% in isthmus
5% in fimbria
2% interstitial
2% in a rudimentary horn of a bicornuate uterus
2. Nontubal ectopic pregnancy - Non-tubal ectopic pregnancy is the implantation of an embryo
outside the womb (uterus) or fallopian tubes (which connect the uterus to the ovaries).
Kasama sa mga site ang isang caesarean scar na nabuo bilang paggaling ng isang incision sa
matris after ng caesarean section, ang cornua uteri (kung saan nagtatagpo ang uterus at
fallopian tubes), the ovary, the cervix, and the abdomen. There has been an increase in the
occurrence of these rare conditions, especially caesarean scar pregnancy.
Rare sites (2-5%) are:

The ovaries,
Broad ligaments,
Abdominal cavity and peritoneum
Cervix
3. Heterotopic pregnancy - Ang heterotopic na pagbubuntis ay ang pagkakaroon ng two

simultaneous na pagbubuntis na may magkahiwalay na implantation site, ang isa ay isang
viable intrauterine pregnancy (nagaganap sa matris) at ang isa pa ay isang non-viable ectopic
pregnancy (nagaganap sa labas ng matris, kadalasan sa isang fallopian tube).
In rare case of ectopic pregnancy 1/1000 there maybe two fertilized eggs, one outside the
uterus and the other inside
Fate of Tubal Pregnancy
1. Tubal Mole
2. Tubal abortion
3. Tubal rupture
Presentation
Early symptoms are either absent or subtle. Clinical presentation of ectopic pregnancy occurs at a mean
of 7.2 weeks after the last normal menstrual period, with a range of 5 to 8 weeks.
The most common presenting symptoms that are suggestive for EP are:
Symptoms
Pain and discomfort
Bleeding
Signs
General examination – signs of early pregnancy (breast tenderness, nausea and vomiting, change of
appetite, weakness, pallor, hypotension and tachycardia, tachypnoea due to bleeding.
Abdominal examination – lower abdominal tenderness and rigidity especially on one side may be
present.
Vaginal examination – Vaginal spotting, bluish vagina and bluish soft cervix.
Uterus is slightly enlarged and soft.
Marked pain in one iliac fossa on moving the cervix from side to side.
Risk factors
1. History of pelvic infection

2. History of surgery on the fallopian tubes or within the pelvis
3. Prior history of ectopic pregnancy
4. History of IUD use
Diagnosis
1. Harmonal assay
Serum B- hcg
Progesterone
2. Ultrasound
3. Culdocentesis
4. Laparoscopy or laparotomy
Gestational trophoblastic disease

Gestational trophoblastic disease (GTD) is the term given to a group of rare tumors that develop during
the early stages of pregnancy.
After conception, a woman’s body prepares for pregnancy by surrounding the newly fertilized egg or
embryo with a layer of cells called the trophoblast. The trophoblast helps the embryo implant itself to
the uterine wall. These cells also form a large part of the tissue that make up the placenta — the
organ that supplies nutrients to a developing fetus. In GTD, there are abnormal changes in the
trophoblast cells that cause tumors to develop.
Most GTD tumors are benign (noncancerous), but some have the potential to turn malignant
(cancerous). GTD is usually classified into one of two categories:
 Hydatidiform moles
 Gestational trophoblastic neoplasia (GTN)
Hydatidiform Moles
A hydatidiform mole is also known as a molar pregnancy. In a molar pregnancy, there is a

problem with the fertilized egg, and there is an overproduction of trophoblast tissue. This
excess trophoblast tissue grows into abnormal masses that are usually benign but can
sometimes turn cancerous.
There are two types of hydatidform moles:
1. Partial molar pregnancy:
2. Complete molar pregnancy:
Partial molar pregnancy: The fertilized egg contains the normal set of maternal
DNA but double the number of paternal DNA. Because of this, the embryo only
partially develops and does not become a viable fetus.
Complete molar pregnancy: The fertilized egg has no maternal DNA and instead
has two sets of paternal DNA. A fetus does not form.
Gestational Trophoblastic Neoplasia
There are several types of gestational trophoblastic neoplasia:
 Choriocarcinoma
 Invasive mole
 Placental-site trophoblastic tumor
 Epithelioid trophoblastic tumor
Gestational Trophoblastic Neoplasia
There are several types of gestational trophoblastic neoplasia:
 Choriocarcinoma: This cancerous tumor forms inside a pregnant woman’s uterus.

Choriocarcinomas usually occur when growths from molar pregnancies turn cancerous.
Rarely, choriocarcinomas form from tissue left in the uterus after a miscarriage, an
abortion or the delivery of a healthy baby.
 Invasive mole: Trophoblast cells form an abnormal mass that grows into the muscle
layer of the uterus.
 Placental-site trophoblastic tumor: This extremely rare, slow-growing tumor develops
where the placenta attaches to the uterine wall. Placental-site trophoblastic tumors are
often not discovered until years after a full-term pregnancy.
 Epithelioid trophoblastic tumor: This extremely rare tumor’s progression mimics that
of a placental-site trophoblastic tumor.

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What is Ectopic Pregnancy?

Rare sites (2-5%) are:

3. Heterotopic pregnancy - Ang heterotopic na pagbubuntis ay ang pagkakaroon ng two

Fate of Tubal Pregnancy

Pain and discomfort

Uterus is slightly enlarged and soft.

1. History of pelvic infection

Gestational trophoblastic disease

A hydatidiform mole is also known as a molar pregnancy. In a molar pregnancy, there is a

Gestational Trophoblastic Neoplasia

There are several types of gestational trophoblastic neoplasia:

Gestational Trophoblastic Neoplasia

There are several types of gestational trophoblastic neoplasia:

 Choriocarcinoma: This cancerous tumor forms inside a pregnant woman’s uterus.

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