1. 자궁외임신

3. 발생부위 Tubal Nontubal Ampulla: over 80% Isthmus: 12% Fimbria: 5%
Cornual & interstitial: 2%
Nontubal
Abdominal: 1.4%
Ovarian: 0.2%
Cervical: 0.2%

4. Problem Abnormally implanted gestation As gestation enlarges
grows and draws blood supply from abnormally implanted site
As gestation enlarges
potential for organ rupture because only the uterine cavity is designed to expand and accommodate fetal development.
Massive hemorrhage, infertility, or death.

5. 발생빈도

6. 사망율

7. 원인 Mechanical factors Functional factors Assisted reproduction
Failed contraception

8. 원인 Mechanical factors Salpingitis Peritubal adhesion
Developmental abnormality of the tube
Previous ectopic pregnancy
Previous operations on the tube
Multiple previous induce abortions
Tumors that distort the tube

9. 원인 Functional factors External migration of the ovum
Altered tubal motility
Cigarette smoking

10. 원인 Failed contraception IUD Failed tubal sterilization
Tubal pregnancy after hysterectomy

11. 원인 Failed contraception IUD Failed tubal sterilization
Tubal pregnancy after hysterectomy

12. 증가되는 이유 Sexually transmitted disease Conservative tubal surgery
IUD, Low-dose progestational agent
Ovulation induction, IVF
Induced abortion with infection
Unsuccessful tubal sterilization
Better & earlier Dx

13. 임상증상 Classic clinical triad Nausea, breast fullness, fatigue
Pain
Amenorrhea
Vaginal bleeding
Nausea, breast fullness, fatigue
Low abdominal pain, heavy cramping
Shoulder pain, recent dyspareunia

14. Physical Findings Pelvic tenderness Enlarged uterus
Adnexal mass or tenderness
Hemodynamically compromised

15. 감별진단 Appendicitis Salpingitis Ruptured corpus luteum cyst or follicle
Spontaneous or threatened abortion
Ovarian torsion
Urinary tract disease
Intrauterine pregnancies with other abdominal or pelvic problems such as degenerating fibroids

16. 진단 Significance of early diagnosis To improve future fertility
More conservative management is necessary
Less morbidity

17. 진단 Lab studies Imaging Procedure β-hCG Progesterone Ultrasonography
Dilatation & curettage
Culdocentesis
Laparoscopy

18. Intrauterine G-sac (+)
β-hCG
Doubling time
days
66% 미만의 증가는 비정상 또는 자궁외임신
Discriminatory zone
TV-USG
β-hCG (mIU/mL)
Normal IUP
Intrauterine G-sac (+)
>
Ectopic pregnancy
         "        (-)
Abortion
         "        (+)
<
Unknown

19. Progesterone >25 ng/mL <5 ng/mL Limitation
Excluded ectopic pregnancy
97.4% certainty
<5 ng/mL
Nonviable pregnancy, ectopic pregnancy
100% sensitivity
Limitation
IVF, progesterone supplementation

20. 초음파검사 자궁내 태낭유무 Pseudosac yolk sac Color doppler
Fluid collection in the endometrial cavity
Bleeding from decidualized endometrium
yolk sac
First visible structure in the gestational sac
Color doppler

21. 초음파검사

22. Dilatation & Curettage방법
Villi by floating in saline
Frozen or permanent section
Ectopic pregnancy
Absence of villi
Only be used
In cases where continuation of a pregnancy is not desired

23. Culdocentesis Nonclotting blood Its use today is rare 감별
Ectopic pregnancy
Ruptured corpus luteum
Incomplete abortion
Retrograde menstruation

24. Laparoscopy 진단과 치료를 동시에 할 수 있다
Can miss up to 4% of early ectopic pregnancies

25. Laparoscopy

26. Laparoscopy

27. 치료 Factors influencing therapeutic decision
Medical condition of patient
Location of gestation
Requirement for future fertility
Degree of fallopian tube damage
Presence of confounding complications

28. 치료
Radical management
Conservative management

29. 치료 Radical management Salpingectomy Laparoscopic or Laparotomic
Indication
Who does not want further pregnancy
Tubal rupture with overt hemorrhage

30. 치료
Conservative management
Surgical
Medical

31. Conservative management
Surgical (Laparoscopic or Laparotomic)
Salpingostomy
Salpingotomy
Resection & Anastomosis

32. Conservative Surgery

33. Medical Treatment
Expectant management
Medical therapy

34. Expectant Management Reason Diagnostic indicator
Expect spontaneous remission
Avoidance of unnecessary operation
Diagnostic indicator
Symptom
Serial hCG
Curettage
Laparoscopy

35. Medical Therapy Methotrexate Mechanism of action Folic acid antagonist
Inhibit DNA synthesis
Trophoblasts are vulnerable to MTX

36. Medical Therapy Indication Route Persistent ectopy
Stable, unruptured, small sized ectopy
Interstitial ectopy
Route
Systemic
Local

37. Subsequent outcomes Methotrexate Systemic Local Success rate - 94 83
Salpingectomy
Salpingostomy
Methotrexate
Systemic
Local
Success rate - 94 83
Patent tube 86 81 88
Pregnancy rate 82 66 71 67
Recurrent ectopy 11 23 5