A tubal ectopic pregnancy (or adnexal ectopic pregnancy) is a type a ectopic pregnancy.
It is by far the most common type of ectopic : accounts for ~ 93 - 97 % of cases.
Although the fallopian tube has many anatomical parts, as far as ectopics are concerned it can be divided into :
- ampullary ectopic : most common : ~ 70 % : also considered the longest segment 4
- isthmic ectopic : ~ 12% 4
- fimbrial ectopic : ~ 11% 4
- An adnexal mass that is separate from the ovary is the most common finding may be seen on in up to 89 - 100 % of cases 4.
- The presence of an adnexal mass becomes more specific for an ectopic pregnancy when it contains a yolk sac or a living embryo or when it moves independently from the ovary.
- However, an extrauterine mass may not be sonographically detected upto 35% of patients with an ectopic pregnancy
- There may be evidence of a haematosalpinx (a tubal ectopic is the commonest cause for a haematoslapinx 8).
- A tubal echogenic ring may be also seen : typically a 1 - 3 cm mass consisting of a 2 - 4 mm concentric, echogenic rim of tissue surrounding a hypoechoic center) representing an echogenic ring surrounding a extra-uterine gestational sac.
- Colour Doppler interrogation may show a peripheral vascularity giving a "ring of fire sign".
- There may be evidence of a large haemoperitoneum or large amount of free fluid, especially in cases of rupture
Treatment and prognosis
Medical management includes methotrextate ( a folate antagonist ) either administered systemically or by direct ultrasound guided injection. The ectopic may show a paradoxical increase in size and vascularity on subsequent imaging even with succesful methotrexate.
Increasingly 'conservative' management is being recognised as an option for those ectopics where rupture has not occurred (i.e no haemoperitoneum ) and fetal demise has already taken place.
- 1. Weissleder R, Harisinghani MG, Wittenberg J. Primer of diagnostic imaging. Mosby Inc. (2007) ISBN:0323040683. Read it at Google Books - Find it at Amazon
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- 3. Nama V, Manyonda I. Tubal ectopic pregnancy: diagnosis and management. Arch. Gynecol. Obstet. 2009;279 (4): 443-53. doi:10.1007/s00404-008-0731-3 - Pubmed citation
- 4. Lin EP, Bhatt S, Dogra VS. Diagnostic clues to ectopic pregnancy. Radiographics. 2008;28 (6): 1661-71. doi:10.1148/rg.286085506 - Pubmed citation
- 5. Frates MC, Brown DL, Doubilet PM et-al. Tubal rupture in patients with ectopic pregnancy: diagnosis with transvaginal US. Radiology. 1994;191 (3): 769-72. Radiology (abstract) - Pubmed citation
- 6. Laing FC. Sonographic determination of tubal rupture in patients with ectopic pregnancy: is it feasible? Radiology. 1990;177 (2): 330-1. Radiology (citation) - Pubmed citation
- 7. Cacciatore B. Can the status of tubal pregnancy be predicted with transvaginal sonography? A prospective comparison of sonographic, surgical, and serum hCG findings. Radiology. 1990;177 (2): 481-4. Radiology (abstract) - Pubmed citation
- 8. Subramanyam BR, Raghavendra BN, Balthazar EJ et-al. Hematosalpinx in tubal pregnancy: sonographic-pathologic correlation. AJR Am J Roentgenol. 1983;141 (2): 361-5. AJR Am J Roentgenol (abstract) - Pubmed citation
Synonyms & Alternative Spellings
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