Tubal ectopic pregnancy

Tubal ectopic pregnancy (or adnexal ectopic pregnancy) is the most common location of an ectopic pregnancy.

It is the most common type of ectopic by far, accounting for 93-97% of cases.

Although the fallopian tube has many anatomical parts, for the purposes of ectopic location it can be divided into 4:

Ultrasound
  • 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
    • an extrauterine mass may not be sonographically detected in up to 35% of patients with an ectopic pregnancy
  • usually corpus luteum is on the same side of ectopic gestational sac; rupture of the cyst can presents with abdominal pain and haemoperitonium mimicking ectopic rupture  
  • there may be evidence of a haematosalpinx (a tubal ectopic is the commonest cause for a haematosalpinx 8)
  • tubal echogenic ring
    • typically a 1-3 cm mass consisting of a 2-4 mm concentric, echogenic rim of tissue surrounding a hypoechoic center
    • represents an echogenic ring surrounding a extrauterine 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

Compared to an interstitial ectopic or cervical ectopic, the risk of uncontrollable haemorrhage is fortunately lower. Nonetheless expedient diagnosis is required.

Management was previously only surgical, with open and then laparoscopic salpingectomy being favored. Salpingotomy (thus preserving the tube) is increasingly performed.

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 successful 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.

Complications

Ultrasound - obstetric
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Article Information

rID: 2218
Synonyms or Alternate Spellings:
  • Adnexal ectopic pregnancy
  • Tubal ectopic
  • Adnexal ectopic

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    Figure 1: diagram - location of ectopics
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    Case 1: live adnexal ectopic pregnancy
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     Case 2
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    Case 3: right tubal ectopic without cardiac activity
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    Case 4: left tubal ectopic
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    Case 5
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    Case 6
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    Case 7
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