Tubal ectopic pregnancy
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Tubal ectopic pregnancy, also known as 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 1:
considered the longest segment
most common site, accounting for ~70%
isthmic ectopic: ~12%
fimbrial ectopic: ~11%
an adnexal mass that is separate from the ovary is the most common finding and may be seen on in up to 89-100% of cases 1
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, the corpus luteum is on the same side as ectopic gestational sac 2; rupture of the cyst can present with abdominal pain and hemoperitoneum mimicking ectopic rupture
there may be evidence of a hematosalpinx (a tubal ectopic is the commonest cause for a hematosalpinx 3)
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 an extrauterine gestational sac
color Doppler interrogation may show peripheral vascularity giving a ring of fire sign
a corpus luteum may have similar color Doppler flow
On transvaginal imaging, findings indicating definitive diagnosis of a tubal ectopic pregnancy include:
extraovarian adnexal mass comprising a gestational sac containing a yolk sac
extraovarian adnexal mass comprising a gestational sac and fetal pole (with or without cardiac activity)
On transvaginal imaging, findings indicating a high probability of a tubal ectopic pregnancy include:
extraovarian adnexal mass with an empty gestational sac (tubal ring sign or bagel sign)
extraovarian heterogeneous adnexal mass (blob sign)
On transvaginal imaging, findings indicating possible tubal ectopic pregnancy include:
fluid within the uterine cavity (pseudosac)
The clinical presentation, serum hCG levels, uterine, and adnexal findings must be considered together.
Treatment and prognosis
Medical management includes methotrexate (a folate antagonist) either administered systemically or by direct ultrasound-guided injection. After methotrexate therapy, the ectopic pregnancy may show a paradoxical increase in size and vascularity on subsequent imaging even with successful methotrexate.
Increasingly, conservative management is being recognized as an option for ectopic pregnancy where rupture has not occurred (i.e. no hemoperitoneum) and fetal demise has already taken place.
other forms of ectopic pregnancy 4
may also present as an "adnexal mass" in a patient in whom there is clinical suspicion for ectopic pregnancy and may have similar color Doppler flow
should be attached to the ovary, whereas a tubal ectopic will slide separately from the ovary with transducer pressure
- 1. Lin E, Bhatt S, Dogra V. Diagnostic Clues to Ectopic Pregnancy. Radiographics. 2008;28(6):1661-71. doi:10.1148/rg.286085506 - Pubmed
- 2. Walters M, Eddy C, Pauerstein C. The Contralateral Corpus Luteum and Tubal Pregnancy. Obstet Gynecol. 1987;70(6):823-6. PMID 3684114
- 3. Subramanyam B, Raghavendra B, Balthazar E, Horii S, Hilton S, Goldstein S. Hematosalpinx in Tubal Pregnancy: Sonographic-Pathologic Correlation. AJR Am J Roentgenol. 1983;141(2):361-5. doi:10.2214/ajr.141.2.361
- 4. Jurkovic D & Mavrelos D. Catch Me if You Scan: Ultrasound Diagnosis of Ectopic Pregnancy. Ultrasound Obstet Gynecol. 2007;30(1):1-7. doi:10.1002/uog.4077