An 8 Week Old On A Fallopian Tube Alive

The increased incidence of ectopic pregnancy seen over recent decades has occurred simultaneously with an increased incidence of pelvic inflammatory disease. This suggests a causal relationship (Figure 11.1). Improvements in the treatment of pelvic inflammatory diseases may now preserve tubal function in women who previously would have suffered from tubal factor infertility. However, more recently in Norway a fall in the incidence of ectopic pregnancy has been reported.1 It has been suggested that the falling rates of pelvic inflam matory disease may be responsible for these changes.

Ectopic pregnancy can be defined as the implantation of a fertilized ovum anywhere other than in the endometrial cavity. Ninety-five per cent of ectopic pregnancies occur within the fallopian tube (Table 11.1). Non-tubal ectopic pregnancies, including caesarean section scar pregnancy are discussed elsewhere in this book.2,3

It can be argued that the use of transvaginal ultrasonography (Figure 11.2) and the treatment of ectopic pregnancy using minimal access surgery has contributed to the decreased

Ultrasound Images Hetero Ectopic Cornual

0 1970 1976 1980 1984 1986 1990 1991 1992 1993 1994 1997 1999 2001


Figure 11.1 Ectopic pregnancy trends (from Sintef Health)

0 1970 1976 1980 1984 1986 1990 1991 1992 1993 1994 1997 1999 2001


Table 11.1. Localization of ectopic pregnancy

Fallopian tube

• Ampullary segment


• Isthmic segment


• Fimbrial end


• Cornual and interstitial








Ectopic Pregnancy Weeks
Figure 11.2 Transvaginal ultrasound of a live ectopic pregnancy at 8 weeks 5 days. (See also colour plate)

mortality rate associated with this condition. The result is that the management of unruptured tubal pregnancy has changed from being focused on immediate, life-saving intervention to making more effort to preserve fertility. The treatment options that are available for a given ectopic pregnancy relate to the location, with the majority of tubal ectopic pregnancies surgical management is safe and effective. This chapter will focus on the surgical approach to the management of this condition.

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Pregnancy Guide

Pregnancy Guide

A Beginner's Guide to Healthy Pregnancy. If you suspect, or know, that you are pregnant, we ho pe you have already visited your doctor. Presuming that you have confirmed your suspicions and that this is your first child, or that you wish to take better care of yourself d uring pregnancy than you did during your other pregnancies; you have come to the right place.

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