Abnormal Development - Ectopic Implantation
|Embryology - 13 Dec 2018 Expand to Translate|
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International Classification of Diseases (iCD-10)
Chapter XV Pregnancy Childbirth - O00 Ectopic pregnancy
ICD-11 (beta) - JA01 Ectopic pregnancy - Any condition characterized by implantation of the embryo outside the endometrium and endometrial cavity during pregnancy.
- 1 Introduction
- 2 Some Recent Findings
- 3 About Uterine Tube Anatomy
- 4 Ultrasound Ectopic Implantation
- 5 Computed Tomography Ectopic Implantation
- 6 Magnetic Resonance Imaging Abdominal Ectopic Implantation
- 7 Statistics
- 8 Ectopic Pregnancy Histology
- 9 Tubal Ectopic Pregnancy
- 10 Interstitial Pregnancy
- 11 Ovarian Ectopic Pregnancy
- 12 Cervical Ectopic Pregnancy
- 13 Rudimentary Horn Pregnancy
- 14 Caesarean Scar Pregnancy
- 15 Heterotopic Pregnancy
- 16 Ectopic Molar Pregnancy
- 17 Ruptured Ectopic
- 18 Methotrexate
- 19 International Classification of Diseases
- 20 References
- 21 External Links
- 22 Glossary Links
Ectopic implantation or ectopic pregnancy (Greek, ektopos = "out of place") refers to the abnormal implantation of the blastocyst. Implantation of the blastocyst normally occurs within the body of the uterus, also called eutopic implantation. Ectopic implantation can occur at number of sites outside the uterine body. The most common form of human ectopic pregnancy is when implantation occurs within the uterine tube, described as a tubal pregnancy. Note that the endocrine signals blocking the menstrual cycle and indicating a pregnancy will still be released following this ectopic implantation. Ectopic pregnancies are therefore often identified by early ultrasound scans.
Ectopic pregnancy is also a high-risk maternal medical condition with an approximate incidence of 1.5 to 2 % in reported pregnancies. There is some indication that the incidence may be increasing (United States has increased from 4.5 per 1,000 pregnancies in 1970 to an estimated 19.7 per 1,000 pregnancies in 1992)
The risk factors for tubal ectopic pregnancy include: tubal damage by infection (particularly Chlamydia trachomatis) or surgery, smoking and in vitro fertilization therapy. Prolonged tubal damage is often described as pelvic inflammatory disease and "scarring" can affect the cilia-mediated transport of the blastocyst during the first week of development.
This is also the most common cause of pregnancy-related deaths in the first trimester. A recent United Kingdom enquiry into maternal deaths, identified ectopic pregnancy as the fourth most common cause of maternal death (73% of early pregnancy deaths).
Ectopic sites are named according to the anatomical location: Tubal (Ampullary, Isthmic, Cornual), Cervical and Ovarian. A study of 1800 surgically treated ectopics between 1992 and 2001 identified implantation sites by frequency: interstitial (2.4%), isthmic (12.0%), ampullary (70.0%), fimbrial (11.1%), ovarian (3.2%) or abdominal (1.3%).
- International Classification of Diseases: Chapter XV Pregnancy Childbirth - O00 Ectopic pregnancy | O01 Hydatidiform mole
|Ectopic Links: ectopic pregnancy | implantation | Week 2 | placenta abnormalities | trophoblast | uterus | Chlamydia | Ultrasound - Ectopic Pregnancy | ultrasound | Ectopic Implantation Research|
Some Recent Findings
|More recent papers|
This table shows an automated computer PubMed search using the listed sub-heading term.
References listed on the rest of the content page and the associated discussion page (listed under the publication year sub-headings) do include some editorial selection based upon both relevance and availability.
About Uterine Tube Anatomy
Anatomy - there are 3 main parts (regions) to the uterine tube:
- isthmus - closest to the uterus (body)
- ampulla - middle region, more dilated in diameter and most common site for fertilization.
- infundibulum - furthest from the uterus ending in the fimbriae and open to the peritoneum
Blood Supply - arterial supply is from branches of the uterine and ovarian arteries, these small vessels are located within the mesosalpinx (part of the lining of the abdominal cavity).
Lymphatic drainage - through the iliac and lateral aortic nodes.
Innervation - has both sympathetic and parasympathetic fibers. Sensory fibres from thoracic segments (T11-T12) and the first lumbar segment (L1).
Ultrasound Ectopic Implantation
|Tubal Ectopic||Bicornuate Uterus Ectopic|
Computed Tomography Ectopic Implantation
Computed Tomography imaging findings of a 37-year-old woman with interstitial pregnancy. Showing initial CT detection and a subsequent scan following rupture causing a hematoma around uterus and a massive hemoperitoneum.
Initial CT - gestational sac
Follow-up CT - massive hemoperitoneum
CT - hematoma around uterus
- Links: Computed Tomography
Magnetic Resonance Imaging Abdominal Ectopic Implantation
| 2W SPAIR sagittal MRI of lower abdomen demonstrating the placental invasion.
- Links: Magnetic Resonance Imaging
Rates of pelvic inflammatory disease and ectopic pregnancy in Australia, 2009-2014
- "To analyse yearly rates of pelvic inflammatory disease (PID) and ectopic pregnancy (EP) diagnosed in hospital settings in Australia from 2009 to 2014. METHODS: We calculated yearly PID and EP diagnosis rates in three states (Victoria, New South Wales, Queensland) for women aged 15-44 years using hospital admissions and emergency department (ED) attendance data, with population and live birth denominators. ...For EP, in 2014 the rate of all admissions was 17.4 (95% CI 16.9 to 17.9) per 1000 live births and of all ED presentations was 15.6 (95% CI 15.1 to 16.1). Comparing 2014 with 2009, the rates of all EP admissions (aIRR 1.06, 95% CI 1.04 to 1.08) and rates in EDs (aIRR 1.24, 95% CI 1.18 to 1.31) were higher. PID and EP remain important causes of hospital admissions for female STI-associated complications. Hospital EDs care for more PID cases than inpatient departments, particularly for young women."
Ectopic Pregnancies- United-States 1970-1992
- Links: USA
Ectopic Pregnancy Histology
CDC Image by Dr. Edwin P. Ewing, Jr., 1972
Tubal Ectopic Pregnancy
|Chlamydia infections (Chlamydia trachomatis) are the most common bacterial sexually transmitted infection, often undiagnosed and asymptomatic. The infections can ascend the female genital tract, colonizing the endometrial mucosa, then the uterine tubes. This type of infection is described as pelvic inflammatory disease (PID).|
|(cornual pregnancy) A less common type 2 to 4% of ectopic pregnancies. The gestation develops in the uterine portion of the fallopian tube lateral to the round ligament.|
Ovarian Ectopic Pregnancy
| Clinical operative photograph at the beginning of the procedure of the laparoscopic treatment of the ovarian pregnancy.
Ovarian Ectopic Pregnancy
Cervical Ectopic Pregnancy
This form of ectopic pregnancy is a rare high-risk condition and represents less than 1% of all ectopic pregnancies. The reported incidence varies between 1:1,000 to 1:18,000.
Rudimentary Horn Pregnancy
A rare types of ectopic pregnancy (about 1 in 76,000 pregnancies) in most cases the horn is non-communicating. Therefore fertilisation probably occurs by transperitoneal migration. This form untreated can also lead to uterine rupture.
Caesarean Scar Pregnancy
Caesarean scar pregnancy (CSP) is a rare types of ectopic pregnancy (about 1 in 2000 pregnancies), but probably increasing as caesarean rates rise. The gestation is completely surrounded by both myometrium and fibrous tissue of the caesarean section scar and separated from the endometrial cavity and endocervical canal.
A recent review of 17 studies (69 cases of CSP managed expectantly, 52 with and 17 without embryonic/fetal heart beat)
|Caesarean scar pregnancy (CSP)|
|with embryonic/fetal heart activity||without embryonic/fetal cardiac activity|
(Greek, heteros = other) Clinical term for a very rare pregnancy of two or more embryos, consisting of both a uterine cavity embryo implantation and an ectopic implantation. The ectopic implantation usually identified by prenatal scanning as occurring within the uterine tube (tubal pregnancy) though has also been identified as abdominal pregnancies.
Ectopic Molar Pregnancy
Left-sided unruptured ampullary ectopic pregnancy at laparoscopy.
- Links: Hydatidiform Mole
Ruptured ectopic pregnancy
(MTX, amethopterin) Drug with several different uses including the treatment of ectopic pregnancy and for the induction of medical abortions. Acts as a antimetabolite and antifolate (folic acid antagonist) drug that inhibits DNA synthesis in actively dividing cells, including trophoblasts, and therefore has other medical uses include cancer and autoimmune disease treatment. Treatment success in ectopic pregnancy relates to serum β human chorionic gonadotropin (β-hCG) concentration.
- Links: Medline Plus
International Classification of Diseases
The International Classification of Diseases (ICD) World Health Organization's classification used worldwide as the standard diagnostic tool for epidemiology, health management and clinical purposes.
Note that there is an additional code covering complications of the clinical treatment O08 Complications following abortion and ectopic and molar pregnancy This code is provided primarily for morbidity coding. For use of this category reference should be made to the morbidity coding rules and guidelines in Volume 2.
- Links: O00 Ectopic pregnancy | O01 Hydatidiform mole | Chapter XV Pregnancy Childbirth | International Classification of Diseases
- Centers for Disease Control and Prevention (CDC). (1995). Ectopic pregnancy--United States, 1990-1992. MMWR Morb. Mortal. Wkly. Rep. , 44, 46-8. PMID: 7823895
- Confidential Enquiry into Maternal Deaths (CEMD) Why Mothers Die 2000–2002 PDFPDF2
- Bouyer J, Coste J, Fernandez H, Pouly JL & Job-Spira N. (2002). Sites of ectopic pregnancy: a 10 year population-based study of 1800 cases. Hum. Reprod. , 17, 3224-30. PMID: 12456628
- Goller JL, De Livera AM, Guy RJ, Low N, Donovan B, Law M, Kaldor JM, Fairley CK & Hocking JS. (2018). Rates of pelvic inflammatory disease and ectopic pregnancy in Australia, 2009-2014: ecological analysis of hospital data. Sex Transm Infect , , . PMID: 29720385 DOI.
- Hamed HO, Ahmed SR & Alghasham AA. (2012). Comparison of double- and single-dose methotrexate protocols for treatment of ectopic pregnancy. Int J Gynaecol Obstet , 116, 67-71. PMID: 22035883 DOI.
- Shavell VI, Abdallah ME, Zakaria MA, Berman JM, Diamond MP & Puscheck EE. (2012). Misdiagnosis of cervical ectopic pregnancy. Arch. Gynecol. Obstet. , 285, 423-6. PMID: 21748311 DOI.
- Shao R. (2010). Understanding the mechanisms of human tubal ectopic pregnancies: new evidence from knockout mouse models. Hum. Reprod. , 25, 584-7. PMID: 20023297 DOI.
- Shin BS & Park MH. (2010). Incidental detection of interstitial pregnancy on CT imaging. Korean J Radiol , 11, 123-5. PMID: 20046504 DOI.
- Yildizhan R, Kolusari A, Adali F, Adali E, Kurdoglu M, Ozgokce C & Cim N. (2009). Primary abdominal ectopic pregnancy: a case report. Cases J , 2, 8485. PMID: 19918376 DOI.
- Walid MS & Heaton RL. (2010). Diagnosis and laparoscopic treatment of cornual ectopic pregnancy. Ger Med Sci , 8, . PMID: 20725587 DOI.
- Resta S, Fuggetta E, D'Itri F, Evangelista S, Ticino A & Porpora MG. (2012). Rupture of Ovarian Pregnancy in a Woman with Low Beta-hCG Levels. Case Rep Obstet Gynecol , 2012, 213169. PMID: 23198195 DOI.
- Mohebbi MR, Rosenkrans KA, Luebbert EE, Hunt TT & Jung MJ. (2011). Ectopic pregnancy in the cervix: a case report. Case Rep Med , 2011, 858241. PMID: 22110520 DOI.
- Calì G, Timor-Tritsch IE, Palacios-Jaraquemada J, Monteaugudo A, Buca D, Forlani F, Familiari A, Scambia G, Acharya G & D'Antonio F. (2018). Outcome of Cesarean scar pregnancy managed expectantly: systematic review and meta-analysis. Ultrasound Obstet Gynecol , 51, 169-175. PMID: 28661021 DOI.
- Sun SY, Araujo Júnior E, Elito Júnior J, Rolo LC, Campanharo FF, Sarmento SG, Nardozza LM & Moron AF. (2012). Diagnosis of heterotopic pregnancy using ultrasound and magnetic resonance imaging in the first trimester of pregnancy: a case report. Case Rep Radiol , 2012, 317592. PMID: 23259128 DOI.
- Gayer G. (2012). Images in clinical medicine. Abdominal ectopic pregnancy. N. Engl. J. Med. , 367, 2334. PMID: 23234516 DOI.
- Bousfiha N, Erarhay S, Louba A, Saadi H, Bouchikhi C, Banani A, El Fatemi H, Sekkal M & Laamarti A. (2012). Ectopic molar pregnancy: a case report. Pan Afr Med J , 11, 63. PMID: 22655097
- Samiei-Sarir B & Diehm C. (2013). Recurrent ectopic pregnancy in the tubal remnant after salpingectomy. Case Rep Obstet Gynecol , 2013, 753269. PMID: 24151570 DOI.
- Stovall TG & Ling FW. (1993). Single-dose methotrexate: an expanded clinical trial. Am. J. Obstet. Gynecol. , 168, 1759-62; discussion 1762-5. PMID: 8317518
Exalto N, Vooys GP, Meyer JW & Lange WP. (1980). Ovarian pregnancy: a morphologic description. Eur. J. Obstet. Gynecol. Reprod. Biol. , 11, 179-87. PMID: 7194809
Purslow CE. (1915). Tubal Pregnancy showing Foetus undergoing Dissolution. Proc. R. Soc. Med. , 8, 68. PMID: 19978839
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Cite this page: Hill, M.A. (2018, December 13) Embryology Abnormal Development - Ectopic Implantation. Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/Abnormal_Development_-_Ectopic_Implantation
- © Dr Mark Hill 2018, UNSW Embryology ISBN: 978 0 7334 2609 4 - UNSW CRICOS Provider Code No. 00098G