Many variations occur in the complex process of human development. Although population heterogeneity is based on such events, some deviations from the usual developmental process result in aberrations of normal structure and function.…

A. Expectant Management
Because many ectopic pregnancies resolve spontaneously, it may be reasonable to manage an asymptomatic, compliant patient expectantly if β-hCG titers are low (< 200 mIU/mL) or decreasing, and the risk…

In tubal ectopic pregnancy, implantation is typically in the wall of the tube, in the connective tissue beneath the serosa. There may be little or no decidual reaction and minimal defense against the permeating…

Several special procedures are helpful in diagnosing ectopic pregnancy.

1. Ultrasound - Ultrasound is useful in evaluating patients at risk for ectopic pregnancy, namely by documenting the presence or absence of an intrauterine…

No specific symptoms or signs are pathognomonic for ectopic pregnancy, and many disorders can present similarly. Normal pregnancy, threatened or incomplete abortion, rupture of an ovarian cyst, ovarian torsion, gastroenteritis, and appendicitis can…

Rupture is usually spontaneous. Isthmic pregnancies tend to rupture earliest, at 6 to 8 weeks’ gestation, due to the small diameter of this portion of the tube. Ampullary pregnancies rupture later,…

In approximately 50% of spontaneous abortions occurring during the first trimester, there is an abnormal karyotype. This incidence decreases to 20-30% in second trimester losses, and 5-10% in third trimester losses. As will be…

Successful management of spontaneous abortion depends upon early diagnosis. Every patient should receive a general physical examination, and a complete history should be taken. Laboratory studies should include a complete blood count, blood typing,…

Severe or persistent hemorrhage during or following abortion may be life threatening. The more advanced the gestation, the greater the likelihood of excessive blood loss. Sepsis develops most frequently after selfinduced abortion. Infection, intrauterine…

A. Complete Blood Count
If significant bleeding has occurred, the patient will be anemic. Both the white blood cell count and the sedimentation rate may be elevated even without the presence of…

In spontaneous abortion, hemorrhage into the decidua basalis often occurs. Necrosis and inflammation appear in the area of implantation. The pregnancy becomes partially or entirely detached. Uterine contractions and dilatation of the cervix result…

Essentials of Diagnosis

• Suprapubic pain, uterine cramping, and/or back pain.
• Vaginal bleeding.
• Cervical dilatation.
• Extrusion of products of conception.
• Disappearance of symptoms and signs of pregnancy.
• Negative pregnancy…