DRG Category: 777

Mean LOS: 2.3 days

Description MEDICAL: Ectopic Pregnancy

classification section:



An ectopic pregnancy is an implantation of the blastocyst (a solid mass of cells, formed by rapid mitotic division of the zygote, that eventually form the embryo) in a site other than the endometrial lining of the uterus. It is the leading cause of maternal death in the first trimester of pregnancy. In more than 95% of ectopic pregnancies, this implantation occurs somewhere in the fallopian tubes, hence the term "tubal pregnancy." The fallopian tube lacks a submucosal layer, which allows the ovum to burrow through the epithelium. Fertilization occurs and the zygote lies within the muscular wall of the tube, drawing its blood supply from maternal vessels. The ampullary portion of the tube is the most common site (80%), followed by the isthmic portion (12%) and the fimbria (5%). The cornual and interstitial regions of the tube have lower (2%) prevalence but a higher risk of mortality. Nontubal sites are more rare and include abdominal, ovarian, and cervical locations.

After the blastocyst implants in the tube, it begins to grow and can cause bleeding into the abdominal cavity. Eventually, the ovum becomes too large, and the tube can rupture, causing further bleeding that can lead to shock and maternal death. Ectopic pregnancies occur in approximately 2 in 100 pregnancies and non–European Americans have a 1.4 times increased risk over European Americans. Heterotopic pregnancies, in which there is an ectopic and a uterine pregnancy at the same time, occur at a rate of 1:10,000. The frequency of ectopic pregnancy has increased fourfold since 1970, owing to the increase in sexually transmitted infections (STIs), better diagnostic techniques, increased use of artificial reproductive technology, and increased use of tubal surgeries to treat infertility. Ectopic pregnancy accounts for 10% of all pregnancy-related deaths and reduces a woman's chance of future pregnancy because of tubal damage; approximately one-third of women who experience an ectopic pregnancy subsequently give birth to a live infant. Hemorrhage, peritonitis, and infertility are the main complications.