Fallopian tubes
Benign or nonneoplastic conditions
Ectopic / tubal pregnancy

Author: Nicole Riddle, M.D. (see Authors page)
Editor: Jamie Shutter, M.D.

Revised: 4 August 2017, last major update April 2013

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: Ectopic tubal pregnancy [title] fallopian tube

Cite this page: Ectopic / tubal pregnancy. PathologyOutlines.com website. http://pathologyoutlines.com/topic/fallopiantubesectopicpregnancy.html. Accessed October 23rd, 2017.
Definition / general
  • Implantation of fertilized egg within fallopian tube
Terminology
  • Also known as eccyesis
Epidemiology
  • Estimated prevalence of 1 in 40 pregnancies (25 cases per 1000 pregnancies); US incidence ~2%
  • Approximately 85 - 90% occur in multigravid women
  • Rates are nearly twice as high for women of other ethnicities as Caucasian women
  • n US from 1991 to 1999, ectopic pregnancy caused 8% of pregnancy - related deaths among black women, versus 4% among white women (MMWR Surveill Summ 2003;52:1)
  • Any woman with functioning ovaries (menache to menopause) can potentially have an ectopic pregnancy; women > 40 years have adjusted odds ratio of 2.9
Sites
  • Ampulla (~80%), isthmus (12%), fimbriae (5%), cornu (2%)
Pathophysiology
  • Occurs in women of all ages, often with a history of infertility, usually secondary to prior tubal damage
  • Often results in rupture of maternal vessels at week 8 into gestational sac
Etiology
  • Risk factors:
    • Tubal damage:
      • Infections (PID) or salpingitis (may not be documented)
      • Abdominal / pelvic surgery or tubal ligation
    • Congenital abnormality (DES)
    • History of previous ectopic pregnancy
    • Smoking identified in 1/3 of ectopic pregnancies; smoking may contribute to decreased tubal motility by damaging ciliated cells
    • Altered tubal motility: due to smoking or hormonal contraception; progesterone only contraception and progesterone intrauterine devices (IUDs) have been associated with increased risk of ectopic pregnancy
    • History of 2+ years of infertility (whether treated or not): women using assisted reproduction have 2x risk of ectopic pregnancy, although this is mostly due to the underlying infertility (related associations are fertility drugs and treatments, such as in vitro fertilization)
    • History of multiple sexual partners
    • Use of an intrauterine device (IUD) inserted at the time of conception
    • Maternal age: not an independent risk factor
Diagrams / tables

Images hosted on other servers

Implantation

Ruptured tube
leading to acute,
life threatening bleeding

Clinical features
Diagnosis
  • Clinical: abdominal / pelvic ultrasound shows mass (gestational sac) within fallopian tube, plus positive hCG levels
  • Microscopic: placental tissue or fetal parts, use hCG, HPL or keratin stains to find trophoblastic elements if necessary
  • Note: death of embryo or fetus may cause expulsion of endometrial decidual cast, regeneration of epithelium and normal appearing endometrium; thus presence of cycling endometrium does not rule out a tubal pregnancy if adnexal mass present
Case reports
Treatment
Gross description
  • Distension of tube with thin or ruptured wall, dusky red serosa and hematosalpinx, possibly with fetal parts identified
Gross images

Images hosted on PathOut servers

Various images



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Hemorrhage and
placental tissue
with fetal part

Rupture and hemoperitoneum

Microscopic (histologic) description
  • Intraluminal chorionic villi and extravillous trophoblast (may be degenerated); variable fetal parts
  • Decidual change in lamina propria in 1/3; mesothelial reactive proliferation with papillary formation and psammoma bodies
  • Uterus: gestational hyperplasia with Arias-Stella reaction, no enlarged, hyalinized spiral arteries, no fibrinoid matrix
Microscopic (histologic) images

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Epithelium, rupture site and chorionic villi

Various images

Differential diagnosis