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Tubal ectopic pregnancy

Tubal ectopic pregnancy (or adnexal ectopic pregnancy) is the most common location of an ectopic pregnancy.

It is the most common type of ectopic by far, accounting for 93-97% of cases.

Although the fallopian tube has many anatomical parts, for the purposes of ectopic location it can be divided into 4:

  • an adnexal mass that is separate from the ovary is the most common finding, and may be seen on in up to 89-100% of cases 4
    • the presence of an adnexal mass becomes more specific for an ectopic pregnancy when it contains a yolk sac or a living embryo or when it moves independently from the ovary
    • an extrauterine mass may not be sonographically detected in up to 35% of patients with an ectopic pregnancy
  • usually the corpus luteum is on the same side as ectopic gestational sac 10; rupture of the cyst can presents with abdominal pain and haemoperitonium mimicking ectopic rupture  
  • there may be evidence of a hematosalpinx (a tubal ectopic is the commonest cause for a hematosalpinx 8)
  • tubal echogenic ring
    • typically a 1-3 cm mass consisting of a 2-4 mm concentric, echogenic rim of tissue surrounding a hypoechoic center
    • represents an echogenic ring surrounding an extrauterine gestational sac
  • color Doppler interrogation may show peripheral vascularity giving a "ring of fire sign"
    • a corpus luteum may have similar color Doppler flow
  • there may be evidence of a large hemoperitoneum or large amount of free fluid, especially in cases of rupture

Compared to an interstitial ectopic or cervical ectopic, the risk of uncontrollable hemorrhage is fortunately lower. Nonetheless, expedient diagnosis is required.

Management was previously only surgical, with open and then laparoscopic salpingectomy being favored. Salpingotomy (thus preserving the tube) is increasingly performed.

Medical management includes methotrexate (a folate antagonist) either administered systemically or by direct ultrasound-guided injection. After methotrexate therapy, the ectopic pregnancy may show a paradoxical increase in size and vascularity on subsequent imaging even with successful methotrexate. 

Increasingly 'conservative' management is being recognized as an option for ectopic pregnancy where rupture has not occurred (i.e no hemoperitoneum) and fetal demise has already taken place.

  • other forms of ectopic pregnancy 9
  • corpus luteum
    • may also present as an "adnexal mass" in a patient in whom there is clinical suspicion for ectopic pregnancy and may have similar color Doppler flow
    • should be attached to the ovary, whereas a tubal ectopic will slide separately from the ovary with transducer pressure
Ultrasound - obstetric

Article information

rID: 2218
Synonyms or Alternate Spellings:
  • Adnexal ectopic pregnancy
  • Tubal ectopic
  • Adnexal ectopic

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Cases and figures

  • Figure 1
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  • Case 1: live adnexal ectopic pregnancy
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  •  Case 2
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  • Case 3: right tubal ectopic without cardiac activity
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  • Case 4: left tubal ectopic
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  • Case 5
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  • Case 6
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  • Case 7
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  • Case 8: MRI
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