Anatomy
Abdomen
A 21 year old female presents to ED complaining of acute severe pelvic pain. She reports she has not had a period for 6 weeks which is not normal for her. A urine pregnancy test is positive. Which of the following is the most common site of an ectopic pregnancy:
Answer:
The endometrium in the fundus of the uterus is the normal site of implantation. Ectopic pregnancy most commonly occurs in the uterine tubes, more precisely in the ampulla of the uterine tubes.Uterine Tube
Anatomy / Abdomen / Female Reproductive System
Last Updated: 11th April 2019
Superiorly, uterine tubes project laterally from the uterus, extending to the lateral pelvic wall, passing superior to the ovaries and opening into the peritoneal cavity immediately lateral to the ovaries.
Uterine Tubes. (Image modified by FRCEM Success. Original by Blausen.com staff. “Blausen gallery 2014”. Wikiversity Journal of Medicine. DOI:10.15347/wjm/2014.010. ISSN 20018762. (Own work) [CC BY 3.0 , via Wikimedia Commons)
Divisions
Each uterine tube is approximately 10 - 12 cm long and has:
- fimbriae (finger-like ciliated projections)
- an infundibulum, (the funnel-shaped opening which curves around the superolateral pole of the ovary and opens into the peritoneal cavity)
- an ampulla (the elongated middle part)
- an isthmus (the narrow proximal end which joins the body of the uterus).
Ectopic pregnancy most commonly occurs in the ampulla (70% of cases).
Site of Ectopic Pregnancy. (Image by BruceBlaus [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)], from Wikimedia Commons)
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- Biochemistry
- Blood Gases
- Haematology
| Biochemistry | Normal Value |
|---|---|
| Sodium | 135 – 145 mmol/l |
| Potassium | 3.0 – 4.5 mmol/l |
| Urea | 2.5 – 7.5 mmol/l |
| Glucose | 3.5 – 5.0 mmol/l |
| Creatinine | 35 – 135 μmol/l |
| Alanine Aminotransferase (ALT) | 5 – 35 U/l |
| Gamma-glutamyl Transferase (GGT) | < 65 U/l |
| Alkaline Phosphatase (ALP) | 30 – 135 U/l |
| Aspartate Aminotransferase (AST) | < 40 U/l |
| Total Protein | 60 – 80 g/l |
| Albumin | 35 – 50 g/l |
| Globulin | 2.4 – 3.5 g/dl |
| Amylase | < 70 U/l |
| Total Bilirubin | 3 – 17 μmol/l |
| Calcium | 2.1 – 2.5 mmol/l |
| Chloride | 95 – 105 mmol/l |
| Phosphate | 0.8 – 1.4 mmol/l |
| Haematology | Normal Value |
|---|---|
| Haemoglobin | 11.5 – 16.6 g/dl |
| White Blood Cells | 4.0 – 11.0 x 109/l |
| Platelets | 150 – 450 x 109/l |
| MCV | 80 – 96 fl |
| MCHC | 32 – 36 g/dl |
| Neutrophils | 2.0 – 7.5 x 109/l |
| Lymphocytes | 1.5 – 4.0 x 109/l |
| Monocytes | 0.3 – 1.0 x 109/l |
| Eosinophils | 0.1 – 0.5 x 109/l |
| Basophils | < 0.2 x 109/l |
| Reticulocytes | < 2% |
| Haematocrit | 0.35 – 0.49 |
| Red Cell Distribution Width | 11 – 15% |
| Blood Gases | Normal Value |
|---|---|
| pH | 7.35 – 7.45 |
| pO2 | 11 – 14 kPa |
| pCO2 | 4.5 – 6.0 kPa |
| Base Excess | -2 – +2 mmol/l |
| Bicarbonate | 24 – 30 mmol/l |
| Lactate | < 2 mmol/l |
