Es la implantacin del vulo fecundado en el canal cervical

RELEVANCIA
En EUA

3.5 defunciones por 1,000 casos en los aos 70s 0.5 defunciones por 1,000 casos en el 2,000
Cuando se presenta constituye importante causa de

morbimortalidad materna, debido a hemorragia.

EMBARAZOS ECTOPICOS
93% Ampulares 4% Istmicos

2.37% Intersticiales

(Cornuales) 0.5% Ovricos

0.1% Cervicales 0.03% Abdominales

FACTORES DE RIESGO
Legrado uterino
Biopsia de crvix Cesrea

Ectpico
Miomatosis uterina Tcnicas de Reproduccin Asistida Alteraciones en el transporte embrionario

MANIFESTACION
TRIADA Dolor Plvico Hemorragia vaginal Masa

CUADRO CLINICO
Dolor plvico
Hemorragia vaginal Crvix engrosado, vascularizado y friable

Retraso menstrual

PIE POSITIVO

Expulsin del tejido CON HEMORRAGIA PROFUSA

DIAGNOSTICO
ULTRASONIDO

Vaginal Plvico Doppler

Es importante solicitar Cuantificacin de GCH

antes de iniciar el tratamiento

TRATAMIENTO
Metotrexate
KCl 2ml intracardiaco (FCF presente) Vasopresina, Adrenalina, Lidocaina

Prostaglandina F2
Ligadura la embolizacin de arterias uterinas

Cerclaje cervical

de arterias cervicales

TRATAMIENTO
Legrado cervical
Taponamiento intracervical con baln de Foley

inflado Reseccin histeroscpica endocervical Electrodiseccin con Dispositivo Kleppinger Amputacin cervical Dilatacin de crvix con tallos de laminaria Histerectoma

METOTREXATE
Es un antagonista del Acido flico
Inhibe DHFR Disminuye Tetrahidrofolato

Su antagonista: Acido folnico

INDICACIONES ABSOLUTAS
Desea a futuro fertilidad Hemodinmicamente estable No dolor abdominal persistente o severo No tiene contraindicaciones para el MTX Se pueda dar seguimiento a la paciente

CONTRAINDICACIONES ABSOLUTAS
Embarazo intrauterino Alergia al metotrexate

Lactancia
Enfermedad pulmonar activa Ulcera pptica activa Disfuncin heptica, renal hematolgica

CONTRAINDICACIONES ABSOLUTAS
Antecedente de discrasia sanguinea anemia

moderada severa Alcoholismo Evidencia de inmunodeficiencia No se apegue al tratamiento Hemodinmicamente inestable No se pueda dar seguimiento a la paciente

CONTRAINDICACIONES RELATIVAS
FCF presente por US Vaginal

Saco gestacional 4cm

GCH 100,000 mU/ml

EFECTOS COLATERALES DEL METOTREXATE

Estomatitis, gastritis, enteritis, nusea, vmito, dolor

abdominal Conjuntivitis Elevacin de enzimas hepticas Dermatitis, alopecia Pleuritis Supresin de mdula sea

ESQUEMA DE DOSIS UNICA

Dia del Rp Antes de iniciar 1 4 7 Laboratorio BH,QS, PFHs, GCH, Tipo y Rh GCH GCH GCH MTX 50mg/m2sc IM si 15% entre da 4 y 7 Intervencin Rhogam: si es Neg MTX 50mg/m2sc IM

ESQUEMA DE MULTIDOSIS
Dia del Rp Antes de iniciar 1 2 3 4 5 6 7 8 GCH GCH GCH Laboratorio BH,QS, PFHs, GCH, Tipo y Rh GCH Intervencin Rhogam: si es Neg MTX 1mg/Kg IM Acido folnico 0.1mg/Kg MTX 1mg/Kg IM Acido folnico o.1mg/Kg MTX 1mg/Kg IM Acido folnico 0.1mg/Kg MTX 1mg/Kg IM Acido folnico 0.1mg/Kg

APLICACION LOCAL
MTX 50mg dentro del saco gestacional
Guiado por ultrasonido

Ventajas: Mayor efectividad

Acorta el tiempo del tratamiento Poca dsis menos efectos colaterales

SEGUIMIENTO
Cuantificacin de GCH
120000 100000 80000 60000 40000

US

GCH

20000
0 1 3 5 7 14 21 28

FACTORES DE RIESGO PARA NO RESPONDER AL TRATAMIETO CONSERVADOR

GCH

inicial 100,000 mU/ml antes de Tx aumento >50% en 48hrs durante el Tx continua aumentando rpidamente FCF presente LCR 10mm Embarazo 9semanas

CONCLUSION
Dx temprano
Tx Individualizado Px Favorable

Disminuir la morbimortalidad materna

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