Fallopian tubes
Benign / nonneoplastic
Ectopic / tubal pregnancy

Topic Completed: 1 April 2013

Minor changes: 13 December 2019

Copyright: (c) 2002-2019, PathologyOutlines.com, Inc.

PubMed Search: Ectopic tubal pregnancy [title] fallopian tube

Nicole Riddle, M.D.
Jamie Shutter, M.D.
Page views in 2019: 10,623
Page views in 2020 to date: 4,971
Cite this page: Riddle N, Shutter J. Ectopic / tubal pregnancy. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/fallopiantubesectopicpregnancy.html. Accessed June 4th, 2020.
Definition / general
  • Implantation of fertilized egg within fallopian tube
  • Also known as eccyesis
  • 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
  • Ampulla (~80%), isthmus (12%), fimbriae (5%), cornu (2%)
  • 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
  • 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


Ruptured tube
leading to acute,
life threatening bleeding

Clinical features
  • 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
Gross description
  • Distension of tube with thin or ruptured wall, dusky red serosa and hematosalpinx, possibly with fetal parts identified
Gross images

AFIP images

Various images

Images hosted on other servers

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

Images hosted on other servers

Epithelium, rupture site and chorionic villi

Various images

Differential diagnosis
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