7 - Ectopic Flashcards
Why get an US in setting of suspected ectopic?
To evaluate the uterus - if there’s an embryo or fetus in the uterus, ectopic can move down your list
Higher risk for ectopic
PID STD’s Tubal surgery Conception with IUD in place Older age Assisted reproduction techniques Smoking Previous abortion
MC location of ectopics
Ampulla
Reason for ectopic
Damaged tubes -> messed up transport of ovum
Classic signs
Amenorhea from 4 to 12 weeks after the LMP
If woman has a hx of hysterectomy with oophorectomy:
Cannot be ectopic pregnancy
Describe the pain
Lateralized
Sudden
Sharp
Severe
What is the life-threatening part of ectopic pregnancy?
Rupture - leads to significant hemorrhage
In unruptured ectopic
V/S may be totally normal
You gotta catch it before it turns unstable
Definitive dx
US
Or
Direct visualization by laparoscopy
Or
Surgery
Negative HCG
Empty uterus
Can i rule out ectopic?
Nope
Do serial measurements of HCG (can help but not diagnostic)
If you do a POC US and see an embryo within the uterine cavity
We refer to it as a viable IUP
If you do a POC US and see cardiac activity in the adnexa
Definitive dx ectopic pregnancy
But in reality it’s hard to see this, so order a comprehensive US anyway
If laparoscopy is needed for dx:
A surgical approach is most appropriate
Most frequently used medical approach
Systemic methotrexate
