Early Pregnancy: Ectopic Pregnancy Flashcards
What is an ectopic pregnancy
pregnancy outside of the uterus
What three factors in women past medical history predispose to ectopic pregnancy
- PID
- Previous ectopic
- Endometriosis
What are 3 contraceptive factors that contribute to ectopic pregnancies
IUD
Progesterone-only contraceptive
Tube ligation
why do progesterone-only implants increase risk of ectopic pregnancy
Cause ciliary dysmotility
what surgery increases risk of ectopic
IVF
Previous tubal surgery
how will an ectopic pregnancy present clinically
abdominal pain with or without vaginal bleeding
why does bleeding occur in ectopics
due to insufficient bHCG to maintain the decidua causing bleeding
why may patient with ectopic pregnancy have amenorrhoea
pregnant
why may patient with ectopic pregnancy have shoulder tip pain
due to bleeding into abdominal cavity
why may patient with ectopic pregnancy have brown vaginal discharge
break-down decidua
what is the most common site for ectopic pregnancies
ampulla
if patient has ruptured ectopic pregnancy how will they present
peritonitis and haemodynamically unstable
what investigations may be performed initially for ectopic pregnancy
bHCG
when is TV-US performed
If intrauterine pregnancy is not seen on trans abdominal US
When is the pregnancy termed pregnancy of unknown location
If bHCG is high but pregnancy cannot be seen on US
What are the 3 differentials of pregnancy of unknown location
- Early intrauterine pregnancy
- .Miscarriage
- Ectopic
If a pregnancy of unknown location, what investigation should be ordered
Serum bHCG
If serum bHCG >1500 and no intrauterine pregnancy, what does this indicate
Ectopic pregnancy
What should be offered for patients with bHCG >1500
Diagnostic laparotomy
If <1500 IU and patient is haemodynamically stable what should be offered
bHCG 48h later
In a viable pregnancy, what would you expect bHCG to do in a viable pregnancy
Expect bHCG to double every 48h
If bHCG remains high but does not double every 48h what would you expect
Ectopic pregnancy
How is a haemodynamically unstable patient with ectopic pregnancy managed
A-E approach
What are the 3 methods of managing ectopic pregnancy
- Conservative
- Medical
- Surgical
