Early pregnancy problems Flashcards
Incidence of ectopic pregnancies?
1%
Most common site of implantation in ectopic?
Ampulla of fallopian tube
Fallopian tube = 95%
Cervix
Ovary
Peritoneal cavity and abdominal cavity
Aetiology of ectopic
Tubal disease - pelvic infections e.g. chlamydia (PID accounts for 40% ectopic) Previous ectopic Previous tubal surgery Sub fertility Use of IUD Advanced maternal age Lower socioeconomic class
Clinical features of ectopic
Usually subacute presentation of:
Lower abdominal pain (unilateral) + PV bleeding
Colicky pain –> constant and localised to iliac fossa
Dizzy
N+V
Amenorrhoea for 4-10 weeks
Shoulder tip pain (+/- pain on defecation) and syncope = intraperitoneal bleed
Examination for ectopic
Bimanual - cervical motion tenderness and tenderness in the adnexa
Speculum
Tachycardia (suggests blood loss)
Hypotension and collapse only occur at extremis
Investigations for ectopic
Urine HCG - consider in all women of reproductive age with abdominal pain
Serial serum HCG:
If 1000-1500U/L then uterine pregnancy is usually visible on USS (if empty this suggests an ectopic)
If <1000 but rising by 66% in 48 hrs = intrauterine pregnancy
If <1000 but rising <66% in 48hrs or plateaus = ectopic
TV USS - IU pregnancy should be visible by 5weeks
Laproscopy - investigation/treatment when signs are highly indicative of ectopic
Management of all ectopic patients?
Symptoms present - admit patient, gain IV access and take blood for x-match
Administer anti-D if patient is Rh -ve
Management of acute ectopic?
When patient id haemodynamically unstable
Laparoscopy:
Remove fallopian tube (salpingectomy) - more common
Remove trophoblastic tissue (salpingostomy) - higher risk of recurrence
Management of subacute ectopic?
Surgical - laparotomy
Medical - ectopic enraptured and no cardiac activity and HCG <3000 U/L - use METHOTREXATE
(ensure IU pregnancy is not also present)
Conservative - if ectopic is small and HSCG is <1000IU/L and declining 0 watch and wait
