Ectopic Flashcards
Definition
Pregnancy outside the uterine cavity
Most common site
Fallopian tube–>ampulla
Most common cause of T1 pregnancy related death
Ectopic pregnancy
Biggest risk factor for ectopic
Previous ectopic
Risk factors
Previous ectopic PID STI's Pelvic/abdominal surgery IUD Infertility treatment Smoking
Epidemiology
2% pregnancies
More common in >35 yo
Symptoms
Abdominal pain
Amenorrhea
Vaginal bleeding
History
Abdominal pain, amenorrhea, vaginal bleeding
Risk factors
Evidence of rupture->shock, peritonitis
Shoulder tip pain, urge to deficate
Examination
General–>evidence of hemodynamic instability (rupture), hypotensive, orthostatic, tachyC, pallor
Pelvic examination->tender, mass, blood in vaginal vault
Cervical motion tenderness
Palpable adnexal mass
Rebound tenderness
Investigations
FBC
bHCG
TVUS/Pelvic U/S
When can a gestational sac be seen on TVUS (bHCG level)
serum hCG levels above 1500-2000 U/L (1500-2000 mU/mL) with a TVUS (higher levels for transabdominal ultrasound).
What to do if bHCG levels below which you can see a gestational sac
If the initial serum hCG levels are below these discriminatory levels, a repeat ultrasound in 1 week or serial serum hCG levels can be requested.
Medical management Indications Contraindications Caution Regimen Followup
I: hemodynamically stable, unrupture, no signs of active bleeding, low HCG
CI: Geographic isolation, allergy, potential non-compliance
Caution: Baseline bHCG >5000, ectopic >3cm on TVS, presence of F. heart motion
R: Methotrexate
F/U: weekly bHCG until negative, , defer conception for 3-4 months
Surgical management
Indications
Method
F/U
I: Hemodynamically unstable, persistent excessive bleeding, other CI to medical
M: Laparoscopy GOLD
F/U: Weekly until bHCG -ve
Following salpingotomy, if bHCG fails to fall consider salpingectomy/medical management
Expectant management
Indications
Cautions
F/U
I: Hemodynamically stable
Low or falling bHCG, mass
