ectopic Flashcards
definition
fertilised ovum implants outside the uterine cavity
predisposing factors
anything slowing the ovums passage to the uterus- damage to tubes (salpingitis, prev surgery), prev ectopic, PID, endometriosis, POP, IUCD
where are most ectopics
tubal- mostly in the ampulla
where can ectopics implant
tubal, narrow isthmus, ovary, cervix, peritoneum
how can rupture take place
suddenly and catastrophic, or gradual-increasing pain and bloodloss
how long can peritoneal pregnancies last
into third trimester, may present with failure to induce labour
when is tubal rupture more likely
when it is in the isthmus
presentation- typical patient
always think ectopic in a sexually active woman with abdo pain, bleeding, fainting, D+V
presentation
around 8 weeks amenorrhoea. early sign is dark blood loss (prune juice) or fresh blood. tubal colic- abdominal pain.
what happens if the ectopic ruptures the tube
severe pain, peritonism, shock. bleeding into the peritoneum causing shoulder tip pain (diaphragmatic irritation), pain on defacation and urination
signs
tender abdomen, enlarged uterus, cervical excitation, adnexal mass
presentation may just be
D+V or nausea and dizzy
initial management
anti D prophylaxis. dipstix testing for BHCG, ultrasound.
when is an ectopic likely with results
BHCG high and no intrauterine gestational sac seen
normally what happens to BHCG
doubles over 48h
management in ruptured ectopic
immediate laparotomy- clamping the bleeding artery
laparoscopy v laparotomy
laparoscopy preferred as recovery time reduced and less costly. persisting trophoblasts more of a problem
how to reduce persisting trophoblasts
methotrexate
what is the problem with persistent trophoblasts
later rupture and will need further treatment
salpingectomy v salpingotomy
if contralat tube is healthy- salpingectomy as it preserves the tube.
if the contralat tube is not healthy what is the management
salpingotomy- preserve the chance of future intrauterine pergnancy
what medication can be used for small early ectopics
methotrexate
side effects methotrexate treatment
abdominal pain, ovarian, cysts, neutropenia, pneumonitis, late pelvic collections of blood
expectant management
some end themselves without intervention. conservative management without acute symptoms and with a falling BHCG.
to what BHCG should you follow up until
management persistent trophoblast
if bhcg is not dropping as it should be. methotrexate IM
reduce risk of missing ectopics
send uterine curettings at ERPC for histology
