Ectopic

Question 1

What are your differential diagnoses?

Answer 1

•	Ovarian torsion
•	Salpingitis
Femoral hernia
•	Ruptured corpus luteum cyst or ovarian follicle
•	Spontaneous abortion or threatened abortion
•	Appendicitis
•	UTI/Pyelonephritis
•	Constipation

Question 2

Investigations?

Answer 2

ABC approach
Abdominal examination
No speculum/bimanual if there is access to USS
Urine Hcg
Urine dip

Bloods:
Group and save
BHCG
FBC
U+E
LFT
White cell, CRP, culture

Question 3

What would you see on USSS

Answer 3

free fluid in the abdomen, adnexal mass.

Question 4

What are the risk factors for Ectopic

Answer 4

Any damage or scarring of the fallopian tubes, caused by salpingitis, PID, endometriosis, previous ectopic.
smoking and an IUD

Question 5

Management?

Answer 5

Involvement of seniors
Group and save with rhesus status
Iv access
consent the patient for potential salpingectomy

Question 6

Treatment?

Answer 6

Salpingotomy if possible and if there are concerns over maintaning fertility for example if there is contrlateral tubal damage.

salpingectomy is very likely especially if patient is in a lot fo pain

We would consider allowing medical methotrexate treatment if the patient was diagnosed with a tubal pregnancy without any significant pain and the bhcg was on the lower side. and they were bale to return for follow up. smaller than 35mm and no heart beat. 1in 20 to

may even consider