Ectopic Flashcards
Symptoms
Abdominal or pelvic pain Amenorrhoea or missed period Vaginal bleeding with or without clots Breast tenderness GI symptoms Dizziness, fainting, syncope Shoulder tip pain Urinary symptoms Passage of tissue Rectal pressure or dyschaezia
Signs
CMT Pelvic or adnexal tenderness Rebound Pallor Abdo distension Enlarged uterus Tachy Shock or collapse Hypotension
Expectant management with suspicion of ectopic
<6/40
Bleeding but not in pain
No risk factors
Repeat hcg 7-10days
USS features of ectopic
An adnexal mass moving separate to the ovary, comprising a gestational sac with a YS
OR
As above with a fetal pole w/ or w/o a fetal heartbeat
Tubal ring or bagel sign - empty gestational sac
A complex, heterogenous adnexal mass moving separate to the ovary
Hcg levels suggestive of ectopic
<50% decrease or 63% increase 48 hours after last test
Expectant management of ectopic
Stable and pain free
<35mm with no visible heartbeat
Hcg <1000
Able to return for follow up
Repeat hcg on days 2, 4, and 7 of original test
Should see drop of 15% or more from previous levels
Medical management
No pain
I ruptured with an adnexal mass smaller than 35mm with no FHR
Hcg <5000
Surgical management
Pain
35mm mass
FHR visible on scan
Hcg >5000
Methotrexate treatment f/u
Day 4 and day 7
Then weekly until <5
Salpingotomy risk of further treatment
1:5
Retest hcg 7 days post op, and follow weekly until negative
Cause of pain in tubal pregnancy
Release of prostaglandins at the implantation site
Free blood in the peritoneal cavity
Cervical ectopic pregnancy signs
Empty uterus
Barrel-shaped cervix
Gestational sac present below the internal cervical os
Absence of the sliding sign
Blood flow around the gestational sac using colour doppler
Incidence
11:1000
Risk factors for ectopic
Previous ectopic Tubal damage Infection IUD Smoking Infertility Fertility treatment Younger or older maternal age
