ECTOPIC / HETEROTOPIC

Question 1

Considerations for the Critically Ill Ectopic

Answer 1

C -
Treat hypotension and shock with 1-2 L crystalloids

Early transfusion of O-negative blood

Consider massive transfusion protocol

If the patient is Rh(D)-negative:

Rh(D) immunoglobulin 50 μg IM (<13 weeks gestation) as soon as possible and within 72 hours.

There is no harm in giving the more readily available 300 μg IM dose.

Oxytocin IV if non viable pregnancy and ongoing heavy bleeding

STAT REFERRAL TO OBGYN

Question 2

DDx for bleeding in 1st TM

Answer 2

Trauma

Ectopic Pregnancy

Abortion:
Threatened
Inevitable
Incomplete
Complete
Missed
Septic

molar
pregnancy
subchorionic hematoma
implantation bleeding

Question 3

Clinical Features

Answer 3

abdominal pain (98%)

vaginal bleeding
(50-80% )

palpable abdominal tenderness (97%)

adenexal tenderness (98%)

Shock and periotonitis in ruptured ectopic

Question 4

Risk Factors: Heterotopic Pregnancy

Answer 4

Risk is 1/30,000 increases to 1/100 pregnancies with assissted reproduction
IVF
Previous Ectopic

Question 5

Management: Stable Ectopic Pregnancy

Answer 5

Refer to Gynecology in the ER

If the patient is Rh(D)-negative:

Rh(D) immunoglobulin 50 μg IM (<13 weeks gestation) as soon as possible and within 72 hours.

There is no harm in giving the more readily available 300 μg IM dose.

Question 6

Investigations

Answer 6

CBC

Type and Screen

BHCG

Transvaginal Ultrasound

Question 7

Management: Stable

Answer 7

methotrexate 50 mg/m2 IM

Re-evaluated on day 4 and day 7 after treatment to have repeat β-hCG levels checked.

β-hCG levels should decrease by 15% between day 4 and 7.

Follow-up is typically with an obstetrician.

OR

Surgically

Always consult OBGYN