Ectopic preg

Question 1

Early preg assessment should include

Answer 1

• Hx and examination
• USS
• BHCG
  +/- progesterone

Question 2

High risk factors for early scan

Answer 2

• Prev ectopic
• Prev molar
• Recurrent miscarrigae

Question 3

Signs of ectopic- pt

Answer 3

• Abdo/pelvic pain
• PV bleeding
• Dizziness
• Shoulder tip pain
• Pain on defecation

Always do a preg test- pt might not have done one

Question 4

Diagnosis for ectopic

Answer 4

TV USS
Lap is no longer gold standard

TA if enlarged uterus, pt does not accept TV

Question 5

Signs of ectopic on scan

Answer 5

• Adnexal mass, moving separate to ovary - Sliding sign +
• Might contain gestational sac and fetal pole
• Empty GS- tubal ring or bagel sign
• Empty uterus
• Free fluid +/-

Question 6

Cervical ectopic signs

Answer 6

• Empty uterus
• Barrel shaped cervix
• Gest sac below the int os
• No sliding sign - if + it is miscarriage
• Blood flow in the gest sac

Question 7

CS Scar ectopic rate

Answer 7

1:2000 preg

Question 8

Scar ectopic signs

Answer 8

• Empty uterus
• Gest sac/mass anteriorly at level of int os - in the prev CS scar
• Mass has + blood flow on doppler
• Thin myometrium bet gest sac and bladder
• Empty endocervical canal

Question 9

Further imaging for scar ectopic

Answer 9

MRI

Question 10

Interstitial ectopic

Answer 10

• Empty uterus
• RPOC/Gest sac in interstitial part of the tube surrounded by <5mm myometrium
• Interstitial line present

Question 11

Incidence of interstital ectopic

Answer 11

1-6.3%

Question 12

Cornual ectopic signs

Answer 12

• Single interstitial portion of tube in the main uterine body
• Gest sac separate to the uterus and completely surrounded by myometrium
• Vascular pedicle adjoinging the gest sac to unicornuate uterus

Question 13

Abdominal preg

Answer 13

• Empty uterus
• No tubal mass/dilation
• Gest sac surrounded by bowel loops
• Wide mobility of sac w pressure

Question 14

Expectant mx of ectopic

Answer 14

• Clinicall stable and pain free
• Ectopic <35mm and no FH
• HCG <1000, 1000-1500 - consider
• Able to return for f/u
• F/u- HCG on day 0, 2, 4 and 7 then weekly till negative.
• Expect 15% drop each time

Question 15

Medical mx of ectopic- Methotrexate

Answer 15

• No pain
• Unruptured ectopic <35mm w no FH
• HCG <1500
• HCG 1500-5000- consider and discuss
• No IUP
• Can come for f/u
• F/u HCG day 0, 2, 4 and 7 then weekly till negative.
• DO NOT need anti D

Question 16

Dose and sucess rates of methotrexate

Answer 16

• 50mg IM
• 65-95% success
• Higher success w lower HCG <1000
• Lower if HCG >10 000

Question 17

Methotrexate and future preg

Answer 17

• Wait 3 months before trying

Question 18

Surgical mx of ectopic

Answer 18

• Sig pain
• Adnexal mass >35mm
• FH on cans
• HCG >5000
• Give anti D

Question 19

Salpingectomy vs sapingotomy

Answer 19

• Salpingectomy 1st line unless
• Infertility, other tube damaged
• Salpingotomy- 1 in 5 will need further rx
• metho/surgery
• HCG on D7 then weekly till negative

Question 20

Anti D

Answer 20

• All surgical mx
• Medical if very heavy bleeding
• Ruptured ectopic

Question 21

Ectopic mx w hx of sub-fertility

Answer 21

• Expectant or medical mx inc reproductive outcomes in future