Ectopic Pregnancy Flashcards
What is an ectopic pregnancy?
Embryo implanting outside the uterine cavity. If in the tubes, usually bursts by 8/40.
What are the risk factors for ectopic pregnancy?
- PID
- Endometriosis
- IUS/IUD
- Previous surgery, previous ectopic
- IVF
- Smoking
Where do ectopic pregnancies usually occur?
97% are tubal, majority in the ampulla.
What is this a presentation of?
Lower abdominal pain (classically unilateral), followed by dark PV bleeding, pain initially colicky then constant, shoulder tip pain, adnexal tenderness, cervical excitation, amenorrhoea 6-8 weeks.
Ectopic pregnancy
What should be performed in any woman of reproductive age with abnormal PV bleeding, abnormal pain, or collapse?
Pregnancy test
How is a suspected ectopic pregnancy investigated?
- If unstable - NBM, FBC, group and save (+ crossmatch 6U), 2 large bore cannulas, IV fluids and call senior.
- Pregnancy test +ve - between 50% fall and 63% rise in 48 hours
- TVUSS to rule out intrauterine pregnancy
If there is a pregnancy of unknown location where TVUSS cannot see pregnancy in presence of +ve hCG, what should be done in a woman in pain and unstable, vs a woman not in pain and stable?
- Pain and unstable - laparoscopy
2. No pain and stable - serial scans and hCG
What is the criteria for medical management of ectopic pregnancy?
Must meet all of the below:
- Asymptomatic/mild symptoms
- hCG <3000IU
- Ectopic pregnancy <3cm on scan
- No hemoperitoneum on TVUSS
- Willing to undertake regular follow-up
What is the medical management for ectopic pregnancy?
- IM methotrexate in a single dose followed by serial hCG (day 4 and 7)
- Monitor until -ve pregnancy test (takes 4 weeks)
What is the surgical management of an ectopic pregnancy?
Laparoscopic salpingectomy if other tube is healthy, if not salpingostomy.
