Ectopic Pregnancy Flashcards
What is an ectopic pregnancy?
Pregnancy that has implanted any site outside of the uterus
What is the most common location for an ectopic pregnancy?
Ampulla of fallopian tube
What are risk factors for ectopic pregnancy?
Previous ectopic
Previous PID
Pelvic surgery
IUS/IUD
What are features of ectopic pregnancy?
Lower abdominal pain
Vaginal bleeding
+/- missed period
+/- shoulder tip pain
Why may shoulder tip pain occur in ectopic pregnancy?
Diaphragm irritation
How are suspected ectopic pregnancies managed?
Urine B-HCG
Pelvic USS
What happens if the USS shows no uterine pregnancy?
Take serum HCG
> 1500 = offer diagnostic laparoscopy
<1550 - repeat in 48 hrs
- increase >63% = viable pregnancy
- increase <63% = ectopic pregnancy
- decrease = miscarriage
What are indications for expectant management of ectopic pregnancy?
Pain free Clinically stable Adnexal mass <35mm No heart beat HCG <1500
How is ectopic pregnancy managed expectantly?
Repeat HCG on day
- 2
- 5
- 7
What are criteria for medical management of ectopic pregnancy?
Pain free
<35 mm adnexal mass
Confirmed absence of intrauterine pregnancy
HCG <5000
How is ectopic pregnancy managed medically?
IM methotrexate
Advise contraception use 3 month post use
What are criteria for surgical management of ectopic pregnancy?
Significant pain
Adnexal mass >35mm
Visible heartbeat
HCG >5000
How is ectopic pregnancy managed surgically?
Laparoscopic surgery
- removal of tube = salpingectomy
- removal of ectopic = salpingotomy
Offer anti-D if rhesus negative
