Ectopic Pregnancy Flashcards
What is an ectopic pregnancy?
Implantation of fertilised ovum outside the uterus
What is the first symptom of an ectopic pregnancy present?
Constant unilateral lower abdominal pain
Can radiate to shoulder tip
What is the constant unilateral lower abdominal pain due to?
Tubal spasm
What other symptoms does an ectopic pregnancy present with?
Vaginal Bleeding
Amenorrhoea- 6-8 weeks since last period
How is the vaginal bleeding described?
Less than a normal period
Dark brown in colour
What might happen to the patient due to the blood loss?
They may become haemodynamically unstable
What investigations might you carry out for an ectopic pregnancy?
Transvaginal ultrasound
Will a pregnancy test be positive or negative in an ectopic pregnancy?
Positive
What is the main risk for an ectopic pregnancy?
Anything slowing the ovum’s passage to the uterus
What types of things slow the passage of the ovum to the uterus?
Pelvic Inflammatory Disease- Previous chlamydia
Endometriosis
Progesterone Only Pill
IVF
What does expectant management of an ectopic pregnancy mean?
You expect the ectopic pregnancy to resolve naturally without any intervention
What is the criteria for expectant management of an ectopic pregnancy?
Adnexal mass size <35mm
Unruptured
Asymptomatic
No fetal heartbeat
What level should the B-hCG be at to allow expectant management of an ectopic pregnancy?
Low
Serum B-hCG <1,000IU/L (and declining)
What is the medical management of an ectopic pregnancy?
Give the patient a one off dose of IM methotrexate
What would you do if the medical management of an ectopic pregnancy didn’t work?
A second dose of methotrexate
Surgery
What is the criteria for medical management of an ectopic pregnancy?
Adnexal mass size <35mm
Unruptured
No significant pain
No fetal heartbeat
What level should the B-hCG be at to allow medical management of an ectopic pregnancy?
serum B-hCG <1,500IU/L
What is the surgical management of an ectopic pregnancy?
Salpingectomy or Salpingotomy
What is the criteria for surgical management of an ectopic pregnancy?
Adnexal mass size >35mm
Can be ruptured
Pain
Visible fetal heartbeat
What level should the B-hCG be at to allow surgical management of an ectopic pregnancy?
Serum B-hCG >5,000IU/L
An ectopic pregnancy in which part of the fallopian tube is most associated with rupture?
The Isthmus
What is a typical history of someone presenting with an ectopic pregnancy?
Female with a history of 6-8 weeks amenorrhoea who presents with lower abdominal pain and later develops vaginal bleeding
What other symptoms might an ectopic pregnancy present with?
dizziness, fainting or syncope may be seen
symptoms of pregnancy such as breast tenderness
What examination findings might there be in someone with an ectopic pregnancy?
abdominal tenderness
cervical excitation (also known as cervical motion tenderness)
adnexal mass (DO NOT EXAMINE FOR DUE TO RISK OF RUPTURE)
Why would you not examine for an adnexal mass?
Due to teh risk of rupture
What is the main differential of an ectopic pregnancy?
Miscarriage
(bleeding is minor in an ectopic in comparison to a miscarriage)
What is the first line surgical management of an ectopic pregnancy?
Salpingectomy is first-line for women with no other risk factors for infertility
What is first line surgical management of an ectopic pregnancy in women with other RF for infertility?
Salpingotomy
How is the dose of methotrexate administered?
IM
What is salpingectomy?
The surgical removal of one (unilateral) or both (bilateral) fallopian tubes.
What is salpingotomy?
Removal of the product of an ectopic pregnancy from the fallopian tube without removing the fallopian tube
Where is an ectopic pregnancy most likely to occur?
In the ampulla of the fallopian tube
