Ectopic pregnancy

Question 1

Define ectopic pregnancy.

Answer 1

Pregnancy outside the uterus. Mainly fallopian tube ampula (98%). Can also occur in ovary, uterus cornua or cervix, broad ligament and abdomen.

Question 2

Explain the aetiology/risk factors of ectopic pregnancy.

Answer 2

Damage to fallopian tube (infection, surgery, endometriosis).

Associated with STI, PID, previous surgery in tubes, previous ectopic, pregnancy with IUD/IUS in situ, assested conception.

Question 3

Summarise the epidemiology of ectopic pregnancy.

Answer 3

1% pregnancies.

Question 4

Recognise the presenting symptoms of ectopic pregnancy.

Answer 4

Abdominal pain, amenhorrea, PV bleeding. Shoulder tip pain (referred), dizziness.

Ruptured ectopic leads to circulatory collapse.

Question 5

Recognise the signs of ectopic pregnancy on physical examination.

Answer 5

Abdomen: tender, rebound, guarding if rupture.

Vaignal: cervical excitation, adenxal tenderness, adenxal mass.

Question 6

Identify appropriate investigations for ectopic pregnancy and interpret the results.

Answer 6

Urine BHCG.

Serum BHCGRepeat after 48h: BHCG levels should double in uterine pregnancy, but less than double in ectopic.

USS TVS.

Question 7

Generate a management plan for ectopic pregnancy.

Answer 7

All Rh- women should receive anti-RhD prophylaxis.

Conservative: only premissible in stable, asymptomatic patient with falling BHCG levels (tubal abortion)

Medical: MTX injection – only if patient stable, asymptomatic, no blood in pouch of douglas on USS, normal renal and liver function, BHCG<3000, ectopic <4cm.

Surgery: if patient is stable, laparoscopic salpingiectomy. Unstable: laparotomy.

Question 8

Identify the possible complications of ectopic pregnancy and its management. Summarise the prognosis for patients with ectopic pregnancy.

Answer 8

Rupture, heamorrage, death, tubal infertility, psychological. 5 death py for ectopic pregnancies in UK. 15% recurrence in future pregnancies.