Ectopic pregnancy Flashcards
what is the most common site of an ectopic pregnancy?
the ampulla of the fallopian tube (97%)
6 risk factors for an ectopic
previous ectopic previous PID previous abdo surgery smoking Coil in situ (if they do become pregnant the pregnancy is more likely to be an ectopic) older age
at what stage of pregnancy does an ectopic generally present?
6-8 weeks gestation
5 typical presenting features of an ectopic
PV bleeding
missed MP
constant lower abdominal pain
—–>particularly in the iliac fossae
pelvic tenderness
cervical motion tenderness
what does shoulder tip pain in an ectopic indicate?
peritonitis
what is the investigation of choice for diagnosing an ectopic pregnancy?
transvaginal USS
what is meant by “blob sign”/”bagel sign”/tubal ring sign”?
these all refer to the same thing - a non-specific mass seen within the fallopian tubes on USS
how can an ectopic pregnancy mass be differentiated to a corpus luteum on USS?
look at the movement of the ovary - a corpus luteum will move with the ovary and a tubal pregnancy will not
2 findings within the uterus when performing an USS in an ectopic pregnancy
an empty uterus (!)
fluid within the uterus - AKA “pseudogestational sac”
at what level of bHCG should you be able to see a pregnancy on USS?
1500 IU
how is pregnancy of unknown location investigated?
with serial HCG - one 48 hours after the first
pregnancy of unknown location: which HCG results correspond to…
uterine pregnancy
ectopic pregnancy
miscarriage
rise in HCG of >63%
rise in HCG of <63%
fall in HCG of >50%
true or false: all ectopic pregnancies require termination
all ectopic pregnancies will need to be terminated - either naturally or by inducing termination
criteria for expectant management of an ectopic
follow-up must be possible unruptured no foetal heartbeat HCG <1500 IU no significant pain adnexal mass <1500
criteria for medical management of an ectopic
as with expectant, except also:
confirmed absence of intrauterine pregnancy on USS
HCG <5000
how is an ectopic pregnancy terminated medically?
with IM methotrexate
effect of medical termination of an ectopic on later fertility
patients advised not to get pregnant for 3 months after methotrexate injection because of potential teratogenicity
4 common AEs to medical termination of an ectopic pregnancy
stomatitis
PV bleeding
abdo pain
N+V
true or false: most patients with an ectopic will require surgical management
true
4 criteria which necessitate surgical management of an ectopic pregnancy
HCG 5000+
adnexal mass >35mm
visible foetal heartbeat
significant pain
what is the first line surgical management of choice for an ectopic
laparoscopic salpingectomy
when may a laparoscopic salpingotomy be used?
when there is a risk to fertility due to damage to the other tube
NB considering that ectopics can recur this probably isn’t that uncommon
how commonly do patients who have been treated with a salpingotomy require further management i.e. either methotrexate or a salpingectomy?
20%
true or false: all ectopic pregnancies are “sensitising events” for Rh -ve patients
false - but surgical management of an ectopic is, and anti-D should be given prophylactically
