Ectopic Pregnancy

Question 1

What is an ectopic pregnancy?

Answer 1

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

Question 2

What is the aetiology of an ectopic pregnancy?

Answer 2

Damage tofallopian tube (infection, surgery, endometriosis). Associated with STI, PID, previous surgery in tubes, previous ectopic, pregnancy with IUD/IUS in situ, assisted conception.

Question 3

What is the epidemiology of an ectopic pregnancy?

Answer 3

1% pregnancies.

Question 4

What would you find on history and exam of an ectopic pregnancy?

Answer 4

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

Ruptured ectopic leads to circulatory collapse.

Abdomen: render, rebound, guarding if rupture.

Vaignal: cervical excitation, adenxal tenderness, adenxal mass.

Question 5

What investigations would you do for an ectopic pregnancy?

Answer 5

Urine BHCG,

Blood FBC, clotting, X match, serum BHCG, Releat after 48h: BHCG levels should double in uterine pregnancy, but less than double in ectopic.

USS TVS.

Question 6

What is the management of an ectopic pregnancy?

Answer 6

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 7

What are the complications/ prognosis of an ectopic pregnancy?

Answer 7

Rupture, heamorrage, death, tubal infertility, psychological.

5 death py for ectopic pregnancies in UK. 15% recurrence in future pregnancies