Ectopic pregnancy

Question 1

Ectopic pregnancy

Answer 1

One that occurs anywhere outside of the uterus. The most common location for ectopic pregnancy to occur is in one of the fallopian tubes

Question 2

Classification of Ectopic pregnancy

Answer 2

1. Ampullary ectopic: 64%
2. Fallopian isthmus ectopic: 25%
3. Fallopian infundibular ectopic: 9%
4. Interstitial ectopic 1-2%
5. Ovarian ectopic: 0.5%
6. Cervical ectopic: 0.4%
7. Other: <1%

Question 3

Symptoms of ectopic pregnancy

Answer 3

o	Abdominal pain
o	Pelvic pain
o	Amenorrhoea or a missed period
o	Vaginal bleeding (with or without clots)
o	Dizziness, fainting or syncope
o	Shoulder tip pain

Question 4

Investigations in ectopic pregnancy

Answer 4

hCG urine dipstick

Urinalysis: to rule out a urinary tract infection. If findings suggest a urinary tract infection, ectopic pregnancy would still need ruling out (as the patient may have both).

Blood tests

Group and save

Transvaginal ultrasound scan

Question 5

Management of ectopic pregnancy

Answer 5

ABCDE

Question 6

What would be the HCG urine dipstick finding in ectopic pregnancy?

Answer 6

Positive

Question 7

What is the medical & surgical management options for ectopic pregnancy

Answer 7

Systemic methotrexate as the first-line MEDICAL treatment

Surgery for removal of ectopic pregnancy

Question 8

What is the criteria for being able to use Systemic methotrexate in management of ectopic pregnancy

Answer 8

o Able to return for follow-up
o No significant pain
o Unruptured ectopic pregnancy with an adnexal mass <35 mm and no visible heartbeat
o No intrauterine pregnancy is seen on the ultrasound scan
o Serum hCG <1500 IU/L

Question 9

When is surgical management considered for ectopic pregnancy?

Answer 9

Should be offered to those women who meet any of the following criteria:

1. Unable to return for follow-up
2. Significant pain
3. Adnexal mass ≥35 mm
4. Foetal heartbeat visible on the scan
5. Serum hCG level ≥5000 IU/L