Ectopic pregnancy Flashcards
What is ectopic pregnancy and pregnancy of unknown location (PUL) (RF(
Pregnancy outside the uterus - 98% of the time in fallopian tube but can ovary, uterus, broad ligament, abdomen
aetiology/RF
damaged tubes- infection, PID, endometriosis
Previous ectopic, tubal surgery,
IUD/IUS, IVF
1.1% of pregnancies
Sx of ectopic pregnancy and pregnancy of unknown location (PUL)
Abdominal pain
ammenorhoea 4-10w inital, dark/scanty blood
diarrhoea, shoulder tip pain, backpain
dizziness/shock - if ruptures
exam - abdomen - rebound tender/guarding
Vaginal -cervical excitation, abnexal tender/mass
Ix of ectopic pregnancy and pregnancy of unknown location (PUL)
Pregnancy Test -> Speculum/bimanual -> TVUSS
either locate ectomic - empty uterus, adnexal mass, free fluid, etc
or PUL - serial bHCV at 0, 48h
if increase >63% -developing, rescan in 7d
if increase <63%/decrease <50% - review <24h
If decrease >50% - misscarriage
USS signs- Tubal - bagel signs, blob sign
Cervical - barrel cervix, -ve sliding sign, below internal Os
Bimanual -excitation, mas
Speculum - bad sign of cervix wide open
bloods - FBC, clotting, cross match
until found, Manage as PUL
Mx of ectopic pregnancy and pregnancy of unknown location (PUL)
1st thing is always to call gynea on call!!!
expectant - if stable, asympto patient with falling HCG
size<30mmm, serum hcg <200, no foetal HR
Medical - 1x IM methotrexate IF
Stable, asympto, no blood in pouch of douglas
Normal LFT/UE, bHCG<3000, ectopic <35mm
tell to go home, repeat BT, no intercourse for 3m, dont drink alcohol
SE- pain, nausea, diarrhoea
Surgical- laprosopic salpinectomy
if significant pain, foetal HR, adnexal mas>35mm, bHCG >5000
Anti D prophylaxis required
Salpingoostomy can be used if minimal bleed and occlusion can be removed (and/if pt has only 1 viable tube)
cannot use copper IUD after salpingECTOMY
Prognosis and complications of ectopic pregnancy and pregnancy of unknown location (PUL)
Rupture, hemoarrhage, death, tubal infertility, psych
Prog- 5 deaths per year in UK
15% reccurence
