ectopic pregnancy Flashcards
what
pregnancy implanted outside uterus
most common site = fallopian tube
risk factors
prev ectopic prev PID prev tubal surgey assisted conception IU device - coil older age smoking
presentation
missed period right lower abdo/LIF pain vaginal bleeding lower abdo/pelvic tenderness cervical motion tenderness
Ix
BHGC
USS
USS findings
no intrauterine gestational sac
adnexal mass
fluid in pouch of douglas
pregnancy of unknown location
woman has + pregnancy test and no evidence of pregnancy on USS
PUL - monitoring
HCG trakced over time - repeated 48hrs
HCG rise >63% after 48hrs
indicated intrauterine pregnancy
HCG rise <63% after 48hrs
may indicate ectopic pregnancy
HCG fall >50%
likely to indicate misscarriage
pregnancy test should be performed after 2wks to confirm misscarirage is complete
Mx options
expectant
medical - methotrexate
surgical
criteria for expectant Mx
- follow up must be possible
- ectopic is unruptrues
- adnexal mass < 35mm
- no visible heartbeat
- no significant pain
- HCG < 1500 IU/L
expectant management - follow up
monitor hCG
criteria for Mx with methotrexate
- follow up must be possible
- ectopic is unruptrues
- adnexal mass < 35mm
- no visible heartbeat
- no significant pain
- HCG < 5000 IU/L
- confirmed absence intrauterine pregnancy on USS
Mx with methotrexate - advice to women
don’t get pregnant for 3mo following treatment
