Ectopic Pregnancy

Question 1

What is ectopic pregnancy?

Answer 1

Implantation of embryo outside the uterus, usually in fallopian tube.

Question 2

What are the types of ectopic pregnancy?

Answer 2

Tubal (fallopian tube)
Ovarian
Abdominal 
Cervical 
Pregnancy in previous scarring

Question 3

Risk factors of ectopic pregnancy?

Answer 3

Abnormal fallopian tube anatomy 
IUDs, STDs
Smoking 
History of ectopic pregnancy
Endometriosis

Question 4

Acute and Chronic ectopic pregnancy?

Answer 4

Acute - high hCG -> early diagnosis. High chance of rupture

Chronic - low hCG -> late diagnosis (requires surgical dx). Low chance of rupture (form a complex pelvic mass)

Question 5

Symptoms of EP?

Answer 5

Triad - PAV. Pain. Amenorrhea, Vaginal bleeding
Ruptured - Sharp stabbing pain, hypotension and tachycardia.
Unruptured - palpable mass, non-specfic pain

Question 6

Diagnosis of ectopic pregnancy?

Answer 6

LAPAROSCOPY
Raised HCG but lower than that of pregnancy
Clinical symptoms - triad
Culdocentesis (if ruptured)
TV US
Physical exam (for mass) + rebound tenderness
Progesterone levels - <5ng/ml - nonviable pregnancies. >25ng/ml - viable pregnancies

Question 7

Treatment of ectopic pregnancy?

Answer 7

Salpingostomy - removal of gestation through linear incision
Salpingectomy - removal of a fallopian tube
Methotrexate - targets rapidly dividing cells (3 to 4 weeks)