Ectopic pregnancy Flashcards
typical history
A typical history is a female with a history of 6-8 weeks amenorrhoea who presents with lower abdominal pain and later develops vaginal bleeding
typical history
A typical history is a female with a history of 6-8 weeks amenorrhoea who presents with lower abdominal pain and later develops vaginal bleeding
what are the symptoms
- lower abdominal pain
- vaginal bleeding
- recent history of amenorrhoea
- shoulder tip pain - peritoneal bleeding
- pain one defecation or urination - peritoneal bleeding
- symptoms of pregnancy - breast tenderness
examination findings
abdominal tenderness
cervical excitation/ cervical motion tenderness
adnexal mass - advised not to examine for this as increases risk of rupture
what will the serum bHCG levels be like
> 1500
what will the serum bHCG levels be like
> 1500
what is it?
Implantation of a fertilized ovum outside the uterus results in an ectopic pregnancy
epidemiology
0.5% of all pregnancies
risk factors
ANYTHING SLOWING DOWN THE OVUM PASSAGE TO THE UTERUS
damage to tubes (pelvic inflammatory disease, surgery)
previous ectopic
endometriosis
IUCD
progesterone only pill
IVF (3% of pregnancies are ectopic)
Investigation
- pregnancy test - positive
- gold standard - transvaginal us
3 ways to manage ectopics
- expectant
- medical
- surgical
What is the criteria for expectant management?
Size <35mm
Unruptured
Asymptomatic
No fetal heartbeat
hCG <1,000IU/L
Compatible if another intrauterine pregnancy
What does expectant management involve?
Expectant management involves closely monitoring the patient over 48 hours
if B-hCG levels rise again or symptoms manifest intervention is performed.
what is the criteria for medical management?
Size <35mm
Unruptured
no significant pain
no metal heart beat
hug < 15000
Not suitable for intrauterine pregnancy
what does medical management involve?
methotrexate
can only be done if the patient is willing to attend follow-up.
