Ectopic pregnancy Flashcards

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1
Q

Ectopic pregnancy

A

Implantation of a fertilised ovum outside of the uterus

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2
Q

Features

A

6-8 weeks amenorrhoea

Lower abdo pain (typically first syptom)

Vaginal bleeding

Peritoneal bleeding can cause shoulder tip pain and pain on defecation/ urination

Symptoms of pregnancy (breast tenderness)

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3
Q

Examination findings

A

Abdominal tenderness

Cervical tenderness

Adnexal mass (don’t exam due to risk of rupturing pregnancy)

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4
Q

Risk factors

A

Damage to tubes (PID, surgery)

Previous ectopic

Endometriosis

IUCD

Progesterone only pill

IVF

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5
Q

Most common place

A

Ampulla

(more dangerous if isthmus)

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6
Q

Investigations

A

Pregnancy test

Transvaginal US

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7
Q

Criteria for expectant management

A

Size <35mm

Unruptured

Asymptomatic

No fetal heartbeat

hCG <1000IU/L

Compatible if another intrauterine pregnancy

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8
Q

Medical management criteria

A

Size <35mm

Unruptured

No significant pain

No fetal heartbeat

hCG<1500IU/L

Not suitable if intrauterine pregnancy

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9
Q

Surgical management criteria

A

Size >35mm

Can be ruptured

Pain

Visible heartbeat

hCG >5000IU/L

Compatible with another intrauterine pregnancy

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10
Q

Expectant management

A

Closely monitor over 48hours and if B-hCG rise again or symptoms manifest then intervention is performed

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11
Q

Medical management

A

Methotrexate

Need to attend follow up

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12
Q

Surgical management

A

Salpingectomy: first-line for women with no other risk factors for infertility

Salpingotomy: considered for women with risk factors for infertility

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