Ectopic pregnancy

Question 1

Ectopic pregnancy: RFs

Answer 1

PID
STI
IUD
IVF
Previous ectopic
Endometriosis

Question 2

Ectopic pregnancy: features

Answer 2

Unilateral pelvic pain (iliac fossa)
shoulder tip pain
Amenorrhoea or IMB

Question 3

Main differential for ectopic pregnancy

Answer 3

Miscarriage
- Ectopic predominantly pain and less bleeding

Question 4

Ectopic pregnancy: Invx

Answer 4

TVUS

Question 5

Ectopic pregnancy: Conservative mx

Answer 5

Size <35mm
Unruptured
Asymptomatic
No fetal heartbeat
hCG <1,000IU/L

Serial b-hcg: if rise or no fall –> consider medical

Question 6

Ectopic pregnancy: Medical mx

Answer 6

Size <35mm
Unruptured
No significant pain
No fetal heartbeat
hCG <1,500IU/L

Single dose methotrexate (if willing to attend f/u and adhere to contraception)

If one dose fails –> another dose or surgical

Question 7

Ectopic pregnancy: surgical mx

Answer 7

Size>35mm
significant amount of pain
There is an adnexal mass of size ≥35mm
B-hCG levels are ≥5000IU/L
Ultrasound identifies a foetal heartbeat

1st line –> salpingectomy

If other RFs for infertility e.g. contralateral tube damage –> salpingotomy

GIVE RHESUS-D immunoglobulin to all women undergoing this procedure