Ectopic Pregnancy Flashcards
What is this?
→ Where does it most often occur?
What are its risk factors?
How does it present?
→ How does this differ from a miscarriage?
What is the main complication?
→ How would this present?
➊ Implantation of pregnancy outside endometrial cavity
→ 98% in fallopian tubes – interstitial, ovarian, cervical, abdominal much rarer
➋ PID, Endometriosis, Previous ectopic, Previous pelvic (esp. tubal) surgery IVF, Pregnant with IUCD/Sterilisation/POP
➌ • Pain
• PV Bleeding
→ Pain comes before the bleeding!
➍ Rupture
→ Shoulder pain as the blood leaks into the peritoneum and irritates the diaphragm
What are the initial investigations to do?
What shouldn’t be done? Why?
What is the key way for a definitive diagnosis?
➊ • Pregnancy test
• TVUS – Free peritoneal fluid, Sac w/o foetus, Tubal ring sign
➋ Examining as this could increase the risk of rupture
➌ Laparoscopy
What’s the diagnosis if nothing is seen/confirmed on TVUS?
→ What should be done in these cases?
Pregnancy of Unknown Location i.e. could be an ectopic pregnancy or very early intrauterine pregnancy that’s too small to see.
→ If systemically well with minimal pain, monitor b-HCG every 48 hrs:
* Fall = foetus won’t develop, or there has been a miscarriage
* Slight increase = likely ectopic pregnancy
* Normal increase = foetus growing normally (doesn’t exclude ectopic, but makes it less likely)
N.B. An intrauterine pregnancy should be seen by 5 wks after LMP.
Management:
What is the medical option?
What are the surgical options?
→ What is important to consider here?
What is the expectant option?
➊ Methotrexate
N.B. Methotrexate is contraindicated when a foetal heartbeat is detected due to an increased rate of treatment failure.
➋ Salpingectomy or Salpingotomy
→ * Salpingotomy is an option if the pt has only 1 functioning tube or they still want to have children in the future
* Salpingotomy carries the risk that not all tissue has been removed
➌ Waiting for ectopic to resolve on its own
