Ectopic pregnancy Flashcards
Risk factors for ectopic pregnancy
Pregnancy implanted otuside of uterus
Where is the most common site of ectopic pregnancy
Fallopian tube
Where can an ectopic plant
Entrance to fallopian tube (cornual region)
Ovary
Cervix
Abdomen
Risk factors of ectopic pregnancy
Previous ectopic pregnancy
Prev pelvic inflammatory disease
Prev surgery to fallopian tubes
Intrauterine devices - coils
Older age
Smoking
When does ectopic pregnancy typically present
6-8 weeks gestation
Classic features of ectopic pregnancy
Missed period
Constant lower abdominal pain in R or L iliac fossa
Vaginal bleeding
Lower abdominal or pelvic tenderness
Cervical motion tenderness - pain when moving cervix during bimanual exam
What is it worth asking about in ectopic pregnancy
Dizziness or syncope (blood loss)
Shoulder tip pain (peritonitis)
What is the diagnosis of choice for miscarriage
transvaginal US scan - may seen gestational sac containing yolk sac or foetal pole in fallopian tube
What is the blob sign, babel sign or tubal ring sign
mass containing empty gestational sac seen in fallopian tube
How to differentiate between tubal ectopic pregnancy and corpus luteum
Look similar - tubal ectopic moves seperately to ovary
corpus luteum will move with ovary
Features that indicate an ectopic pregnancy
An empty uterus
Fluid in the uterus, which may be mistaken as gestational sac - pseudogestational sac
What is a PUL
Pregnancy of unknown location - positive pregnancy test no evidence of pregnancy on US scan
What should hcG do every 24 hours
Double - it doesnt in ectopic pregnanct
What should hcG do every 24 hours
Double - it doesnt in ectopic pregnanct
63% increase is line for normal IU pregnancy vs ectopic will be less than that
When should a pregnancy be visible on US - at what hcG
1500IU/I
Level of hcG that indiacates ectopic vs miscarriage
Ectopic - less than 63% increase
Miscarriage 50% fall in 24 hours
What should be done after 2 weeks of sus miscarriage
Urine pregnancy test
What to always ask about when woman presents with abdominal pain
Possibility of pregnancy
Missed periods
Recent unprotected sex
What should be done in all women with abdominal or pelvic pain
Caused by ectopic pregnancy
Where refer women with positive pregnancy test and abdominal pain
Early pregnancy assessment unit - EPAU or gynae service
Options for terminating an ectopic pregnancy
Expectant management - awaiting natural termination
Medical - methotrexate
Surgical management - salpingectomy or salpingotomy
Criteria for expectant management of ectopic pregnancy
Follow up needs to be possible to ensure successful termination
Ectopic unruptured
Adnexal mass <35 mm
No visible heartbeat
No significant pain
HCG level < 1500IU/I
Criteria for methotrexate termination of pregnancy
Same as expectant except
HCG <5000 IU/I
Confirmed absence of IU pregnancy on US
How is methrotrexate given in ectopic pregnancy
IM injection into bum
How long after methotrexate should women not get pregnant for
3 months
teratogenic efefcts
Common side effects of methotrexate
Vaginal bleeding
N+V
Abdo pain
Stomatitis - inflammation of mouth
What patients need surgery for extopic pregnancy
Pain
Adnexal mass > 35 mm
Visible heartbeat
HCG levels >5000IU/I
What is first line treatement for ectopic pregnancy
Laparoscopic salpingectomy - removal of affected fallopian tube
When is a salpingotomy used instead of a salpingetectomy?
Increased risk of infertility due to damage to the other tube
Avoid removing tube - cut made, pregnancy removed and tube closed
Increased risk of failure - may need methotrexate after
What do you need to check a womans status for when surgical management of ectopic pregnancy
Rhesus status - rhesus negative needs anti-rhesus D prophylaxis
