Ectopic pregnancy

Question 1

Risk factors for ectopic pregnancy

Answer 1

Pregnancy implanted otuside of uterus

Question 2

Where is the most common site of ectopic pregnancy

Answer 2

Fallopian tube

Question 3

Where can an ectopic plant

Answer 3

Entrance to fallopian tube (cornual region)
Ovary
Cervix
Abdomen

Question 4

Risk factors of ectopic pregnancy

Answer 4

Previous ectopic pregnancy
Prev pelvic inflammatory disease
Prev surgery to fallopian tubes
Intrauterine devices - coils
Older age
Smoking

Question 5

When does ectopic pregnancy typically present

Answer 5

6-8 weeks gestation

Question 6

Classic features of ectopic pregnancy

Answer 6

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

Question 7

What is it worth asking about in ectopic pregnancy

Answer 7

Dizziness or syncope (blood loss)
Shoulder tip pain (peritonitis)

Question 8

What is the diagnosis of choice for miscarriage

Answer 8

transvaginal US scan - may seen gestational sac containing yolk sac or foetal pole in fallopian tube

Question 9

What is the blob sign, babel sign or tubal ring sign

Answer 9

mass containing empty gestational sac seen in fallopian tube

Question 10

How to differentiate between tubal ectopic pregnancy and corpus luteum

Answer 10

Look similar - tubal ectopic moves seperately to ovary
corpus luteum will move with ovary

Question 11

Features that indicate an ectopic pregnancy

Answer 11

An empty uterus
Fluid in the uterus, which may be mistaken as gestational sac - pseudogestational sac

Question 12

What is a PUL

Answer 12

Pregnancy of unknown location - positive pregnancy test no evidence of pregnancy on US scan

Question 13

What should hcG do every 24 hours

Answer 13

Double - it doesnt in ectopic pregnanct

Question 13

What should hcG do every 24 hours

Answer 13

Double - it doesnt in ectopic pregnanct
63% increase is line for normal IU pregnancy vs ectopic will be less than that

Question 14

When should a pregnancy be visible on US - at what hcG

Answer 14

1500IU/I

Question 15

Level of hcG that indiacates ectopic vs miscarriage

Answer 15

Ectopic - less than 63% increase
Miscarriage 50% fall in 24 hours

Question 16

What should be done after 2 weeks of sus miscarriage

Answer 16

Urine pregnancy test

Question 17

What to always ask about when woman presents with abdominal pain

Answer 17

Possibility of pregnancy
Missed periods
Recent unprotected sex

Question 18

What should be done in all women with abdominal or pelvic pain

Answer 18

Caused by ectopic pregnancy

Question 19

Where refer women with positive pregnancy test and abdominal pain

Answer 19

Early pregnancy assessment unit - EPAU or gynae service

Question 20

Options for terminating an ectopic pregnancy

Answer 20

Expectant management - awaiting natural termination
Medical - methotrexate
Surgical management - salpingectomy or salpingotomy

Question 21

Criteria for expectant management of ectopic pregnancy

Answer 21

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

Question 22

Criteria for methotrexate termination of pregnancy

Answer 22

Same as expectant except
HCG <5000 IU/I
Confirmed absence of IU pregnancy on US

Question 23

How is methrotrexate given in ectopic pregnancy

Answer 23

IM injection into bum

Question 24

How long after methotrexate should women not get pregnant for

Answer 24

3 months
teratogenic efefcts

Question 25

Common side effects of methotrexate

Answer 25

Vaginal bleeding
N+V
Abdo pain
Stomatitis - inflammation of mouth

Question 26

What patients need surgery for extopic pregnancy

Answer 26

Pain
Adnexal mass > 35 mm
Visible heartbeat
HCG levels >5000IU/I

Question 27

What is first line treatement for ectopic pregnancy

Answer 27

Laparoscopic salpingectomy - removal of affected fallopian tube

Question 28

When is a salpingotomy used instead of a salpingetectomy?

Answer 28

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

Question 29

What do you need to check a womans status for when surgical management of ectopic pregnancy

Answer 29

Rhesus status - rhesus negative needs anti-rhesus D prophylaxis