Ectopic Pregnancy

Question 1

What is an ectopic pregnancy?

Answer 1

When a pregnancy is implanted outside of the uterus

Question 2

Where is the most common site of ectopic pregnancy?

Answer 2

Fallopian tube

Question 3

What are the risk factors for ectopic pregnancy?

Answer 3

Previous ectopic pregnancy
Previous PID
Previous surgery to the fallopian tubes
Having an IUD
Older age > 35
Smoking
Endometriosis
IVF
Age < 18 years on first sexual intercourse
Black race

Question 4

At what gestation does ectopic pregnancy typically present?

Answer 4

6-8 weeks

Question 5

What are the features of ectopic pregnancy?

Answer 5

Missed period
Constant pain in left or right iliac fossa
Vaginal bleeding
Lower abdominal or pelvic tenderness
Cervical motion tenderness
Shoulder tip pain
Dizziness

Question 6

What is the main differential of an ectopic pregnancy?

Answer 6

Miscarriage

Question 7

What is the investigation of choice for diagnosis of an ectopic?

Answer 7

Pregnancy test
Transvaginal ultrasound

Question 8

What may be seen on transvaginal ultrasound in the investigation of en ectopic pregnancy?

Answer 8

Gestational sac in the fallopian tube
Non-specific mass in the fallopian tube
An empty uterus
Fluid in the uterus

Question 9

What is a pregnancy of unknown location?

Answer 9

Where a pregnancy test has confirmed a pregnancy, but there is no evidence of pregnancy on an ultrasound scan

Question 10

What are the three management options for ectopic pregnancy?

Answer 10

Expectant management
Medical management
Surgical management

Question 11

What is the expectant management of ectopic pregnancy?

Answer 11

For women with few symptoms - await natural termination, and follow up with beta hCG levels

Question 12

What is the medical management of ectopic pregnancy?

Answer 12

A one off dose of IM methotrexate
Follow up to check B-hCG levels falling

Question 13

What are the surgical management options of ectopic pregnancy?

Answer 13

Laparoscopic salpingectomy - removal of affected fallopian tube and ectopic pregnancy
Laparoscopic salpingotomy - removal of the ectopic pregnancy, preserving the fallopian tube

Question 14

What are the signs of an advanced ectopic pregnancy?

Answer 14

Patient in significant amount of pain
Adnexal mass size of >35mm
B-hCG levels > 5000
Ultrasound identifies a fetal heartbeat

All of these are indication for surgical management

Question 15

What are the other differentials of ectopic pregnancy?

Answer 15

Acute appendicitis
Ovarian torsion
PID
UTI
Ruptured corpus luteal cyst