Ectopic Pregnancy Flashcards
What is an ectopic pregnancy?
A medical condition in which the fertilized egg, or the embryo, implants and begins to grow outside of the uterine cavity, usually in the fallopian tubes.
Who is at higher risk?
Higher in women with a history of pelvic inflammatory disease, genital infection, pelvic surgery, an intrauterine device in situ, assisted reproduction, previous ectopic pregnancy, or endometriosis.
What are clinical features?
Pelvic pain, which may be unilateral to the side of the ectopic
Shoulder tip pain - If the ectopic pregnancy bleeds, the blood can irritate the diaphragm causing shoulder tip pain
Abnormal vaginal bleeding e.g. missed period or intermenstrual bleeding
Haemodynamic instability caused by blood loss if the ectopic ruptures
Abdominal examination may reveal unilateral tenderness
Cervical tenderness (chandelier sign) on bimanual examination
What are investigations?
Pregnancy test to confirm pregnancy
Transvaginal ultrasound to locate the pregnancy
When is conservative management used?
Minimal or no symptoms
Require close follow-up with repeat B-hCG tests. If the levels do not decrease at a satisfactory rate, active management is recommended.
How is it medically managed?
One-off dose of methotrexate
Criteria for methotrexate treatment include low HCG level, ability to attend follow up, and adherence to avoiding pregnancy for a period following treatment
If the initial dose of methotrexate fails to treat the ectopic pregnancy, a second dose of methotrexate or surgical management may be indicated
How is it surgically managed?
Recommended in cases where the patient is unable to attend follow-up, the ectopic pregnancy is advanced, or the patient is haemodynamically unstable
Surgical management often involves a salpingectomy, where the fallopian tube containing the ectopic pregnancy is removed. If the patient has only one functioning fallopian tube and wishes to remain fertile, a salpingotomy may be performed where only the ectopic pregnancy is remove. There is a risk with salpingotomy that not all the tissue may have been removed, and so serial serum B-hCG measurements are performed to exclude any remaining trophoblastic tissue within the fallopian tube.
