Ectopic pregnancy Flashcards
What is an ectopic pregnancy?
a medical condition in which the fertilised egg, or the embryo, implants and begins to grow outside of the uterine cavity, usually in the fallopian tubes.
Ectopic pregnancy is regarded as a gynaecological emergency. true/false?
True
Incidence of ectopic pregnancies?
Incidence of around 1 in 80 pregnancies so relatively common
Some factors causing ectopic pregnancy?
Pelvic inflammatory disease
Genital infection e.g. gonorrhoea
Pelvic surgery
Having an intrauterine device e.g. copper coil or Levonorgestrel-releasing intrauterine system (e.g. Mirena) in situ
Assisted reproduction e.g. IVF
Previous ectopic pregnancy
Endometriosis
Clinical signs and symptoms of ectopic pregnancy?
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
Investigations for ectopic pregnancy?
Pregnancy test to confirm pregnancy
Transvaginal ultrasound to locate the pregnancy
Three main management options for ectopic pregnancy?
Conservative
Medical
Surgical
Conservative management for ectopic pregnancy?
This is an option for a small number of women with an ectopic pregnancy who have minimal or no symptoms.
These patients require close follow-up with repeat B-hCG tests. If the levels do not decrease at a satisfactory rate, active management is recommended.
Medical management for ectopic pregnancy?
Involves administration of a 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
Surgical management for ectopic pregnancy?
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 removed
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
What does b-hcg show on ectopic pregnancy?
B-HCG levels in ectopic pregnancy would increase at a lower rate.
In a normal pregnancy, the β-HCG level doubles every 48-72 hours until it reaches 10,000-20,000mIU/mL. In ectopic pregnancies, β-HCG levels usually increase less. Mean serum β-HCG levels are lower in ectopic pregnancies than in healthy pregnancies.
What is a typical presentation for ectopic pregnancy?
Scanty brown PV bleed
Missed menstrual period
Young female (usually)
Can present with iliac fossa pain along with referred shoulder tip pain
Most common region for an ectopic pregnancy?
Ampullary region of the fallopain tube
In a proven ectopic pregnancy, what medication can be used for treatment?
Methotrexate is used in a proven ectopic pregnancy of a certain size and when the patient has a particular beta-HCG level appropriate for medical management.
Methotrexate works by stopping from the cells from growing by blocking enzymes and stopping the pregnancy.
What type of medication is methotrexate?
Folic acid antagonist
