Ectopic Pregnancy

Question 1

What is ectopic pregnancy?

Answer 1

• Is where a pregnancy is implanted outside the uterus, most common site is Fallopian tube

Question 2

Common locations of ectopic pregnancy?

Answer 2

• Fallopian tube
• Ampulla
• Ovarian
• Cervical
• Interstitial
• Isthmus
• Fimbrial

Question 3

HCG levels?

Answer 3

• Non-pregnant women: < 5
• Male : < 2
• Pregnant women: > 25
• Normal pregnancy : 10.000-25.000 mUI/mL ( HCG doubles every 48-72hours in pregnancy)
• Ectopic pregnancy: 1500-3000 mIU/mL

Question 4

Symptoms?

Answer 4

• Abdominal pain
• Abdominal bleeding
• Vaginal bleeding
• Nausea
• Vomiting
• Late or no menstrual cycle
• Tachycardia
• Hypotension

Question 5

Pathogenesis?

Answer 5

• Previous ectopic pregnancy
• Previous pelvic inflammatory disease
• Previous surgery to fallopian tube
• IUD
• Older age
• Smoking

Question 6

Types of ectopic pregnancy?

Answer 6

• Ruptured ectopic pregnancy :
  • Tachycardia
  • Orthostatic hypotension
  • Kehr’r sign
  • Local and generalized abdominal tenderness
• Non-ruptured ectopic pregnancy :
  • Abdominal bleeding
  • Pelvic/abdominal pain
  • Pelvic mass
  • Nausea/vomiting

Question 7

Treatment?

Answer 7

• If early (HCG<6000) we use Methotrexate drug, id more advanced (HCG>6000) surgical management.
• Surgery: Salpingectomy ( to prevent ovarian cancer)
• Medication: Methotrexate ( to stop the pregnancy growing)
  🚩 : It is advised for patients that used Methotrexate no to get pregnant in the next 3months, cause of the remain effect of the drug

Question 8

Differential diagnosis?

Answer 8

• Threatened abortion
• Incomplete abortion
• Molar pregnancy