Ectopic Pregnancy

Question 1

What is ectopic pregnancy

Answer 1

An ectopic pregnancy si implantation of the zygote outside the uterine endometrium OR when
the conceptus implants either outside the uterus (fallopian tube, ovary, abdominal cavity) or ni an abnormal position within the uterus (cornua, cervix).

Question 2

What is Heterotopic pregnancy

Answer 2

combined intrauterine pregnancy
and ectopic pregnancy.

Question 3

List AETIOLOGIES of ectopic pregnancy

Answer 3

• Tubal damage (most important) e.g. from salpingitis secondary to PID, post abortal or puerperal sepsis
• Previous ectopic pregnancy
• Previous tubal surgery
• Endometriosis
• Progesterone contraceptives

Question 4

POSSIBLE LOCATIONS OF
ECTOPIC PREGNANCY 🤰 list 4

Answer 4

.1 Tubal
2. Abdominal
3. Ovarian
.4 Cervical - can cause severe
bleeding per vaginam and mimic miscarriage.

Question 5

CLINICAL PRESENTATION

Answer 5

1. Quiet or Chronic
2. Acute
   .3 Subacute or unruptured

Question 6

What should you ask while taking history for ectopic pregnancy

Answer 6

• Presenting complaint depends on whether it is ruptured or unruptured:
  i) Abdominal pain
  (i1) Amenorrhoea
  (iii) Irregular bleeding per vaginam
  (iv) Syncope

Question 7

How do you clerk for amenorrhoe

Answer 7

AMENORRHOEA:
- LMP? • Early pregnancy symptoms eg. nausea, vomiting, breast tenderness etc.
N.B:
Amenorrhea may be absent in an isthmic ectopic which ruptures very early even before the woman misses a period.

Question 8

How do u clerk BLEEDING PER VAGINAM: in ectopic pregnancy

Answer 8

• It m a y ‘ b e s p o t t i n g or m a y simulate menstrual bleeding. This si
  as a result of shedding of the endometrium because of withdrawal
  of hormonal support from the failed pregnancy.
• Adecidual cast may be seen.

Question 9

Why is bleeding 🩸 per vaginum not usually heavy in ruptured ectopic pregnancy

Answer 9

• It si not usually heavy because bleeding from ruptured ectopic si into hte peritoneal cavity. It usually occurs after abdominal pain (whereas reverse is the case in
  abortion)
• High index o f suspicion ni any woman ofreproductive age

Question 10

What happens if ectopic pregnancy ruptures

Answer 10

It is associated with produce infra-abdominal hemorrhage and this is leads to high maternal mortality

Question 11

What is Heteroectopic pregnancy

Answer 11

It’s the coexistence of ectopic pregnancy and intrauterine pregnancy

Question 12

Most common site of implantation of ectopic pregnancy

Answer 12

Fallopian tube

Question 13

Biggest risk factors of ectopic pregnancy is

Answer 13

*Pelvic inflammatory disease
*Surgeries on the fallopian tubes
*Hormonal imbalance progesterone and estrogen from contraceptives

Question 14

Clinical features of ectopic pregnancies

Answer 14

*abdominal pain with fainting(shock)
*Amenorrhoea
*vaginal bleeding 🩸: due to decidual endometrial sloughing pain occurs vaginal bleeding in ectopic pregnancy

Question 15

On examination 🧐

Answer 15

*pallor pale from blood loss, cold extremities
*Abodmen generalised tenderness
*Pelvic examination:speculum cervical excitation tenderness can be elicited, uterus may be enlarged and adnexal mass maybe palpable

Question 16

Investigations of ectopic pregnancy

Answer 16

*culdocentesis: passage of wide bore needle through posterior fornix into the pouch of douglas-presence of no clotting blood is evidence of haemoperitoneum
*ultrasound :scan showing fluid in the pouch of douglas, in abdominal fetal parts and placenta found outside an empty uterine cavity
*Measurement of Human chorionic gonadotrophin
*laparoscopy
*Abodminal x ray
Dilatation and curettage

Question 17

Management of ectopic pregnancy

Answer 17

• Mainly surgical
  *Emergency laparotomy to stop intrabdominal haemorrhage
  *blood transfusion given
  Surgery in the ruptured or unruptured fallopain tube maybe be radical (salpingectomy or partial salpingectomy(removal of fallopian tubes.

Question 18

Treatment of unruptured ectopic pregnancy

Answer 18

• Methotrexate