Ectopic Pregnancy Flashcards
What is an ectopic pregnancy?
An ectopic pregnancy is the implantation of a fertilised egg outside the uterine cavity, most commonly in the fallopian tube.
What are the typical symptoms of an ectopic pregnancy?
Symptoms include abdominal or pelvic pain, vaginal bleeding, shoulder tip pain, and symptoms of shock if ruptured.
What is the aetiology of ectopic pregnancy?
Causes include conditions that impair normal tubal transport, such as tubal damage, pelvic infections, or previous pelvic surgeries.
What is the pathophysiology of ectopic pregnancy?
It involves implantation of the fertilised egg outside the uterine cavity, leading to inadequate support for embryonic growth and complications.
How prevalent is ectopic pregnancy?
Ectopic pregnancy occurs in approximately 1-2% of all pregnancies.
What are the risk factors for ectopic pregnancy?
Risk factors include previous ectopic pregnancy, tubal surgery, pelvic inflammatory disease, intrauterine device use, and infertility treatment.
What are the potential complications of ectopic pregnancy?
Complications include tubal rupture, haemorrhage, shock, and death if untreated.
How is ectopic pregnancy diagnosed?
Diagnosis involves clinical history, pelvic examination, ultrasound imaging, and serum beta-hCG testing.
What are the typical clinical examination findings in ectopic pregnancy?
Findings may include abdominal tenderness, adnexal tenderness or mass, cervical motion tenderness, and signs of haemodynamic instability in rupture.
What investigations are used for suspected ectopic pregnancy?
Investigations include transvaginal ultrasound, serial serum beta-hCG levels, and complete blood count (CBC).
What is the role of beta-hCG in ectopic pregnancy?
Serial beta-hCG levels help differentiate between viable intrauterine pregnancy and abnormal pregnancy, including ectopic pregnancy.
What imaging modality is most useful for ectopic pregnancy?
Transvaginal ultrasound is the primary imaging modality to identify ectopic pregnancies and assess for complications.
What are the features of ectopic pregnancy on ultrasound?
Ultrasound may show an adnexal mass, free pelvic fluid, and absence of an intrauterine gestational sac.
What is the conservative management of ectopic pregnancy?
Conservative management involves close monitoring with serial beta-hCG levels if the pregnancy is stable and beta-hCG levels are declining.
What are the medical management options for ectopic pregnancy?
Medical management involves the use of methotrexate, a folic acid antagonist that inhibits cell division in trophoblastic tissue.
What are the indications for medical management of ectopic pregnancy?
Indications include stable patients, no evidence of rupture, beta-hCG levels <5000 IU/L, and absence of fetal cardiac activity.
What is the surgical management of ectopic pregnancy?
Surgical options include salpingectomy (removal of the affected fallopian tube) or salpingostomy (removal of the ectopic pregnancy while preserving the tube).
What are the indications for surgical management of ectopic pregnancy?
Indications include haemodynamic instability, signs of rupture, or failure of medical management.
What are the contraindications for methotrexate therapy in ectopic pregnancy?
Contraindications include active liver or renal disease, breastfeeding, peptic ulcer disease, and immunodeficiency.
What follow-up is needed after methotrexate therapy for ectopic pregnancy?
Follow-up involves serial beta-hCG monitoring until levels fall to non-pregnant levels to ensure complete resolution.
What is a ruptured ectopic pregnancy?
A ruptured ectopic pregnancy occurs when the ectopic gestation causes tubal rupture, leading to internal bleeding and haemodynamic instability.
What are the signs of a ruptured ectopic pregnancy?
Signs include severe abdominal pain, shoulder tip pain, hypotension, tachycardia, and syncope.
What is the prognosis for ectopic pregnancy?
Prognosis depends on early diagnosis and management. Most women recover fully, though future fertility may be affected.
What are the differential diagnoses for ectopic pregnancy?
Differential diagnoses include miscarriage, pelvic inflammatory disease, ovarian torsion, and appendicitis.
What support should be provided to women after ectopic pregnancy?
Support includes counselling about recurrence risk, future pregnancy planning, emotional support, and monitoring for complications.
