Ectopic pregnancy Flashcards
What is ectopic pregnancy
Pregnancy outside the uterus –with 98% occurring in the fallopian tubes
Life threatening obstetric emergency
What is the pathogenesis of ectopic pregnancy
Abnormal embryo migration = disrupted tubal motility due to factors such as PID, endometriosis, smoking may impede embryo progress
Impaired tubal environment = inflammatory processes including infection or endometriosis can later tubal milieu
Embryo – tubal interactions = expression of adhesion molecules and chemokines such as integrins and L selectin may effect.
Risk factos for ectopic pregnancy?
: whatever impairs passage of egg
PID and previous STIs
Pelvic surgery
Copper coil
IVF
Previous ectopic
Endometriosis
What time of pregnancy do ectopics present?
6-8 weeks
Presentation of ectopic pregnancy
Pelvic pain, unilateral
Shoulder tip pain
Abnormal bleed
Haemodynamic instability - faint
Chaldelier sign
What is the chandelier sign?
Unilateral tenderness, cervical tenderness on bimanual
Investigations for ectopic?
Bedside:
> Pregnancy test to confirm pregnancy
Bloods:
> FBC for anaemia
> Serum beta – hCG to guide management
Imaging:
- > TVUS to locate pregnancy
When is conservative mx appropriate for ectopic?
Low risk of there is a drop in beta – hCG suggesting self resolution but require close follow up
Medical management of ectopic pregnancy?
If pain is not significant and hCG below 1500
unruptured ectopic below 35mm
= methotrexate
When is surgical management of ectopic needed?
HCG over 5000, mass of 35mm_+
Patient in pain or haemodynamically unstableW
What surgical management is used for ectopic?
Salpingectomy
Why would anti D immunoglobin be given to a women with ectopic?
Given to all rhesus negative women
Most common site of ectopic pregnancy?
Ampulla
