Ectopic Pregnancy

Question 1

What are symptoms of ectopic pregnancy?

Answer 1

Normally develops 6-8 weeks after period
Lower abdominal pain
Vaginal bleeding- less than normal period
Recent history of amenorrhoea
Shoulder tip pain/ pain on defecation or urination
Syncope

Question 2

What is found on examination?

Answer 2

Abdominal tenderness
Pelvic tenderness
Cervical motion tenderness
Abdo distension
Haemodynamic compromise

Question 3

What investigations are required?

Answer 3

Transvaginal US
Beta HCG

Question 4

When can expectant management be done?

Answer 4

Size <35mm
Unruptured
Asymptomatic
No foetal heartbeat
HCG <1000

Monitor closely for 48 hours
- if BCG raises or symptoms then for intervention

Question 5

When can medical management be done?

Answer 5

Size <35mm
Unruptured
No significant pain
No heartbeat
HCG <1500
Able to return for follow up

Can give methotrexate- must wait 3 months before conceiving again

Question 6

When is surgical management required?

Answer 6

Size >35mm
Can be ruptured
Pain
Visible heartbeat
HCG >5000
Not able to return for follow up

If other tube healthy- salpingectomy
If no salpingotomy
If rhesus negative- give anti-D