Ectopic pregnancy Flashcards
What is an ectopic pregnancy
when a pregnancy is implanted outside the uterus.
Most common site of ectopic pregnancy
Ampulla of Fallopian tube
Some other sites of ectopic pregnancy
Cornua (Entrance to fallopian tube)
Ovary
Cervix
C-section scar site
Abdomen
Def: Heterotropic pregnancy
Twin pregnancy in which one is ectopic and one is uterine
Risk factors for ectopic pregnancy
- Previous ectopic pregnancy
- Previous pelvic inflammatory disease
- Previous surgery to the fallopian tubes
- Intrauterine devices (coils)
- Older age
- Smoking
When does ectopic pregnancy usually present
6-8 weeks
Classic features of ectopic pregnancy
- Missed period
- Constant lower abdominal pain in the right or left iliac fossa
- Vaginal bleeding
- Lower abdominal or pelvic tenderness
- Cervical motion tenderness (pain when moving the cervix during a bimanual examination)
- Shoulder tip pain (Peritonitis)
- Dizziness (Blood loss)
Investigations required in ectopic pregnancy
FBC
G+S
USS
FAST scan or TVUS
What will be seen on TVUS in ectopic pregnancy
Gestational sac outwith the uterus
Blob sign, bagel sign or tubal ring sign
What is a pregnancy of unknown location (PUL)
when the woman has a positive pregnancy test and there is no evidence of pregnancy on the ultrasound scan.
What investigations are required in PUL
HCG tracking after 48 hours (Pregnancy doubles every 48 hours, ectopic or miscarriage won’t)
What are the 3 management options for ectopic pregnancy
Expectant management
Medical management
Surgical management
What drug is used for medical management of ectopic pregnancy?
Methotrexate
How does methotrexate work in management of ectopic pregnancy
Folic acid antagonist so inhibits DNA synthesis, halting pregnancy and causing termination (Given as IM)
Advice on pregnancy following methotrexate?
Do not get pregnant for 3 months due to prolonged teratogenic effects
Common side effects of methotrexate
- Vaginal bleeding
- Nausea and vomiting
- Abdominal pain
- Stomatitis (inflammation of the mouth)
In whom is surgery required in ectopic pregnancy
- Pain
- Adnexal mass > 35mm
- Visible heartbeat
- HCG levels > 5000 IU / l
What are the 2 surgical management options for ectopic pregnancy?
Laparoscopic salpingectomy
Laparoscopic salpingotomy
What is involved in laparoscopic salpingectomy
first-line treatment for ectopic pregnancy. This involves a general anaesthetic and key-hole surgery with removal of the affected fallopian tube, along with the ectopic pregnancy inside the tube.
What is involved in laparoscopic salpingotomy
used in women at increased risk of infertility due to damage to the other tube. The aim is to avoid removing the affected fallopian tube. A cut is made in the fallopian tube, the ectopic pregnancy is removed, and the tube is closed.
