Ectopic Pregnancy

Question 1

Definition of ectopic pregnancy.

Answer 1

Implantation of a pregnancy outside the uterine cavity

Question 2

Most common locations for ectopic

Answer 2

ampulla (70%)
isthmus (12%)
fimbriae (11%)

Question 3

Incidence of ectopic pregnancy

Answer 3

1:100

Question 4

Risk factors for Ectopic Pregnancy

Answer 4

Prior ectopic
PID and STIs
Endometriosis
Fallopian tube surgery or congenital abnormality
Adhesions secondary to pelvic/abdominal surgery
Exogenous Estrogen/Progesterone
IUD use (25-50% risk)
IVF/ assisted reproduction
DES exposure
Smoking

Question 5

% increase risk of subsequent ectopic pregnancies after 1 prior? after >1 prior?

Answer 5

10% after 1 prior

25% after 1+ prior

Question 6

S&S of ectopic pregnancy? diagnosis?

Answer 6

Unilateral pelvic or lower abdominal pain, vaginal bleeding

Hypotension, tachycardia, peritoneal irritation if ruptured

B-hCG low for GA and does not double q48hrs

US showing adnexal mass or extrauterine pregnancy and intra-abdominal fluid in pelvis/abdomen

Question 7

Treatment

Answer 7

IV Fluids, blood products, vasopressors if necessary

Exploratory laparotomy/laparoscopy to evacuate hemoperitoneum, coagulate bleeding, and resect via salpingostomy (fallopian tube retained) or salpingectomy (fallopian tube removed)

Methotrexate for uncomplicated, nonthreatening, small ectopic (50 mg/m2 dose IM). B-hCG