Ectopic Pregnancy

Question 1

Define ectopic pregnancy

Answer 1

Implantation of conceptus outside uterine cavity

Women reproductive age + abdominal pain = ECTOPIC UNTIL PROVEN OTHERWISE

Question 2

What is the epidemiology of ectopic pregnancies?

Answer 2

20: 1000

- Most sig cause of death in 1st trimester

Question 3

What are the risk factors of ectopic pregnancy?

Answer 3

• Hx ectopic (recurrence 10-20%)
• Hx infertility
• Smoking
• Assisted conception
• Hx pelvic/tubal surgery
• Endomitriosis, PID, Chlamydia

Question 4

What are the clinical features of ectopic pregnancy?

Answer 4

• Pain: unilateral, generalised, shoulder tip
• Amenorrhea: 6-8 wks previously
• PV bleed: 75%
• Cervical excitation

-COLLAPSE: hypotension, tachycardia, tachypnoea, GCS–, cold peripheries, deterioration of end-organs

Question 5

How are ectopic pregnancies managed?

Answer 5

GENERAL

• Wait and see if not life-threatening
• Rhesus negative = anti D immunoglobulins
• support services

MEDICAL

• Methotrexate injection
• Only if pregnancy very early
• Need close observation for several weeks
• Repeated blood tests and scans
• hCG checks every 2-3 days until level is low
• SE: N+V, abdo pain

SURGICAL
-Emergency removal of tube