Ectopic Pregnancy Flashcards
Predisposing factors for ectopics (8)
damage to fallopian tubes
IUD/IUS
POP
maternal age>35
smoking
previous ectopic
endometriosis
IVF
Presentation of ectopic pregnancy and ruptured ectopics (7)
presents around 8wks w.:
- pain
- bleeding
- cervical excitation
- shoulder tip pain: peritoneal bleeding>diphragmatic irritation
rupture:
- sudden onset pain
- peritonism
- shock
Ix for ectopics (2)
B-hCG
USS:
- empty uterine sac
- fluid in pouch of douglas
detecting ectopic pregnancy <5wks gestation
<5wks, USS cannot detect foetus=> only B-hCG can be used to detect ectopic.
if B-hCG<1500, take another reading 48hrs later, if this doubles>normal pregnancy.
Mx of ectopic pregnancy (6)
NBM
IVI
anti-D if rh-ve
urgent laparotomy if ruptured
salpingectomy/salpingostomy
MTX
salpingostomy vs salpingectomy (4)
ostomy:
- higher chance of subsequent pregnancy and persistent trophoblast
- must have serial hCG until <20
- if part remains>MTX
ectomy:
-preferred option unless other tube is dysfunctional and fertility needs to be preserved.
indications for MTX Rx (5)
(50mg IM/intratubal)
no significant pain
unruptured
hCG<1500
no free fluid in pouch of douglas
<35mm ectopic
(will require regular f/u to check hCG<20. will rise till day 4 and fall by 7d)
(fertility rates similar to after surgery)
CI for MTX Rx (4)
> 35mm
ruptured ectopic
foetal heart beat present
hCG>1500
complications of MTX Rx (4)
multiple ovarian cysts
life-threatening neutropenia
late pelvic collections of blood
pneumonitis
Expectant mx of ectopic pregnancy (4)
can be used for patients w.:
- no acute Sx
- no blood
- falling hCG w. initial levels<1000 (88% resolve spontaneously w. this level)
- <100ml fluid in pouch of douglas
Dx and Mx of persisent trophoblastic disease
hCG doesn’t drop according to expected curve
Rx w. MTX IM
(occurs in 10% after laparoscopic salpingostomy, less likely in salpingectomy)
