Ectopic pregnancy

Question 1

What are the common sites of an ectopic pregnancy?

Answer 1

Fallopian tubes: ampulla, isthmus, fimbrial ends
Ovaries
Peritoneal cavity

Question 2

What are the risk factors for an ectopic pregnancy?

Answer 2

E = ectopics previously, endometriosis
C = contraception - POP, IUD, emergency 
T = tubal surgery, damage or adhesions (PID, STIs)
O = other abdominal surgery (appendectomy)
P = PID
I = IVF
C = cause unknown (50%)
S = smoking and advanced maternal age

Question 3

What is the classic triad of symptoms for an ectopic pregnancy?

Answer 3

Amenorrhoea + lower abdominal pain + vaginal bleeding

Question 4

What might you expect on examination with an ectopic pregnancy?

Answer 4

Tender adnexum and posterior fornix 
Cervical excitation (very tender on palpation)
Acute abdomen +/- shock (massive intraperitoneal bleeding)

Question 5

What Ix would you do for an ectopic pregnancy and what would you expect to see?

Answer 5

Quantitative bHCG every 48hrs x 3 readings: usually doubles in 48hrs, but in ectopic pregnancies it will not double normally (suboptimal rise)
U/S: empty uterus, free fluid in POD

Question 6

What is the management for a ruptured ectopic pregnancy?

Answer 6

DRSABC - assess haemodynamic stability
IV access
FBE
Cross match
Coagulation screen
Resus with O-ve blood or IV fluid if blood unavailable
All Rh-ve women should receive anti D IgG
Call anaesthetics and obstetrician for emergency laparotomy

Question 7

What is the management for an ectopic pregnancy if the patient is stable?

Answer 7

Methotrexate and monitoring of bHCG until drops to 0

Surgery