ectopic pregnancy Flashcards
symptoms of ectopic
6-8wk amenorrhoea (> - other cause)
low abdo pain (poss unilateral) → bleeding
shoulder / rectal / wee / poo pain (peritoneal bleeding)
diarrhoea
management of ruptured ectopic? what about if blood in the peritoneum?
emergency laparoscopy
if haemoperitoneum found, may need ipsilateral salpingectomy
ectopic - followup
no need to wait certain time before retrying
offer 7wk USS to check if next pregnancy is intrauterine
how does serum hcg change in trim 1?
increases by 50% (usually doubles) every 48h
RFs for ectopic
previous ectopic
PID, tubal surgery, endometriosis
IUD
IVF + infertility
ectopic - presentation
5-7wk
abdo/shoulder tip/rectal pain
diarrhoea/bleeding
syncope episodes that bounce back/sudden collapse
ectopic - possible examination findings
abdo tenderness / peritonism cervical excitation DON'T examine for adnexal mass - risk rupture adnexal tenderness - esp if unilateral hypovolaemic shock
?ectopic - potential investigation findings
USS:
intraperitoneal haemorrhage - free fluid in peritoneal cavity (blood)
ectopic (absence doesn’t exclude)
nothing on USS
serum hcg:
do and repeat in 48h - trend
(but some produce hcg like normal)
ectopic - management options
surgical - laparoscopy or laparotomy
medical - methotrexate
conservative - watch + wait
ectopic - surgical management - indications
symptomatic/unstable pain - indicates bleeding has/is about to happen mass > 4mm hCG v high previous ectopic
ectopic - types of surgical management + pros/cons. what may you need to give with surgery?
laparoscopy - 1°:
salpingectomy - remove ectopic + tube (reduces fertility 30%) - v reduces chance of future ectopic
salpingotomy - remove ectopic. damages/scars tube + chance of recurrence
laparotomy - best option if unstable/collapsed
may need anti-D
medical management of ectopic - indications
stable pregnancy
pregnancy small/not well developed
hormone levels not that high
medical management of ectopic?
methotrexate - folate antagonist - stops tissues proliferating
followup for 2mo - small risk rupture (would need emergency surgery)
don’t get pregnant 3mo after completion
ectopic - indications for conservative (w+w) management
asymptomatic
low level + falling hcg
ectopic - chance of recurrence? how will they know in future pregnancy?
10% recurrence
do USS at 7wk in future pregnancies
