Ectopic pregnancy Flashcards
What are the predisposing factors of ectopics?
→ Damage to the tubes - PID, prev. surgery → Prev. ectopic → Endometriosis → IUD → POP → IVF → Smoking → Pregnancy after tubal ligation is 9x more likely to be ectopic
Where do most ectopics occur?
Ampulla of the tube
What location of ectopic is at increased risk of rupture?
isthmus of the tube
what is the typical presentation of an ectopic?
sexually active w abdo pain, bleeding, fainting, or D&V
What are the classic sx of ectopics?
- Often no sx, uncertain LMP
- Amenorrhoea 6-8 weeks
- Pain, can be non-specific lower abdo pain but classically unilateral
- Vaginal bleeding
- Diarrhoea, loose stools +/- vomiting
- Dizziness
- Shoulder tip pain from diaphragmatic irritation from haemoperitoneum
- Collapse
- Normal sized uterus
- Cervical excitation
Is it safe to perform vaginal or speculum examinations in ectopics?
yes!!!! they don’t rupture them lol
What are the invesstigations
- FBC
- G+S
- Serum progesterone - helps identify a failing pregnancy
- hCG - when a normal pregnancy should be visible on TVS (>1500IU)
- TVS - for location
- Laparoscopy in a pregnancy of unknown location where a diagnosis cannot be made
What are the criteria allowing for expectant or medical management of an ectopic?
⎫ Asymptomatic or mild sx
⎫ hCG <3000IU
⎫ Ectopic <3cm on scan w no fetal heart activity
⎫ No haemoperitoneum on TVS
Explain what is done in expectant management
watch for falling hCG by taking serum hCG every 48 until confirmed fall
then weekly until <15IU
What is the medical management
Methotrexate in single dose
hCG levels on days 4 and 7
What is done in medical management if hCG has fallen by <15%
repeat dose of methotrexate
What are the SE of the medical management
conjunctivitis
stomatitis
diarrhoea
abdo pain
What are surgical options for rx, including 1st line
laparoscopy
Salpingectomy if the other tube is healthy
salpingotomy if the other tube isn’t healthy but there reis an increased risk of a future ectopic
