Ectopic pregnancy

Question 1

Risks for getting an ectopic pregnancy

Answer 1

anything which slows the ovums move to the uterus

PID
previous surgery (failed sterilisation)
PHx ectopic
endometriosis (pelvic scarring/adhesions)
copper coil
progesterone only pill
IVF
SMOKING

Question 2

Most common ectopic site?

Answer 2

ampulla of fallopian tubes

if its in the bit where fallopian tubes enters uterus, it can grow bigger before it causes problems - and so can cause dramatic blood loss

Question 3

Presentation of ectopic pregnancy

Answer 3

6-8 weeks amenorrhoea
lower abdominal pain starting unilaterally

rupture ->
vaginal bleeding
shoulder tip pain - from the bleeding irritating the peritoneum
shock, guarding, increased HR etc

Question 4

investigations of ectopic pregnancy

Answer 4

b hCG (static, slowly falling
TVS
laparoscopy if unknown location

Question 5

treatment of ectopic pregnancy

Answer 5

conservative - if hCG is falling by itself, keep checking it continues to fall

medical - if stable - methotrexate - teratogenic for 3 months - cant if theres a fetal HR or bhCG>5000

surgical - laparoscopic salpingectomy if the other fallopian tube is okay - take out whole tube
laparoscopic salpingotomy (just the fetus removed)  if the other tube is unhealthy - reoccurance risk