Ectopic Pregnancy Flashcards
What in patients medical history, might be a risk factor for ectopic pregnancy?
Prev ectopic
PID
Endometriosis
Which contraceptive methods may be a risk factor for ectopic pregnancy?
IUD/IUS
Progesterone only
Tubal ligation
Give iatrogenic risk factors for ectopic pregnancy
Pelvic surgery
Assisted conception
How does an ectopic pregnancy present?
Pain > bleeding
Shoulder tip pain
Vaginal discharge
Tenderness
What is the first line investigation for suspected ectopic pregnancy?
Pregnancy test
What is the second line investigation for an ectopic pregnancy?
USS
How is ectopic pregnancy medically managed?
IM methotrexate
How does IM methotrexate work in management of ectopic pregnancy?
Anti-folate
Disrupts folate dependent cell division of the developing foetus
What is measured to assess response to methotrexate treatment in ectopic pregnancy?
beta-HCG
Should decline by >15% by day 4-5
Who is offered medical management of ectopic pregnancy?
beta-hcg <1500 iU/ml
unruptured
no heartbeat
What must patients be advised to do 3-6 months following the use of methotrexate in ectopic pregnancy?
Use contraception
What surgery is performed in surgical management of ectopic pregnancy?
Laparoscopic salpingectomy or salpingotomy
In which scenario would salpingotomy be used over salpingectomy in management of ectopic pregnancy?
If the other tube was damaged in some way
When is surgical management offered in ectopic pregnancy?
Severe pain
beta-HCG >5000 iU/ml
Adnexal mass > 34mm
Foetal heartbeat visible
In which scenarios is conservative management offered in ectopic pregnancy?
Stable patients
Controlled pain
Low beta-HCG
Small and unruptured
