Ectopic Pregnancy

Question 1

Where is the most common location for an ectopic preg?

Answer 1

Ampulla

Isthmus = most dangerous

Question 2

What are the risk factors for an ectopic preg?

Answer 2

PMH = previous, PID, endometriosis

Contraception = IUD/S, tubal ligation/occlusion

Iatrogenic = pelvic surgery, embryo transfer in IVF

Question 3

What are the possible signs and symptoms of an ectopic preg?

Answer 3

Unilateral lower abdominal/pelvic pain

Vaginal bleeding = decidual breakdown in the uterine cavity due to suboptimal β-HCG levels

Shoulder tip pain = blood in peritoneal cavity

Vaginal discharge = decidua breakdown

Abdo tenderness

Rupture = haemodynamically unstable (pallor, increased capillary refill time, tachycardia, hypotension), with signs of peritonitis (abdominal rebound tenderness and guarding), shoulder tip pain (C3, 4, 5 irritation)

Question 4

How should an ectopic preg be investigated?

Answer 4

Urine β-HCG

Pelvic US

• ve US = serum β-HCG
• > 1500 = ectopic, offer laparoscopy
• <1500 = repeat β-HCG in 48h (rise = preg, fall = miscarriage)

Question 5

Outline the management of an ectopic preg

Answer 5

Conservative (<3cm, hCG <1500 and falling) = watchful waiting (not first line)

Medical (<3.5cm, hCG <5000, no symp/FF) = IM methotrexate, consider Anti-D prophylaxis

Surgical (pt choice, med criteria not met) = removal, salpingotomy