Ectopic Pregnancy Flashcards
What is an ectopic pregnancy?
When an embryo implants outside the uterine cavity
How many pregnancies does it occur in?
1 in every 60-100
What is the mortality rate in the UK?
16.9/100,000 pregnancies
What are the sites of an ectopic pregnancy?
- Fallopian tube (95%)
- Cornu (entry point of the Fallopian tube into the uterine cavity)
- Cervix
- Ovary
- Abdominal cavity
What happens when an embryo tries to implant in a Fallopian tube?
The thin walled tube cannot sustain trophoblastic invasion;
It bleeds into its lumen or may rupture. Can cause intraperitoneal blood loss, which can be catastrophic
What causes ectopic pregnancies?
Often no cause is evident, but any factor that damages the tube can cause the fertilised oocyte to be caught
Commonly pelvic inflammatory disease (usually from an STI)
Other RFx (apart from PID) for ectopic pregnancy?
- Assisted conception
- Pelvic (particularly tubal) surgery
- Previous ectopic pregnancy
- Smoking
What is the worry with a copper IUD and what should be done?
For women who get pregnant despite having a copper IUD, ectopic pregnancy must be urgently excluded as it usually prevents embryos from implanting in the uterus
What Sx in any woman of reproductive age should be considered for ectopic pregnancy? What should be done to exclude this?
Abnormal vaginal bleeding
Abdominal pain
Collapse
Need to do a urine pregnancy test
What is seen in a Hx of a person with an ectopic pregnancy?
Usually lower abdo pain, followed by scanty, dark vaginal bleeding (however one can be present without other)
Pain often initially colicky (as tube tries to remove sac) and then constant
Amenorrhoea for 4-10 weeks
Syncopal episodes and shoulder pain = intraperitoneal blood loss
What is the ‘classic’ presentation of ectopic pregnancy and how many cases does it account for?
Collapse and abdo pain
25%
Will the patient always be aware she is pregnant?
No, as she may interpret vaginal bleeding as a period
What will be seen on examination?
Abdo and rebound tenderness
Movement of the uterus may cause pain
Uterus smaller than expected for gestation
Cervical os closed
Tachycardia suggests blood loss
Hypotension and collapse occur only in extremes
Ix for ectopic pregnancy?
- Pregnancy test (urine hCG)
- Ultrasound (preferable transvaginally)
- Quantitative serum hCG (useful if uterus is empty)
- Laparoscopy
What does it mean if an intrauterine pregnancy is not seen on US?
- Too early (<5 weeks)
- Miscarriage
- Ectopic pregnancy
