Ectopic Pregnancy Flashcards
1
Q
Ectopic Pregnancy Definition
A
Pregnancy occurring anywhere outside the uterus, most commonly the Fallopian tubes
2
Q
Ectopic Pregnancy RFs
A
One third do not have risk factors
- PHx
- IVF
- Hx of PID
- Adhesions from infection or endometriosis
- Previous tubal surgery
- IUCD reduces risk, but when it fails risk is very high
3
Q
Ectopic Pregnancy Presentation
A
- Commonly presents in an atypical way, consider pregnancy test even in women with nonspecific signs
- Abdo pain, pelvic pain
- Amenorrhoea or missed period
- Vaginal bleeding
- Dizziness
- Shoulder tip pain
- Urinary symptoms
- If ruptured; signs of bleeding and shock
- Cervical tenderness
- Do not perform internal examination as there is a risk of rupture
- Refer any women with positive pregnancy test and any of the following
- Pain and abdo tenderness, pelvic tenderness, cervical motion tenderness, vaginal bleeding
4
Q
Ectopic Pregnancy Differentials
A
- Threatened miscarriage; bleeding is predominant feature, comes first, then pain
- Left and right iliac fossa pain differentials
5
Q
Ectopic Pregnancy Ix
A
- Pregnancy test even where remotest possibility, serum hCG
- Transvaginal ultrasounds
- No biochemical investigations needed routinely
6
Q
Ectopic Pregnancy Management
A
- Admit as an emergency
- Anti-D rhesus prophylaxis for rhesus-negative women having surgery
- Conservative management acceptable if levels of hCG are falling and patient is well
- Medical management (Single dose IM methotrexate ) first line if no significant pain, enraptured pregnancy, no pregnancy seen on scan, low serum hCG
- Surgical management if significant pain, adnexal mass ≥35mm, foetal heartbeat, high serum hCG
7
Q
Ectopic Pregnancy Complications
A
-Tubal or uterine rupture, massive haemorrhage, shock, DIC, death
8
Q
Ectopic Pregnancy Prognosis
A
- > 85% diagnosed before rupture, tubal preservation and potential for future fertility
- Risk of another is 10-20%
- Chance of subsequent pregnancy is 64-76%
