Ectopic pregnancy Flashcards
when does an ectopic pregnancy most commonly present ?
6-8 weeks since last period
describe the management of ectopic pregnancy.
expectant management if minimal/no symptoms, no foetal heartbeat, < 35mm, bHCG < 1000, able to return for follow up appointment
methotrexate if symptoms, bHCG < 15000
surgery if severe symptoms, mass > 35mm, bHCG > 5000 foetal heart beat, rupture, contraindications to MTX, failed medical management
1st line surgical management for ectopic pregnancy ?
salpingectomy
(removal of fallopian tube doesn’t affect fertility. only perform if other fallopian tube is functioning. Salpingostomy carries risk of incomplete removal and scar tissue formation)
risk factors for ectopic pregnancy ?
PID assisted conception smoking previous ectopic endometriosis tubal ligation, IUD/IUS, POP, implant previous cesarean section
commonest site of ectopic pregnancy ?
ampulla of fallopian tube
isthmus is most dangerous for rupture
signs of ectopic pregnancy on examination ?
cervical excitation: pain on palpation of the cervix
vaginal fullness in pouch of douglas
unilateral pelvic tenderness
signs of haemodynamic compromise if rupture;
- hypotension
- tachycardia
- shoulder tip pain
features of miscarriage vs ectopic ?
usually occurs 8-10 weeks after last period
pain more prominent in ectopic
PV bleeding more prominent in miscarriage
bHCG low or decreasing in miscarriage but plateau in ectopic
investigations for suspected ectopic ?
urianry bHCG bloods; - serial Bhcg - FBC - U&E - LFT
transvaginal USS
1st line diagnostic investigation for ectopic ?
transvgainal USS
contraindications to methotrexate?
breast feeding
liver, renal, pulmonary, haematological disease
active peptic ulcer
immunosuppression
after having an ectopic pregnancy does it increase the risk of recurrence?
yes 5-20%
if 2 consecutive then risk increases to 30%
what drugs should you avoid when taking methotrexate and why ?
NSAIDS and folic acid
make it inactive
