Ectopic Pregnancy

Question 1

What is an ectopic pregnancy?

Answer 1

Implantation of embryo outside the uterine cavity

Question 2

Where might the embryo implant in ectopic pregnancy?

Answer 2

Fallopian tubes (most common)
C/S scar
Cervix
Ovary
Peritoneum

Question 3

Presentation of ectopic pregnancy

Answer 3

Abdominal pain (RIF, LIF)
Vaginal bleeding
Shoulder tip pain (bleeding into the peritoneum causing irritation of the diaphragm)
Dizziness or syncope
Cervical motion tenderness

Question 4

Risk factors for ectopic pregnancy

Answer 4

Previous ectopic pregnancy
Smoking
Tubal damage: infection, endometriosis, surgery, sterilisation, PID

Question 5

Investigations for ectopic pregnancy

Answer 5

hCG

TVUS

Question 6

Interpretation of hCG results in ectopic pregnancy

Answer 6

> 1500iU + no IUP = ectopic until proven otherwise
<1500iU = another measurement needed in 48hrs
Viable pregnancy: hCG doubles every 48hrs
Miscarriage: hCG halves every 48hrs
An increase or drop outside theses limits = consider ectopic

Question 7

Findings on TVUS in ectopic pregnancy

Answer 7

Empty uterus

Pseudosac = sac but no embryo

Question 8

Treatment of ectopic pregnancy if the patient is acutely unwell

Answer 8

1st line: Salpingectomy = removal of the uterine tube (patient with healthy other tube)
Salpingotomy = removal of the ectopic pregnancy (patient with tube disease who wants to preserve fertility)

Question 9

When is Anti-D prophylaxis needed in ectopic pregnancy management?

Answer 9

For Rh-ve patients who receive surgical treatment

Question 10

Treatment of ectopic pregnancy if the patient is stable

Answer 10

IM methotrexate

Question 11

How long do patients need to avoid pregnancy if their ectopic pregnancy is managed with IM methotrexate?

Answer 11

3 months