Ectopic Pregnancy

Question 1

A 25-year old is seen in the A&E department with a history of right iliac fossa pain and slight vaginal bleeding after 7 weeks of amenorrhoea.

a. What is the differential diagnosis? Give 2 conditions. (2)

Answer 1

1. Ectopic pregnancy
2. Miscarriage

Question 2

b. Give 2 important points in the history which you would wish to elicit. (2)

Answer 2

1. Onset and duration of pain i.e. acute or insidious
2. Has she had a +ve pregnancy test?
3. Dyspareunia over previous days (common in ectopic)
4. Changes in bowel habit (diarrhoea can be present in ectopic or acute appendicitis)
5. Does she know she is pregnant or not? (i.e. has she had a urine or blood hCG test?)
6. Previous pregnancues – any hx of ectopic / recurrent miscarriages?

Question 3

d. Give 2 investigations you would carry out. (3)

Answer 3

1. Urinary pregnancy test
2. Bloods – FBC, clotting, hCG, G+S
3. Imaging – transvaginal USS

Question 4

e. Name 1 treatment option for each of your possible diagnoses. (2)

Answer 4

1. Ectopic
   
   • Surgical e.g. salpingectomy/salpingotomy or
   • Medical e.g. Methotrexate
2. Miscarriage → surgical management of miscarriage (SMM – new name for ERPC)

Question 5

f. What injection must be given to a Rh -ve pregnant woman who bleeds during pregnancy? (1)

Answer 5

Anti-D immunoglobulin

(normally given at 28-32wks once or twice and 72hrs after birth)