Ectopic pregnancy

Question 1

Symptoms

Answer 1

6-8 weeks amenorrhoea, lower abdominal pain +/- bleeding. Shoulder tip pain. Dizziness and syncope.

Question 2

Location

Answer 2

97% tubal, most commonly ampulla. Isthmus is more dangerous. 3% in ovary, cervix or peritoneum.

Question 3

Investigations

Answer 3

Urine pregnancy test will be positive.
Transvaginal USS.
Abdomen will be tender, cervical excitation.

Question 4

When is expectant management appropriate?

Answer 4

Size <35mm, unruptured, no symptoms, no foetal heart beat, bhCG < 1000.
Closely monitor for 48 hours and if bhCG rises or symptoms develop revaluate.

Question 5

When is medical management appropriate?

What do you give?

Answer 5

Size <35mm, unruptured, mild symptoms, no foetal heart beat, bhCG < 1500.
Give methotrexate.

Question 6

When is surgical management necessary?

Answer 6

If > 35mm, ruptured, foetal heart beat detected, in severe pain, bhCG > 1500.
Salpingectomy or salpingotomy.