ectopic pregnancy management Flashcards
What is the first approach for managing ectopic pregnancy?
The first approach for managing ectopic pregnancy is the ABCDE approach.
What criteria make a patient suitable for expectant management of ectopic pregnancy?
Patients who are haemodynamically stable and asymptomatic, with a size < 35mm, unruptured, asymptomatic, no foetal heartbeat, serum hCG < 1000 IU/L, and able to return for follow-up are suitable for expectant management.
How is expectant management monitored for ectopic pregnancy?
Expectant management is monitored with serial hCG measurements until levels are undetectable, typically repeated on days 2, 4, and 7 after the original test.
When should medical management with IM methotrexate be considered for ectopic pregnancy?
IM methotrexate is considered for patients able to attend follow-up, with no significant pain, unruptured ectopic pregnancy with adnexal mass < 35 mm, serum β-hCG < 1500 iU/L, and no co-existing intrauterine pregnancy.
What follow-up is required after methotrexate treatment for ectopic pregnancy?
Follow-up for methotrexate treatment includes serial hCG measurements on days 4 and 7, then once a week until negative, and patients should avoid sexual intercourse and conception for 3 months.
What are some of the precautions patients should take during methotrexate treatment?
During methotrexate treatment, patients should avoid alcohol, prolonged exposure to sunlight, and sexual intercourse. They should not conceive for 3 months after treatment.
When should surgical management be considered for ectopic pregnancy?
Surgical management should be considered if the patient has significant pain, ruptured ectopic, adnexal mass > 35 mm, ectopic pregnancy with a foetal heartbeat, or serum β-HCG > 5000 iU/L.
What are the surgical options for ectopic pregnancy, and what are the follow-up requirements?
Surgical options include laparoscopic salpingectomy or salpingotomy. Follow-up for salpingotomy includes 1 serum hCG test at 1 week, then weekly until negative. For salpingectomy, a urine pregnancy test at 3 weeks.
What is the role of anti-D prophylaxis in the surgical management of ectopic pregnancy?
Anti-D prophylaxis (250 iU) should be offered to all RhD-negative women who have surgical management.
When can patients with an ectopic pregnancy be offered a choice between methotrexate and surgical management?
Patients with an ectopic pregnancy with a serum hCG level of 1500 - 5000 IU/L, who meet certain criteria, can be offered a choice between methotrexate and surgical management.
What should be explained to patients about the nature and risks of ectopic pregnancy?
Patients should be informed that an ectopic pregnancy cannot be saved, won’t develop into a baby, can put the mother’s health at risk, and must be removed.
What should be discussed with patients regarding the risk factors for ectopic pregnancy?
Discuss risk factors such as PID, smoking, IUD/IUS, assisted reproductive technology, and tubal surgery.
What should be explained about the administration and expectations of methotrexate treatment?
Explain that methotrexate is administered as 1 x IM injection, manage expectations regarding side effects, and the need for follow-up blood tests. Advise on avoiding sex, alcohol, and excessive sunlight.
What should be explained about the surgical options and follow-up for ectopic pregnancy?
Explain that salpingectomy is the best procedure but salpingotomy can be considered if fertility issues exist. Discuss the risks and follow-up requirements for both procedures.
What advice should be given regarding ongoing contraception after ectopic pregnancy?
Discuss ongoing contraception options after ectopic pregnancy.
