Ectopics

Question 1

Draw a diagram of potential sites of ectopic pegnanc

Answer 1

Question 2

Which site is most common for Ectopics

Answer 2

Fallopian tube (95%)

Question 3

Outline the Aetiology of Ectopics

Answer 3

• Often no cause present
• Any factor that damages tube
  
  • PID
  • STI
  • Surgery

Question 4

Outline the clinical features of Ectopics

Answer 4

• Symptoms
  
  • Lower abdo pain
  • Bleeding
  • Collapse
• O/E
  
  • Abdo rebound tenderness
  • Cervical excitation
  • Tender adnexum
  • Uterus smaller than expected from gestation

Question 5

Draw a flow diagram detailing the investigations & diagnosis of an Ectopic presenting as Pain, Bleeding & Collapse

Answer 5

Question 6

Outline the management of Ectopics

Answer 6

• Haemodynamically UNSTABLE
  
  • = Laparotomy & salpingectomy
• Haemodrynamically STABLE
  
  • ⇒ >3cm or bHCG >5000
    
    • = Laparoscopy & salpingostomy/ectomy
  • ⇒ <3cm & bHCG <3000(-5000)
    
    • = Systemic single dose methotrexate
    • Measure bHCG on d4 & d7 ⇒ bHCG still high?
      
      • = Recurrent dose or Laparoscopy
• Conservative
  
  • Small unruptured ectopic/ unknown location & bHCG <1000

Question 7

Outline possible complications of Ectopics & their management

Answer 7

• Laparoscopy > Laparotomy
• Salpingostomy = Allows spontaneous pregnancy BUT inc risk of future ectopic
• Salpingectomy = Tube removed so no risk of ectopic in same tube
• SUPPOT