Gyn - Ectopic Pregnancy

Question 1

6 weeks of amenorrhea, lower abdominal pain, vaginal spotting, PT +ve

Physical examination and investigation?

Answer 1

Physical exam:
Vitals
Abd: tenderness/ guarding/ rebound tenderness
Speculum: blood, tissue mass
Bimanual: cervical excitation, adnexal mass & tenderness, uterine size

Investigations:
Repeat pregnancy test
Bloods: CBC (anaemia, thrombocytopenia), clotting profile, L/RFT
Serial B-hCG
USG for IU sac, ectopic pregnancy, uterine & ovarian pathology, snow storm appearance, foetal heart pulsation
MSU

Question 2

DDx?

Answer 2

Gynaecological:
Miscarriage, ectopic pregnancy, molar pregnancy, ovarian cyst torsion

Non-gynaecological:
Acute appendicitis, trauma, acute UTI

Question 3

Ultrasound report shows adnexal mass and presence of free fluid. Diagnosis and management?

Answer 3

DDx: ruptured ectopic pregnancy

Immediate mx:
Vitals and resuscitation with IV access
Admit
Give analgesics and antibiotics prophylaxis

Prepare for OT:
Take consent for OT
Ix: LRFT, CRC, T/S, Xmatch, clotting, ECG, CXR
Prepare EOT and inform senior
Emergency salpingectomy

Post-op
Monitor bHCG
Counsel for contraception to avoid IUCD, POP; refrain from coitus until bHCG normalise
Risk of recurrence 10%, early AN care and USG
CS in future, risk of scar rupture

Question 4

Picture of laparoscopy: Cornual ectopic pregnancy.

Answer 4

Need to convert to laparotomy
Wedge resection of corner of uterus / cornuostomy + salpingectomy

(resect close to edge without cutting mesosalpinx, so ovarian blood supply not affected and ovarian reserve not affected; cut close to cornual region of uterus to prevent stump ectopic)