Gynaecology - Ectopic Pregnancy

Question 1

What is an ectopic pregnancy?

Answer 1

• When the embryo implants outside the uterus
• Embryo may implant in the abdomen, more often is a tubal pregnancy
• most commonly located in the ampulla region of fallopian tube

Question 2

Ectopic pregnancy?

Causes?

Answer 2

Narrowing or damage to the fallopian tube

Remember TIPS

• T - Progesterone only pill (thickened secretions
• I - Infection and IVF treatment
• P - Pelvic Inflammatory disease
• S - Surgical procedures (adhesions)

Question 3

Ectopic pregnancy?

Symptoms?

Answer 3

• Abdominal pain- usually in the lower right/left quadrant
• Vaginal bleeding - dark (prune juice)
• Nausea and vomiting
• Signs of shock: clammy appearance, pale, tachychardic, hypotensive
• Vaginal exam - cervical excitation

Question 4

Ectopic pregnancy?

Investigations?

Answer 4

Pregnancy test and B-hCG levels

Blood tests: FBC, U&Es, group and save

Radiology: transvaginal USS

Question 5

Ectopic pregnancy?

Treatment?

Answer 5

Emergencey Treatment:

• ABCDE approach, insertion of two wide bore cannulas
• Bloods - cross match and blood transfusion
• Consider anti D prophylaxis

Medical:

• Methotrexate

Surgical:

• Laparoscopic salpingotomy/salpingectomy
  
  • Tubal ectopic pregnancy can be surgically treated by salpingectomy, in which the affected Fallopian tube is removed, or salpingotomy, in which the tube is preserved.
• If this fails consider Laparotomy

Question 6

Ectopic pregnancy?

Complications?

Answer 6

Remember Tube:

T - tubal rupture

U - sUb fertility

B - Blues (psychological implications

E - Ectopic preganancy riskfor further pregnancies