OGCO-E22 Management of suspected ectopic pregnancy

Question 1

What is the flowchart for management of suspected ectopic pregnancy?

Answer 1

Question 2

How to monitor expectant management of tubal pregnancy?

Answer 2

Repeat hCG levels on Days 2, 4 and 7 after original test and:
If hCG levels drop by 15% or more from the previous value on days 2, 4 and 7, then repeat weekly until a negative result (less than 20 IU/L) is obtained or
If hCG levels do not fall by 15%, stay the same or rise from the previous value, review the woman’s clinical condition and seek senior advice to help decide further management.

Question 3

What is the indications for medical management of tubal pregnancy?
What is the regimen?

Answer 3

methotrexate indicated in selected cases without laparoscopy when
* Patient is able to return for follow up
* Patient does not have significant abd pain
* Patient has an unruptured ectopic pregnancy with an adnexal mass smaller than 35mm with no visible heart beat
* There is no intrauterine pregnancy (as confirmed on an ultrasound scan)

Regime: single dose of methotrexate 50mg IMI

Question 4

What is the Mx for tubal pregnancy undergoing medical Mx?

Answer 4

Question 5

What are the indications for surgical intervention in tubal pregnancy?

Answer 5

• Clinical evidence of intra-abdominal bleeding (e.g. severe abdominal pain and/or significant drop in Hgb)
• Increase in size of the ectopic pregnancy, especially if there is fetal cardiac activity seen
• Patient refuses further treatment using MTx

Question 6

What is the counselling done for medical Mx of tubal pregnancy?

Answer 6

• Advise patient to avoid sexual intercourse, sunlight exposure and strenuous exercise during treatment.
• Advise patient to avoid alcohol, vitamin preparations containing folic acid and non-steroidal anti-inflammatory drugs (NSAIDs) during treatment.
• Advise patients about side effects of treatment. Lower abdominal pain 3-7 days after treatment is common (75%). Other less common effects include nausea, diarrhoea, oral ulcers and dryness which usually resolve within 4 weeks.
• Contraception will be required for at least 3 months after completion of treatment.
• Patient has to be informed that she has to go to hospital if she experiences increased abdominal pain and/or other evidences if internal bleeding i.e. fainting attack, fast
  pulse rate etc.