PREGNANCY OF UNKNOWN LOCATION

Question 1

Approach to the Critically Ill Pregnancy of Unknown Locations

Answer 1

C -
Treat hypotension and shock with 1-2 L crystalloids

Early transfusion of O-negative blood

Consider massive transfusion protocol

If the patient is Rh(D)-negative:

Rh(D) immunoglobulin 50 μg IM (<13 weeks gestation) as soon as possible and within 72 hours.

There is no harm in giving the more readily available 300 μg IM dose.

Oxytocin IV if non viable pregnancy and ongoing heavy bleeding

STAT REFERRAL TO OBGYN

Question 2

Investigations

Answer 2

CBC
CMP
Blood Type / Rh
Beta HcG

EDE Transabdominal U/S
Transvaginal U/S

Question 3

Beta HCG Findings

Answer 3

Positive within 7-10 days of contraception
Beta HCG should double every 48 hrs
Lowest level Beta HCG an IUP can be visualized is 3000 transabdominally and 1500 transvaginally

Question 4

EDE Transabdominal: Criterial for viable IUP

Answer 4

Yolk sac (double ring) or Fetal Pole with Heart Rate
Gestational Sac
Decidual Reaction

Bladder-Uterine Juxtaposition
Vaginal Uterine Continuity

Adequate myometrial mantle (>/ 8 mm)

HR >/100 = viable

Question 5

Management: Stable

Answer 5

Repeat bHCG / US in 48 hrs

untill IUP or ectopic is found

OR

β-hCG level is above the discriminatory zone and no intrauterine gestation is seen.

OR

if the patient develops signs of ruputure or infection