Ectopic pregnancy Flashcards
Ectopic pregnancy
Implantation of a fertilised ovum outside of the uterus
Features
6-8 weeks amenorrhoea
Lower abdo pain (typically first syptom)
Vaginal bleeding
Peritoneal bleeding can cause shoulder tip pain and pain on defecation/ urination
Symptoms of pregnancy (breast tenderness)
Examination findings
Abdominal tenderness
Cervical tenderness
Adnexal mass (don’t exam due to risk of rupturing pregnancy)
Risk factors
Damage to tubes (PID, surgery)
Previous ectopic
Endometriosis
IUCD
Progesterone only pill
IVF
Most common place
Ampulla
(more dangerous if isthmus)
Investigations
Pregnancy test
Transvaginal US
Criteria for expectant management
Size <35mm
Unruptured
Asymptomatic
No fetal heartbeat
hCG <1000IU/L
Compatible if another intrauterine pregnancy
Medical management criteria
Size <35mm
Unruptured
No significant pain
No fetal heartbeat
hCG<1500IU/L
Not suitable if intrauterine pregnancy
Surgical management criteria
Size >35mm
Can be ruptured
Pain
Visible heartbeat
hCG >5000IU/L
Compatible with another intrauterine pregnancy
Expectant management
Closely monitor over 48hours and if B-hCG rise again or symptoms manifest then intervention is performed
Medical management
Methotrexate
Need to attend follow up
Surgical management
Salpingectomy: first-line for women with no other risk factors for infertility
Salpingotomy: considered for women with risk factors for infertility
