ectopic pregnancy Flashcards
what is an ectopic pregnancy?
implantation of fertilised ovum outside the uterus
what is a typical hx for an ectopic pregnancy?
female with a hx of 6-8 weeks amenorrhoea presents with lower abdo pain and later develops vaginal bleeding
what can cause shoulder tip pain and pain on defecation/urination?
peritoneal bleeding
what other features can be present in ectopic pregnancy?
- dizziness, fainting, syncope
- sx of pregnancy: breast tenderness
what are the examination findings for ectopic pregnancy?
- abdominal tenderness
- cervical excitation
- adnexal mass (DONT examine for this due to increased risk of rupturing the pregnancy)
what points towards a dx of an ectopic pregnancy in the case of pregnancy of unknown location?
serum bHCG levels >1500
how do you investigate for ectopic pregnancy?
- +ve pregnancy test
- transvaginal ultrasound
how is an ectopic pregnancy managed?
- expectant
- medical
- surgical
what is the expectant management (watchful waiting) for ectopic pregnancy?
rarely a suitable option
can only be performed for:
1) an unruptured embryo
2) <35mm in size
3) no heartbeat
4) asx
5) BhCG level <1000 and declining
what is the medical management for ectopic pregnancy?
methotrexate + pt follow up!
what is the surgical management for ectopic pregnancy?
salpingectomy / salpingotomy
where is the most common location for tubal ectopic pregnancy?
ampulla of fallopian tube
what are risk factors for ectopic pregnancy?
anything that slows the ovum’s passage to the uterus
- damage to the tubes (PID, surgery)
- previous ectopic
- endometriosis
- IUCD
- POP
- IVF (3%)
presence of a foetal heartbeat on ultrasound in the context of an ectopic pregnancy is an indication for?
surgical mx
what are the contraindications to medical mx?
- ruptured ectopic pregnancies
- pregnancies with a foetus measuring >35mm
