Early Pregnancy Complications

Question 1

Define cervical incompetence

Answer 1

weakness of the cervix leading to 2nd/3rd trimester miscarriage

Question 1

Common site for ectopic pregnancy

Answer 1

Ampulla of the fallopian tube

93%

Question 2

Define ectopic pregnancy

Answer 2

fertilised ovum implants outside the uterus

Question 3

ectopic pregnancy risk factors

Answer 3

• Prev ectopic pregnancy
• IVF
• pelvic inflammatory disease (PID)
• endometriosis
• tubal occlusion (sterilisation)
• intrauterine contraception (IUD)
• age > 35

Question 4

ectopic pregnancy common Sx

Answer 4

• Unilateral abdominal pain - sharp, stabbing
• pelvic pain
• amenorrhoea
• vaginal bleeding

commonly only w/abdo pain

Question 5

ectopic pregnancy clinical findings

Answer 5

• Pelvic or abdominal tenderness
• Adnexal tenderness
• Vaginal bleeding
• Haemodynamic compromise: if rupture and haemorrhage

Question 6

Ectopic pregnancy Ix

Answer 6

1. Pregnancy test
2. TVUS - diagnostic imaging (MRI is used when TVUS in inconclusive)

Question 7

For women minimal or no symptoms

Ectopic pregnancy expectant Mx criteria

Answer 7

• less than 6 weeks’ gestation
• Pain-free
• Haemodynamically stable
• Tubal ectopic pregnancy visible on TVUS measuring < 35 mm (and no visible heartbeat)
• Serum hCG < 1,000 IU/L
• Able to return for follow-up
  Repeat Pregnancy test in 7-10 days to confirm miscarriage

Question 8

Ectopic pregnancy medical Mx (Methotrexate) criteria

progesterone antagonist

Answer 8

• No significant pain
• Unruptured ectopic pregnancy with an adnexal mass No significant pain
• Unruptured ectopic pregnancy with an adnexal mass < 35 mm and no visible heartbeat)
• No intrauterine pregnancy is seen on the ultrasound scan: some women may have a heterotopic pregnancy where an intrauterine pregnancy occurs alongside an ectopic pregnancy
• Serum hCG < 1500 IU/L
• Able to return for follow-up
  Follow-up to confirm hCG level decreasing**

Question 9

Ectopic pregnancy in primary care

Answer 9

Refer stat to the early pregnancy assessment unit (EPAU)

Question 10

Ectopic pregnancy surgical Salpingectomy or salpingotomy Mx

Answer 10

• unable to return for follow up after methotrexate treatment
• Significant pain
• Adnexal mass of > 35 mm
• Fetal heartbeat visible on an ultrasound scan.
• Serum hCG level of > 5000 IU/L
  Follow-up to confirm hCG level decreasing