Ectopic pregnancy Flashcards
(27 cards)
What is an ectopic pregnancy?
When a pregnancy is implanted outside of the uterus; the fallopian tube is the most common site. It can also implant in the cornual region, ovary, cervix, or abdomen.
What are the risk factors for ectopic pregnancy?
Previous ectopic pregnancy, surgery to fallopian tubes, pelvic inflammatory disease (PID), intrauterine devices (coils), older age, and smoking.
When does ectopic pregnancy typically present?
6-8 weeks gestation.
What are the classic features of ectopic pregnancy?
Missed period, constant lower abdominal pain in right or left iliac fossa, vaginal bleeding, lower abdominal or pelvic tenderness, and cervical motion tenderness.
What extra symptoms should you ask about in suspected ectopic pregnancy?
Dizziness or syncope (blood loss) and shoulder tip pain (peritonitis).
How is diagnosis of micarriage done?
Transvaginal ultrasound (USS) where a gestational sac containing yolk sac or fetal pole may be seen in a fallopian tube
What is a non-specific mass in the tube with an empty gestational sac called?
‘Blob sign’, ‘bagel sign’, or ‘tubal ring sign’.
How can you differentiate between a tubal ectopic pregnancy and a corpus luteum?
A tubal ectopic pregnancy moves separately from the ovary, while a corpus luteum moves with the ovary.
What other features can indicate an ectopic pregnancy?
- Empty uterus
- fluid in the uterus which may be mistaken as a gestational sac (pseudogestational sac).
What is a PUL?
When a woman has a positive pregnancy test but no evidence of pregnancy on the ultrasound. You can’t exclude an ectopic, and careful follow-up is required.
What can you track over time in suspected ectopic pregnancy?
Serum hCG which is repeated after 48 hours to measure change from baseline.
What does a HCG rise of more than 63% after 48 hours indicate?
An intrauterine pregnancy; a repeat USS is required after 1-2 weeks to confirm.
What does a HCG rise of less than 63% after 48 hours indicate?
An ectopic pregnancy; the patient requires close monitoring and review.
What does a HCG fall of more than 50% after 48 hours indicate?
Indicates miscarriage; a urine pregnancy test should be performed after 2 weeks to confirm miscarriage as complete.
What is more important than hCG level in managing ectopic pregnancy?
Monitoring clinical signs and symptoms, and any change in symptoms needs careful assessment.
What are the 3 options for terminating an ectopic pregnancy?
- Expectant management (awaiting natural termination) 2. Medical management (methotrexate) 3. Surgical management (salpingectomy or salpingotomy).
What is the criteria for expectant management?
Follow-up must be possible, ectopic must be unruptured, adnexal mass < 35mm, no visible heartbeat, no significant pain, and HCG level < 1500 IU/L.
What is the criteria for methotrexate treatment?
HCG level must be < 5000 IU/L and confirmed absence of intrauterine pregnancy on ultrasound.
How is methotrexate termination done?
Methotrexate is given as an IM injection into the buttock, halting the progress of pregnancy and resulting in spontaneous termination.
What are women advised after methotrexate treatment?
Not to get pregnant for 3 months after treatment.
What are common side effects of methotrexate?
Vaginal bleeding, nausea & vomiting, abdominal pain, and stomatitis (inflammation of the mouth).
What criteria is there for surgical management of ectopic pregnancy?
Pain, adnexal mass > 35mm, visible heartbeat, and HCG levels > 5000 IU/L.
What are the 2 options for surgical management?
Laparoscopic salpingectomy and laparoscopic salpingotomy.
What happens in laparoscopic salpingectomy?
First line treatment where keyhole surgery removes the affected fallopian tube.
