Pregnancy of unknown location Flashcards
Define ectopic pregnancy.
Ectopic pregnancy typically presents 6 to 8 weeks after the last normal menstrual period, but can present earlier or later.
What is the aetiology of ectopic pregnancy?
A fertilised ovum implanting and maturing outside of the uterine endometrial cavity, with the most common site being the fallopian tube (97%), followed by the ovary (3.2%) and the abdomen (1.3%).
What are the risk factors for ectopic pregnancy?
Previous ectopic pregnancy
Previous tubal sterilisation surgery
In utero diethylstilbestrol exposure of the mother
Intrauterine device (IUD) use
Previous genital infections
Chronic salpingitis
Salpingitis isthmica nodosa
Infertility
Multiple sexual partners
Summarise the epidemiology for ectopic pregnancy.
1 in 80-100 pregnancies
What are the signs and symptoms of ectopic pregnancy?
Abdominal pain
Amenorrhoea
Vaginal bleeding
Abdominal tenderness
Adnexal tenderness or mass
Blood in vaginal vault
What investigations should be performed for ectopic pregnancy?
Urine or serum pregnancy test
High resolution transvaginal ultrasound (TVUS)
Transabdominal ultrasound
Serial serum human chorionic gonadotrophin (hCG) - hCG should double with each day, with ectopic pregnancy, hCG will increase but not double every day
Uterine aspiration
What is the management for ectopic pregnancy?
Surgery - Removal of fallopian tube if it is the site of implantation
Post-surgical methotrexate
Anti-D immunoglobulin
Haemodynamically unstable
Fluid resuscitation
What are complications associated with ectopic pregnancy? What is the prognosis of ectopic pregnancy?
Adverse effects associated with methotrexate therapy
Persistent trophoblast
Damage to surrounding organs or vasculature resulting from surgical intervention
Recurrent ectopic pregnancy
With proper patient selection, expectant, medical, and surgical treatments are 82%, 90%, and 92% successful, respectively.
