Flashcards in Pregnancy of Unknown Location Deck (12):
What is pregnancy of unknown location (PUL)?
When there is no sign of intrauterine pregnancy, ectopic pregnancy of retained products in the presence of a positive pregnancy test
What are the possible explanations for PUL?
Early intrauterine pregnancy
Failing PUL (early intrauterine or ectopic pregnancies which will fail)
Early ectopic pregnancy
hCG secreting tumour
In which scenarios are you more lily to have higher hCG levels?
Multiple pregnancies (high hCG even before pregnancy can be visualised)
Molar pregnancies (very high hCG levels)
At what rate do hCG levels usually increase in weeks 4-8 in pregnancy?
Levels will usually double every 72 hours.
66% rise over 48h
What could be the cause if hCG is not increasing at the rate it should be?
Suggestive of ectopic pregnancy
Which markers are suggestive of a failing PUL?
If hCG levels are not increasing at the correct rate/ are falling.
If progesterone is less than 20nmol/L
Define ectopic pregnancy?
When the embryo implants outside the uterine cavity
What is the most common implantation sites in ectopic pregnancies?
What is the classical presentation of an ectopic pregnancy?
8 week amenorrhoea followed by mild lower abdominal pain.
Referred shoulder tip pain (diaphragmatic irritation form haemoperitoneum)
How should you initially manage a stable patient with a suspected ectopic pregnancy?
-Anti D to be given if patient is rhesus negative and not already sensitised
-Nil by mouth
What are the treatment options in a stable patient with suspected ectopic pregnancy?
Only if ectopic is enruptured has no cardiac activity and has hCG levels less than 1500IU/ml.
Single dose of methotrexate. Requires follow up hCG levels. 15% of women will need a 2nd dose and 10% will require surgery.
-Laparoscopic salpingostomy (remove ectopic but not tube)
-Laparoscopic salpingectomy (remove whole tube)
If other tube is normal fertility rates are similar.