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Obs & Gynae > Pregnancy of Unknown Location > Flashcards

Flashcards in Pregnancy of Unknown Location Deck (12):
1

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

2

What are the possible explanations for PUL?

Early intrauterine pregnancy
Failing PUL (early intrauterine or ectopic pregnancies which will fail)
Early ectopic pregnancy
Complete miscarriage
hCG secreting tumour

3

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)

4

At what rate do hCG levels usually increase in weeks 4-8 in pregnancy?

Levels will usually double every 72 hours.
OR
66% rise over 48h

5

What could be the cause if hCG is not increasing at the rate it should be?

Suggestive of ectopic pregnancy

6

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

7

Define ectopic pregnancy?

When the embryo implants outside the uterine cavity

8

What is the most common implantation sites in ectopic pregnancies?

Tubes (95%)

9

What is the classical presentation of an ectopic pregnancy?

8 week amenorrhoea followed by mild lower abdominal pain.

Vaginal bleeding.

Referred shoulder tip pain (diaphragmatic irritation form haemoperitoneum)

Collapse

10

How should you initially manage a stable patient with a suspected ectopic pregnancy?

Initial management:
-IV access
-X match
-Anti D to be given if patient is rhesus negative and not already sensitised
-Nil by mouth

11

What are the treatment options in a stable patient with suspected ectopic pregnancy?

Medical:
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.

Surgical:
-Laparoscopic salpingostomy (remove ectopic but not tube)
OR
-Laparoscopic salpingectomy (remove whole tube)
If other tube is normal fertility rates are similar.

12

What is the management of an unstable patient with a suspected ectopic pregnancy?

ABC resus

Surgery:
Laparoscopic salpingectomy (if operator is experienced)
OR
Laparotomy with salpingectomy