Ectopic pregnancy

Question 1

Where do most ectopic pregnancies commonly occur?

Answer 1

Ampulla

Question 2

Which location for an ectopic pregnancy is most dangerous?

Answer 2

Isthmus - high risk of rupture

Question 3

What is the typical presentation of an ectopic pregnancy?

Answer 3

• Lower abdo pain
• Vaginal bleeding
• History of recent amenorrhoea
• Bleeding into the peritoneum can cause shoulder tip pain, and pain on defecation/urination
• Dizziness, fainting, syncope

Question 4

What examination findings point towards a diagnosis of ectopic pregnancy?

Answer 4

• Abdominal tenderness
• Cervical excitation
• Adnexal mass –> do not examine for an adnexal mass as it increases risk of rupture

Question 5

In the case of pregnancy of unknown location, what level of serum bHCG points towards a diagnosis of ectopic pregnancy?

Answer 5

> 1,500

Question 6

What are the risk factors for ectopic pregnancy?

Answer 6

• Damage to ‘tubes’ (PID, surgery)
• Previous ectopic
• Endometriosis
• IUD/IUS
• POP
• IVF (3% of pregnancies)

Question 7

How should a woman who is haemodynamically stable with an expected ectopic pregnancy be investigated?

Answer 7

Refer to early pregnancy assessment unit for urine b-HCG and TVUS

Question 8

How should a woman who is not haemodynamically stable with an expected ectopic pregnancy be investigated?

Answer 8

Referred to ED

Question 9

What is the investigation of choice for suspected ectopic pregnancy?

Answer 9

TVUS

Question 10

What are the indications for expectant management of an ectopic pregnancy?

Answer 10

• Size <35mm
• Unruptured
• Asymptomatic
• No foetal heartbeat
• hCG <1000 IU/L

Question 11

What does expectant management of an ectopic pregnancy involve?

Answer 11

• Closely monitor patient over 48h

- Intervene if b-hCG rises or symptoms develop

Question 12

What are the indications for medical management of an ectopic pregnancy?

Answer 12

• Size <35mm
• Unruptured
• No significant pain
• No foetal heartbeat
• hCG <1,500 IU/L

Question 13

What does medical management of an ectopic pregnancy involve?

Answer 13

• Methotrexate

- Can only be done if patient is willing to attend follow-up

Question 14

What are the indications for surgical management of an ectopic pregnancy?

Answer 14

• Size >35mm
• Can be ruptured
• Pain
• Visible foetal heartbeat
• hCG >5,000 IU

Question 15

What does surgical management of an ectopic pregnancy involve?

Answer 15

• Salpingectomy or salpingotomy

- Anti-D prophylaxis to all women receiving surgical management