Ectopic pregnancy

Question 1

ectopic pregnancy

Answer 1

pregnancy has been implanted outside the uterine cavity

• caused by conditions that damage the uterine tubes or ciliary linings thus hindering the passage of the fertilised egg towards uterine cavity

Question 2

causes of ectopic pregnancy (7)

Answer 2

1. PID
2. Tubal surgery : sterilisation/reversal of sterilisation/previous ectopic preg
3. Pelvic surgery : peritonitis/appendicitis
4. IUCD (coil)
5. IVF
6. Endometriosis
7. progesterone only pill

Question 3

symptoms of ectopic pregnancy

Answer 3

1. abdominal / pelvic pain and tenderness
2. amenorrhea / missed period
3. vaginal bleeding ( with/without clots )
4. Gastrointestinal symp : diarrhoea/vomitting

Question 4

Clinical evaluation of ectopic pregnancy

Answer 4

1. ensure patient is haemodynamically stable/resus
2. Transvaginal ultrasound is a diagnostic tool of choice for a suspected ectopic pregnancy
3. uterus is empty or mass at adnexae
4. laproscopy to confirm diagnosis of ectopic pregnancy
5. empty uterus - also means v early gestation pregnancy
6. two B-hCG blood test 48 hours apart - if pregnancy is viable then BHCG levels double /ectopic - will plateau/rise//miscarriage - fall significantly

Question 5

Treatment of tubal surgery

Answer 5

1. surgical management - performed laproscopically or via laparotomy
2. Saplingectomy - affected tube or part of it is removed if ectopic has ruptured
3. Saplingotomy - incision is made over the ectopic which is removed and tube is allowed to heal
4. ‘Milking’ the tube
   if ectopic is near the ampulla , it is possible to squeeze it out of the end of the tube

Question 6

laparoscopy vs laprotomy

Answer 6

1. laprotomy - surgical incision into the abdominal cavity for diagnosis/prep for further invest
2. laproscopy - key hole surgery within abdomen/pelvis. Used for diagnosis/surgery.

Question 7

Medical treatment

Answer 7

1. chosen for asymptomatic patients if pregnancy is small and if tube is intact + non ruptured + no heartbeat
2. Methotrexate ( cytotoxic drug)
   - given IM or injected directly into ectopic pregnancy

Question 8

Prognosis after ectopic pregnancy

Answer 8

1. increases risk of future ectopic pregnancies

2. increased risk of tubal scarring