Ectopic Pregnancy

Question 1

What is an ectopic pregnancy?

Answer 1

When a fertilised egg implants outside of the uterus. (Usually fallopian tube)

Question 2

Can an ectopic pregnancy come to full term? (2)

Answer 2

1) Fetal development can’t occur outside the womb.

2) Ectopic Pregnancy is a huge risk to mother’s health.

Question 3

How common is an ectopic pregnancy?

Answer 3

1 in 90 women.

Question 4

What are the risk factors for ectopic pregnancy? (5)

Answer 4

• Previous ectopic pregnancy
• Previous tubal surgery
• Pelvic inflammatory disease
• Assisted conception (i.e. IVF)
• Smoking

Question 5

Where is an ectopic pregnancy most likely to occur?

Answer 5

Tubal (95-97%)

Ampullary - Most common
Isthmus - 2nd most common

Question 6

Where else can an ectopic pregnancy occur outwith tubal? (4)

Answer 6

Interstitial / Cornual - Rarest
Ovary
Fimbria (only theoretically)
Cervix

Question 7

What is the primary presentation of Ectopic pregnancy? (2)

Answer 7

Period of Ammenorhoea

• Missed Period
• Positive urine pregnancy test

Question 8

What supportive symptoms may present with ectopic pregnancy? (5)

Answer 8

• Vaginal Bleeding (or brown discharge)
• Abdominal pain
• Tip of the shoulder pain (coincides with heavy blood loss)
• GI Symptoms
• Urinary Symptoms

Question 9

What investigations can we conduct when a wahmen presents with symptoms of an ectopic pregnancy?

Answer 9

• Pelvic Examination
• Ultrasound
• Serum BHCG Levels
• Serum Progesterone Levels

Question 10

What do we expect to see in an ultrasound of an ectopic pregnancy?

Answer 10

• No intrauterine gestational sac. (though may see adnexal mass)
• Fluid in Pouch of Douglas

Question 11

How do we manage ectopic pregnancy?

Answer 11

• Methotrexate
• Laparoscopic surgery (salpingectomy)
• Conservative treatment