Describe the pathophysiology of ectopic pregnancy
Implantation of a fertilised ovum outside of the uterus
Give some risk factors for ectopic pregnancy
- Previous ectopic pregnancy
- Previous pelvic inflammatory disease
- IUD
What is the most common anatomical location of an ectopic pregnancy?
Ampulla of fallopian tube
When does an ectopic pregnancy usually present?
6-8 weeks
Give 2 symptoms and 2 signs which may be present in ectopic pregnancy
Symptoms:
- Acute lower abdo pain
- PV bleeding
Signs:
- Cervical excitation
- Adnexal mass
What is the classical ‘textbook’ sign patients may have in ectopic pregnancy?
Shoulder tip pain (referred pain as a result of peritonitis)
Describe the investigation of ectopic pregnancy
- Pregnancy test (urine and serum bhCG)
- Transvaginal USS
a) What is meant by pregnancy of unknown location (PUL)?
b) How is PUL investigated further?
a) When there is a positive pregnancy test, but no evidence of pregnancy on imaging (US)
c) Serum bhCG is repeated after 48 hours:
- If bhCG doubles = viable pregnancy
- If bhCG halves = miscarriage
- Anything in between = ectopic
Briefly describe the management options available for ectopic pregnancy
- Expectant (awaiting natural termination)
- Medical (IM methotrexate)
- Surgical (salpingectomy vs. salpingotomy)
What are the criteria for expectant management of ectopic pregnancy?
- Ectopic unruptured
- Adnexal mass < 35mm
- No visible heartbeat
- No pain
- HCG < 1000
What are the criteria for medical management of ectopic pregnancy?
- Ectopic unruptured
- Adnexal mass < 35mm
- No visible heartbeat
- No significant pain
What advice is given to women about future pregnancy following medical management of an ectopic pregnancy?
Women are advised not to get pregnant for 3 months following treatment due to the harmful effects of methotrexate
What are the criteria for surgical management of an ectopic pregnancy?
Any of the following:
- Ruptured ectopic
- Adnexal mass > 35mm
- Visible heartbeat
- Significant pain
- HCG > 5000
Why would a salpingotomy be performed instead of a salpingectomy?
- Salpingectomy is usually first line surgical management
- However, a salpingotomy may be performed instead if the woman has a history of increased risk of infertility, e.g. contralateral fallopian tube damage
Anti-rhesus D prophylaxis is given to rhesus negative women having surgical management of ectopic pregnancy. True or false?
True
