Differential for sudden onset LIF pain
Ectopic, early intrauterine pregnancy with corpus luteum pain, miscarriage, ovarian cyst rupture or haemorrhage, PID
Acute appendicitis, ureteric stone, diverticulitis
Qs for suspected ectopic history and why is there rebound tenderness/guarding
Previous ectopics, miscarriages, fertility treatments, Hx of PID or STD. Smoking
Peritoneal irritation due to free blood
LIF pain : Investigations, 2 blood and 2 others
Blood tests
- b-hcg, FBC (infection/anaemia), Blood group and Rhesus status (anti-D immunoglobulin), Clotting profile
TVUS - absence of sac, adnexal mass/tubal ring sign, free fluid in pouch of Douglas
Doppler ultrasonography
Urinalysis - rule out UTI or confirm pregnancy
Ectopic : Risk factors
Older, Previous ECP, IUD, Smoking (impairs ciliary function), Previous pelvic surgery (adhesions affect tubal motility), PID (F-tube lining), IVF, Endo
Immediate management of heavy vaginal bleeding and positive pregnancy test
IV access with two large-bore cannulae
Fluid resus with crystalloids
Check vitals
Ectopic: Indications for Surgical management
> 35mm, significant pain, visible heartbeat, other IU pregnancy, hCG> 5,000IU/L
