Ectopic pregnancy

• What are the risk factors of ectopic pregnancy?

  Previous ectopic

  Previous pelvic inflammatory disease

  Smoking

  Older age

  Previous surgery on fallopian tubes

  Intrauterine devices
• How many weeks gestation would you expect to see a patient present with ectopic pregnancy?

  6-8 weeks
• What would dizziness and syncope represent in a suspected ectopic pregnancy patient?

  Blood loss
• What would shoulder tip pain represent in a suspected ectopic pregnancy patient?

  Peritonitis
• What is a clinical sign you would find on bimanual examination in ectopic pregnancy?

  Cervical motion tenderness
• What two criteria have to be met for a pregnancy of unknown location?

  1. Positive pregnancy test
  2. No evidence of pregnancy on USS
• When do you measure hCG once you have a baseline reading?

  48 hours later
• In an intrauterine pregnancy, how would you expect the hCG level to do after 48 hours?

  Double atleast
• In intrauterine pregnancy - hCG rise of >63% after 48h

  In ectopic pregnancy - hCG rise of <63% after 48h

  Miscarriage - Fall of >50% after 48h
• 3 options for managing ectopic pregnancy?

  1. Expectant management
  2. Medical management
  3. Surgical management
• What is the criteria which needs to be met in order to undergo expectant management?

  Follow up needs to be possible

  Unruptured ectopic

  Adnexal mass <35mm

  No visible heartbeat

  No significant pain

  hCG <1500IU/L
• What criteria needs to be met for medical management with methotrexate?

  hCG <5000IU/L

  Confirmed absence of intrauterine pregnancy on USS
• What criteria needs to be met for the patient to undergo surgical management in ectopic pregnancy?

  Pain

  Adnexal mass >35mm

  Visible heartbeat

  hCG >5000IU/L
• What advice needs to be given to patients once they are given methotrexate?

  Do not get pregnant for 3 months following MTX treatment, teratogenic.
• What are the side effects of medical management with methotrexate?

  Vaginal bleeding

  Nausea and vomiting

  Abdominal pain

  Stomatitis
• How is methotrexate given in ectopic pregnancy management?

  Intramuscularly to the buttock
• What is given to rhesus negative women having surgical management for ectopic pregancy?

  Anti-rhesus D prophylaxis