ectopic pregnancy
| Headline | |
|---|---|
| Etiology | >95% in fallopian tube, of which 75% in ampulla |
| Epidemiology | Risk factors: ↑ age, previous tubal pathology, endometriosis, IUCD, smoking |
| Clinical presentation | lower abdo pain - due to tubal spasm peritoneal bleeding → shoulder tip pain or pain on defaecation |
| Pathogenesis | major haemorrhage - peritoneal irritation |
| Investigations: | quantitative bHCG TVUS if bHCG is > 1200 and there is no intrauterine pregnancy = probable ectopic |
management
| Management | Patient criteria |
|---|---|
| Expectant management | Suitable for patient who is clinically stable and pain free. Active intervention reconsidered if symptoms worsen or if βhCG levels fail to fall at an acceptable rate |
| Medical management | Parenteral methotrexate used It is offered first line to women who are and able to return for follow up and have all of the following: - No significant pain - An unruptured ectopic pregnancy with an adnexal mass <35 mm with no visible heartbeat - Serum hCG level <1500 IU/L - No intrauterine pregnancy (confirmed by ultrasound scan) |
| Surgery | Salpingectomy or salpingotomy (laparoscopically or open surgery) It is offered first line to women who are: - Unable to return for follow up after methotrexate treatment or Have an ectopic pregnancy and any of the following: - Significant pain - Adnexal mass ≥ 35 mm - Fetal heartbeat visible on an ultrasound scan - Serum hCG level >5000 IU/L or more |