Ectopic Pregnancy

 
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    Ectopic Pregnancy
    Dr Swapnil Pawar

Ectopic Pregnancy

Written by Dr Ashley Liu

Ectopic Pregnancy

Ectopic pregnancies should always be considered in any patient of reproductive age with vaginal bleeding +/- abdominal pain.

Clinical Manifestation

The most common presentation of ectopic pregnancy is usually first-trimester vaginal bleeding and/or abdominal pain. This may be associated with normal pregnancy discomforts (breast tenderness, frequent urination, nausea).

Vaginal bleeding: varied but usually preceded by a period of amenorrhoea.

Abdominal pain: varied but may be diffuse or localised and usually localised in the pelvis. Sudden onset of pain may be associated with tubal rupture. Shoulder pain may be associated with bleeding irritating the diaphragm.

It is also important to remember ectopic pregnancies may also present asymptomatically.

Risk Factors

  • Previous ectopic pregnancy
  • Prior tubal pathology
  • Previous surgery (e.g. pelvic inflammatory disease, tubal ligation)
  • Current use of IUD or IVF

Note>50% of patients do not have an identifiable risk factor for pregnancy.

Diagnostic criteria

B-Hcg + Transvaginal/Transabdominal US

  • B-Hcg > 1500 – Should be able to see gestational sac on US
  • B-Hcg < 1500 – Continue serial monitoring 48h. If it continues to rise/plateau, it would be concerning for an ectopic pregnancy

Management

Conservative

If stable, B-hcg <1500

Monitor serum B-hcg every 48 hours until it reaches 0
Medical

If compliant, B-hcg <5000, mass < 3.5cm, no fetal heart rate

IM Methotrexate (single dose or more)

  • Measure B-Hcg on Day 4 or Day 7 for 15% drop in B-Hcg
  • Monitor serum B-hcg until it reaches 0

Contraindicated in renal/hepatic failure, breastfeeding, immunodeficiency, peptic ulcer disease

Surgical

If medical management is contraindicated, poor compliance, B-hcg >5000, mass >3.5cm present fetal heart rate

Salpingectomy

  • More commonly performed

Salpingotomy

  • 10% recurrence
  • Indicated if only one tube left

Sources:

UpToDate “Ectopic Pregnancy: Clinical manifestations and diagnosis”: https://www.uptodate.com.acs.hcn.com.au/contents/ectopic-pregnancy-clinical-manifestations-and-diagnosis?search=ectopic%20pregnancy&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H2251071846

UpToDate “Ectopic pregnancy: Choosing a treatment”: https://www.uptodate.com.acs.hcn.com.au/contents/ectopic-pregnancy-choosing-a-treatment?search=ectopic%20pregnancy&source=search_result&selectedTitle=3~150&usage_type=default&display_rank=3

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