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Ectopic Pregnancy - Epidemiology - Risk Factors - Diagnostic Tools

An ectopic pregnancy develops outside the uterus, most commonly in the fallopian tubes. It accounts for 2% of reported pregnancies and can be life-threatening if ruptured. Risk factors include previous ectopic pregnancy, fallopian tube damage, smoking, and certain birth controls. Diagnosis involves ultrasound, quantitative HCG levels, and ruling out intrauterine pregnancy. Treatment options are surgery such as laparoscopy or the drug methotrexate, depending on factors like size and stability. Follow up HCG levels are crucial to monitor treatment success and detect potential complications.

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Lana Amerie
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58 views3 pages

Ectopic Pregnancy - Epidemiology - Risk Factors - Diagnostic Tools

An ectopic pregnancy develops outside the uterus, most commonly in the fallopian tubes. It accounts for 2% of reported pregnancies and can be life-threatening if ruptured. Risk factors include previous ectopic pregnancy, fallopian tube damage, smoking, and certain birth controls. Diagnosis involves ultrasound, quantitative HCG levels, and ruling out intrauterine pregnancy. Treatment options are surgery such as laparoscopy or the drug methotrexate, depending on factors like size and stability. Follow up HCG levels are crucial to monitor treatment success and detect potential complications.

Uploaded by

Lana Amerie
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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Ectopic Pregnancy

- a pregnancy that develops anywhere other than the endometrium lining the uterine cavity
Epidemiology
- 2% of all reported pregnancies
- Up to 18% of women presenting to ER with complaints of vaginal bleeding or abdominal
pain
- Sites: Fallopian tube 90%, Abdomen 1%, Cervix 1%, Ovary 1-3%, C-section scar 1-3%,
Interstitial 2-4%
- Ruptured ectopic = 2.7% of all pregnancy-related deaths
- Heterotopic pregnancy: 1 in 4,000 to 1 in 30,000 spontaneous pregnancies 1/100 IVF
pregnancies
Risk Factors
- Previous ectopic (10% risk)
- Damage to fallopian tubes
- PID
- Prior tubal surgery (e.g., tubal ligation with reversal)
- Smoking Age >35
- IUDs?
Diagnostic Tools
- Chief complaint
- History
- Physical exam
- Ultrasound
o FAST exam
o transvaginal
- Serum quantitative HCG, CBC, Rh factor
Diagnostic Criteria
- Ruptured ectopic: positive pregnancy test + free fluid in the pelvis = ruptured ectopic
unless you can rule it out
- Easiest to rule out: intrauterine gestation sac
o Take home message: heterotopic is possible but not really a thing
- Rule in:
o quant HCG >2,000 and nothing in the uterus
o Embryonic heart motion in the adnexa
- Pregnancy of unknown location: everything else
o Ddx: normal early pregnancy, spontaneous abortion, ectopic
- Don’t get too sidetracked by other stuff
o Adnexal mass
o “double decidual reaction”

Pregnancy of unknown location


- Serial HCGs, 48 hours apart. Usually will double Expected rise dependent on initial
value:

- Ultrasound q week

Ectopic pregnancy management


- Surgery: laparoscopy with salpingectomy or salpingostomy
- Methotrexate

Methotrexate
- Mechanism: folate antagonist that affects actively proliferating tissues
- Criteria :
o Unruptured ectopic
o Clinically stable
o Normal liver, kidney, and bone marrow function
o Intrauterine pregnancy ruled out
- Relative contraindications:
o Embryonic cardiac activity
o Ectopic pregnancy mass >4 cm
o Refusal to accept blood transfusion

Methotrexate protocols: 3 diff


Methotrexate 50 mg/m2 day 1
Serum HCG day 1, 4, 7
Treatment success: 15% decrease day 4->7; measure hcg weekly until 0
Can administer second dose day 7 if less than 15% decrease

Ruptured ectopic
- Surgical emergency: Laparoscopy by surgeon preference and patient stability
- Positive pregnancy test and free fluid in the pelvis
o ER FAST exams useful for this
o Unstable patient can have a quick cath urine dipstick HCG
- Don’t be fooled by stable vitals
- CBC, type and screen, get to the OR

Follow-up
- HCG levels MUST be followed to 0, whether surgical or medical management
- Fertility:
o Methotrexate does not appear to affect future fertility.
o Surgical effect depends on procedure. Conflicting evidence of salpingectomy vs.
salpingostomy
- Patient must be counseled about high risk of recurrence with future pregnancy

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