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Ectopic Pregnancy

Ectopic pregnancy occurs when a fertilized egg implants outside the uterus, usually (98% of cases) in the fallopian tubes. Without treatment it can cause life-threatening bleeding. Risk factors include prior ectopic pregnancy, pelvic inflammatory disease, assisted reproduction, IUD use, and tubal or pelvic surgery. Patients often present with abdominal pain and vaginal bleeding 6-8 weeks into a missed period. Diagnosis involves serial HCG tests, transvaginal ultrasound to locate the pregnancy, and sometimes laparoscopy. Treatment depends on hemodynamic stability but may include expectant management if HCG is low, methotrexate injection, or laparoscopic surgery to remove or open the fallop

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عبد الله الحربي
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138 views2 pages

Ectopic Pregnancy

Ectopic pregnancy occurs when a fertilized egg implants outside the uterus, usually (98% of cases) in the fallopian tubes. Without treatment it can cause life-threatening bleeding. Risk factors include prior ectopic pregnancy, pelvic inflammatory disease, assisted reproduction, IUD use, and tubal or pelvic surgery. Patients often present with abdominal pain and vaginal bleeding 6-8 weeks into a missed period. Diagnosis involves serial HCG tests, transvaginal ultrasound to locate the pregnancy, and sometimes laparoscopy. Treatment depends on hemodynamic stability but may include expectant management if HCG is low, methotrexate injection, or laparoscopic surgery to remove or open the fallop

Uploaded by

عبد الله الحربي
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 PDF, TXT or read online on Scribd
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Ectopic Pregnancy

• Definition:
Presence of conceptus outside of the uterus. It’s an emergency because it could cause
massive Obstetric bleeding. (most commonly > intraperitoneal bleeding that you wouldn’t
know about)
Incidence: 1-2%

• Site:
1- Most common site: Tubal pregnancy 98% (ampullary is the most common part of the
tube).
2- Most dangerous site: cervical or interstitial part of the tube because it’s very vascular
and very difficult to deal with. (sometimes you’d have to do hysterectomy)
3- Others: isthmic, fimbrial, ovarian, broad ligament, abdominal (rare).

• Risk factors/etiology:
1- 50% idiopathic
2- Hx of ectopic pregnancy (20% risk)
3- Hx of PID. (specially chlamydia or gonorrhea)
4- ART: assistive reproductive technology like IVF, ICSI (intracytoplasmic sperm injection),
GIFT, ZIFT.
5- Anything that would decrease tubal motility like: smoking, progesterone P4 like the one
in Plan B.
6- IUD in situ specially cupper
7- Any kind of tubal or pelvic surgery
8- Endometriosis

• Presentation:
1- Classical triad: 1- Amenorrhea 6-8wks
2- Unilateral pelvic pain
3- Spotting (decidual bleeding of thick endometrium)

2- Could present with rt shoulder pain: if there was bleeding inside, the endometrium
will irritate the peritoneum and diaphragm > radiating pain
3- N/V, Diarrhea
4- Collapse > in case of rupture ectopic > emergency

• Examination:
1- Vital signs: BP, temp, HR > make sure it’s afebrile, vital signs stable (AFSS)
2- Abdominal examination: lower abdomen tenderness, or guarding rigidity, cullen’s
sign, grey-turner sign in case of ruptured ectopic due to peritonitis.
3- Sterile speculum examination: like any case of Obgyn with bleeding to exclude local
causes (Contraindicated in placenta previa)
4- Bimanual examination: cervical motion tenderness, or adnexal tenderness
• Investigation:
1- Serial serum HCG: → To confirm pregnancy
→ Check pattern of raise: -> Doubling every 2-3 days? -> normal
→ Not doubling /slowly increasing (suboptimal)? -> Abnormal
2- Transvaginal sonogram TVS: Location of gestational sac? intrauterine or extrauterine
So if you have HCG >1500 mIU and you did TVS
→ you would find an intrauterine gestational sac in a normal pregnancy
→ if you find an empty uterus -> 95% ectopic pregnancy
→ if you don’t have TVS and only transabdominal sonogram the level of HCG has to be 6000

3- MRI (safe in pregnancy) but not usually needed


4- Cludocentesis > of you get blood or pus in the needle from the pouch of Douglas >
intraabdominal bleeding
5- Gold standard: laparoscopy invasive so we depend on HCG and US but can be diagnostic
and therapeutic

• Management:

Hemodynamically unstable Hemodynamically stable

• Loss of consciousness, increased HR, • Expectant: if HCG <3000-6000 mIU


hypotension, pale, cold clammy 1- Measure HCG every 2-3days
peripheries. → emergency → if it’s decreasing pregnancy is failing
(Hypovolemic hemorrhagic shock) it will go away by its own just put her
• Resuscitation /ABCs under monitoring
• Call for help! Airway, breathing, insert
two IV lines: • Medical: if HCG is low3000 -6000
→ one for cross match and 6 blood and gestational size <3.5 cm
units and stable pt
→ one for IV fluids → you can use IM methotrexate MTX
• Take pt for laparotomy (She doesn’t (it’s anti-folic acid)
need to be fasting > emergency) → After MTX check HCG every 1wk until
• Do a salpingectomy it reaches < 10 mIU
→Side effects of MTX: conjunctivitis,
stomatitis, GI upset

• Laparoscopy:
→ salpingectomy
→ Salpingostomy: has risk of another
ectopic

• Give Rhogam (anti-D) IM like any case of RH-ve mother with pregnancy

Rand Alazzaz
Source: Wessam Khalfallah Youtube channel

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