Flashcards in Ectopic Pregnancy Deck (72)
What is an ectopic pregnancy?
Any pregnancy which is implanted at a site outside of the uterine cavity
What are the most common sites of implantation in ectopic pregnancy?
Ampulla and isthmus of the fallopian tubes
What are the less common sites of implantation in ectopic pregnancy?
- Peritoneal cavity
What is the rate of ectopic pregnancy in the UK?
11 in 1000 pregnancies
What is the mortality rate in ectopic pregnancy?
~ 0.2 per 100
What proportion of ectopic pregnancy mortalities are due to substandard care?
What proportion of women with ectopic pregnancy do not have any known risk factors?
What are some known risk factors for ectopic pregnancy?
- Past medical history factors
- Contraceptive factors
- Iatrogenic factors
What are the past medical history risk factors for ectopic pregnancy?
- Previous ectopic pregnancy
What are the contraceptive risk factors for ectopic pregnancy?
- IUD or IUS
- Progesterone oral contraceptive or implant
- Tubal ligation or occlusion
Why can PID and endometriosis lead to ectopic pregnancy?
Due to adhesion formation
Why can progesterone oral contraceptive or implant lead to ectopic pregnancy?
- Due to fallopian tube ciliary dysmotility
What are the iatrogenic risk factors for ectopic pregnancy?
- Pelvic surgery - especially tubal
- Assisted reproduction
What is an example of a tubal surgery that can lead to higher risk of ectopic pregnancy?
Reversal of sterilisation
What are the most common symptoms of ectopic pregnancy?
- Abdominal pain
- Pelvic pain
- Amenorrhoea or missed period
- Vaginal bleeding with or without clots
- Vaginal discharge
How does discharge in ectopic pregnancy appear?
Brown, and like prune juice
What causes the brown discharge in ectopic pregnancy?
The decidua breaking down
What are some other symptoms of ectopic pregnancy?
- Dizziness, fainting or syncope
- Breast tenderness
- Shoulder tip pain
- Urinary symptoms
- GI symptoms such as diarrhoea and/or vomiting
What may be seen on examination in ectopic pregnancy?
- Localised abdominal tenderness
- Vaginal examination reveals cervical excitation and/or adnexal tenderness
What may be seen in the patient if the ectopic pregnancy has ruptured?
Signs of haemodynamic instability and/or signs of peritonitis
What are some signs of haemodynamic instability?
- Increased CRT
What are signs of peritonitis?
- Rebound tenderness
Why may the amount of vaginal bleeding be misleading in ruptured ectopic pregnancy?
Blood will mostly enter the pelvis and so vaginal bleeding may be minimal
What are the differentials for ectopic pregnancy?
- Ovarian cyst accident
- Acute PID
What are the first line tests for suspected ectopic pregnancy?
- Urine pregnancy test
- Pelvic USS
Which investigation is most important in first assessing ectopic pregnancy?
Urine pregnancy test
When should a pelvic USS be performed in suspected ectopic pregnancy?
If pregnancy test is positive
What can pelvic USS show in suspected ectopic pregnancy?
Presence or absence of intrauterine pregnancy
What should be offered if transabdominal USS cannot identify an intrauterine pregnancy?