Ectopic Pregnancy

A very important topic to be familiar with, no matter what specialty you are doing. This podcast is brought to you in association with Oxford University Press.

 

Lecture by

Video Duration: 12 minutes

  • Ectopic Pregnancy
    Created by Dr Ed Wallitt
    General
    Epidemiology

    Common

    Occurs in 20:1000 pregnancies and rising

    Pathology

    Implantation of an embryo outside the uterine cavity

    Most occur implant within the fallopian tube (ampulla>isthmic>fimbrial>interstitial) but can rarely occur within the abdominal cavity, ovary or cervis

    Top three causes

    Tubal injury: post surgical/infection

    Chromosomal abnormalities

    Clinical Features
    Symptoms

    A woman of child bearing age presents with acute onset lower abdominal pain and is pale and clammy

    Remember:

    WOMAN OF REPRODUCTIVE AGE + POSITIVE PREGNANCY TEST+ PAIN = ECTOPIC PREGNANCY until proven otherwise

    Signs

    Shock: increased HR, low BP

    Acute abdomen: pain +- rebound tenderness (haemoperitoneum)

    Investigations
    Cultures

    Urine sample for pregnancy test

    Bloods

    FBC

    U&Es

    GS and cross match

    Imaging

    Ultrasound (may be inconclusive)

    Scopic/Biopsy

    None

    Functional

    None

    Treatment
    Conservative

    NBM, IVF

    Analgesia

    Medical

    Methotrexate if ectopic is small < 3cm and without haemoperitoneum

    Surgical

    Laparosopic/open salpingectomy/otomy for haemoperitoneum