Editing Ectopic pregnancy

* Pregnancy that grows outside of the uterine cavity
* Most commonly within the Fallopian tubes. Otherwise ovary, cervix, broad ligament, abdominal cavity.
* Incidence
** 11 per 1000 pregnancies
* Risk factors
** Previous PID
** Smoking
** Infertility
** Use of IUCD
** Previous ectopic
** Previous abdominal/pelvic surgery
** Previous tubal surgery
** Endometriosis
* Symptoms
** Pain
** Vaginal bleeding
** GIT symptoms
** Dizziness, fainting, syncope
** Shoulder tip pain
** Asymptomatic
* Signs
** Pelvic, abdominal and/or adnexal tenderness or fullness
** Peritonism
** Cervical motion tenderness
** Tachycardia/hypotension
* Investigation
** Transvaginal ultrasound - look for absence of intra-uterine gestational sac (especially with B-hCG >1500) with positive pregnancy test. More likely if free fluid in PoD or an adnexal mass is seen.
** Serial B-hCG - rise in 63% over 48 hours is more indicative of a viable intra-uterine pregnancy, while static or sub-optimal increase suggests ectopic.
* Management:
** Expectant
** Medical
*** Methotrexate
** Surgical
*** Laparoscopic salpingectomy or salpingostomy
**** Salpingectomy is preferred if healthy contra-lateral tube
***** Use LigaSure to resect the tube
***** Stay close to the tube and won't need to take much broad ligament with you
**** Salpingostomy carries an 8% risk of persistent trophoblastic tissue, intra-abdominal bleeding and an increased risk of repeat ectopic.
**** Should be followed up with monitoring of B-hCG until a negative restult is obtained
*** Laparotomy if unstable
**** Pfannenstiel is just as good access as laparotomy, if you can do it quickly
*** More complex ectopics, such as intra-abdominal, are best managed in a tertiary centre
* Post-op management
** Will still be able to become pregnant, however higher risk of future ectopics and miscarriages. Reduced overall fertility but >50% of women will still be able to become pregnant.
** Future pregnancy attempts should be under the care of an obstetrician
** Give anti-D immunoglobulin within 48 hours to women whose blood group is Rh-negative

[[Category:O+G]]