Ectopic Pregnancy

Normal embryo that is implanted outwith the endometrial cavity

Aetiology

Risk factors

  • Previous ectopic
  • Tubal damange - infection, endometriosis, surgery
  • IUD
  • Smoking
  • Infertility
  • Infertility treatment
  • Extremes of reproductive age

Pathophysiology

  • Fallopian tube is the most common site
  • Other sites: ovary, peritoneum, other organs (e.g. liver, cervix, C-section scar)
  • Pregnancy of unknown location is halfway diagnosis if no pregnancy is located on US

Clinical presentation

  • Consider diagnosis in any female of reproductive age with amenorrhoea and acute hypotension or an acute abdomen

Symptoms

  • Pain, shoulder tip pain
  • Bleeding
  • Collapse
  • Short of breath

Signs

  • Pallor
  • Haemodynamic instability
  • Signs of peritonism - guarding and tenderness

Investigations

  • Bloods - FBC, G+S, βhCG
  • Ultrasound - TVS gold standard
    • Empty uterus/pseudosac +/- mass in adenexa
    • Free fluid in pouch of Douglas

Management

  • Surgical management if patient is acutely unwell
    • Laparoscopic salpingectomy (removal of tube)
    • If conservative surgery is needed salpingotomy can be considered with follow-up as protocol
  • Medical management if woman is stable, low levels of βhCG and ectopic is small and unruptured
    • Methotrexate
  • Conservative management for the 'well patient' who is compliant with follow-up visits