Ectopic Pregnancy
OVERVIEW
Ectopic pregnancy = fertilized ovum which implants outside the lining of the uterus
RISK FACTORS
- history of T/L
- history of ectopic pregnancy
- previous tubal infection
- Fallopian and endometrial anomalies
- fertility treatment
- endometriosis
- IUCD’s
CLINICAL FEATURES
History
- PV bleeding
- abdominal/pelvic pain
- 6-8 weeks LMP
- shoulder tip pain (large amount of bleeding)
- lightheaded
- postural symptoms
Examination
- adnexal tenderness and masses
- state of cervix and material passing through it
- fetal heart (almost never heard in ectopic)
INVESTIGATIONS
- beta-HCG (should almost double every 2 days)
- bloods to rule out other causes of abdominal pain
- Rh status
- MSU
- TV U/S
-> if bHCG is > 1200 and there is no intrauterine pregnancy = probable ectopic
TREATMENT
Surgery
- unstable
- large
- peritonitis
Methotrexate
- no peritonitis
- < 3.5cm
- no free fluid on USS
- ability to closely monitor as an outpatient
Further reading
- Hiller J. Ectopic pregnancy. FFS
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC