Ectopic Pregnancy

Clinical description

Ectopic pregnancy is a pregnancy that occurs outside of the uterus. The most common location is the fallopian tube, but other possible sites include: cervical, cornual, ovarian, abdominal, or within a hysterotomy scar. The chance of a heterotopic pregnancy (including both a uterine and extrauterine pregnancy) is very rare, but can occur.

Risk Factors Prior ectopic pregnancy, prior BTL, current use of IUCD

Signs and symptoms

History Classic triad of abdominal pain, amenorrhea and vaginal bleeding Exam +/- Tenderness, +/- adnexal mass, +/- shock if ruptured InvestigationsVital signs, Urine pregnancy test, US (transvaginal is preferred), send blood for X-match Ultrasound Findings diagnostic or suggestive of ectopic: extrauterine gestational sac/yolk sac/fetal pole, extraovarian mass, echogenic fluid in the cul-de-sac and/or abdomen

Treatment

• Obtain IV access with 2 large-bore cannulae (i.e., 16G or 18G).
• If shock, then resuscitate with IV fluids and/or BT while organizingemergency laparotomy.
• If not in shock and:
• If ruptured, then perform emergency laparotomy with possible blood transfusion.
• If not ruptured, then consider urgent laparoscopy or laparotomy.

 If conservative management is desired, monitor as inpatient with serial abdominal exams and repeat ultrasound in 2 days if surgery not yet performed.

• Send tissue to pathologist for confirmation and consider dilation and curettage (evacuation) if appropriate
• If patient stable, medical management can be considered at the Central Hospitals under Consultant

supervision Follow-up: Counsel patient about family planning options and risk of future ectopic pregnancy prior to discharge.