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Ectopic pregnancy is a pregnancy that implants outside the uterine cavity.…
Ectopic pregnancy is a pregnancy that implants outside the uterine cavity.
Risk Factor
Previous ectopic pregnancy
Damage to fallopian tubes from previous pelvic inflammatory disease or surgery
History of infertility.
cigarette smoker, over the age of 35, multiple sexual partners
contraception
Assisted reproduction techniques, especially in vitro fertilization
Complications
Recurrent ectopic pregnancy
maternal death
Tubal rupture — if an ectopic pregnancy is undiagnosed and untreated, spontaneous tubal abortion occurs in about 50% of cases
Psychological effects — grief, anxiety, and depression
Diagnosis
Confirm pregnancy with urine pregnancy test kit
Examine- signs of abdominal tenderness, pelvic tenderness, and adnexal tenderness. Less common signs- cervical motion tenderness, rebound tenderness or peritoneal signs, pallor, abdominal distension, enlarged uterus, tachycardia or hypotension, shock or collapse, and orthostatic hypotension.
Identify any risk factors or causes
Assess for symptoms and signs of tubal rupture and intra-abdominal bleeding- D&V, shoulder pain, Pallor, tachycardia, hypotension, and shock or collapse may indicate tubal rupture and severe bleeding.
Hx of symptoms
Common symptoms- Abdominal or pelvic pain, Amenorrhoea or missed period, Vaginal bleeding (with or without clots)
Less common symptoms- Breast tenderness, GI symptoms (such as diarrhoea and/or vomiting), Dizziness, fainting, or syncope, Shoulder tip pain, Urinary symptoms, Passage of tissue, Rectal pressure or pain on defecation
Symptoms generally appear 6–8 weeks after the last normal menstrual period (or much later for a non-tubal ectopic pregnancy).
Differential
Pregnancy-related conditions that can cause abdominal pain in the first and second trimesters include miscarriage, ruptured ovarian cyst, pregnancy related fibroid
Non-pregnancy-related conditions that can cause bleeding in early pregnancy include urethral bleeding, haemorrhoids, trauma, cancer, vaginitis, Cervicitis, cervical ectropion, or cervical polyps
Pregnancy-related conditions that can cause bleeding in the first and second trimesters include miscarriage and molar pregnancy
Non-pregnancy-related conditions that can cause abdominal pain in early pregnancy include MSK, UTI, constipation, IBS, PID, Appendicitis, renal colic, bowel obstruction, fibroid,adhesions, ovarian cyst, pelvic vein thrombosis
Management
If the woman is less than 6 weeks pregnant and is bleeding but not in pain, consider expectant management
repeat a urine pregnancy test after 7–10 days and to return if the test is positive or if her symptoms continue or worsen.
explain reasons for referral
negative pregnancy confirms miscarriage
Follow up- cancel antenatal, assess mental health, provide advice and support and sign post, contraception advice, rhesus -ve who have had surgical removal received anti d immunoglobulin
Referral
EPAU or out-of-hours gynaecology service for diagnosis and treatment
immediate referral- pelvic or cervical motion tenderness during pelvic examination
If there is no abdominal pain and tenderness, pelvic tenderness, or cervical motion tenderness and the woman is 6 or more weeks pregnant or of uncertain gestation, ectopic pregnancy is still possible (although less likely).- clinical assessment would determine urgency of referral
immediate referral- if pain and tenderness during abdominal examination
Refer women with a positive urine pregnancy test, or continuing or worsening symptoms
Immediate Hospital admission if haemodynamically unstable
Reference -
https://cks.nice.org.uk/ectopic-pregnancy#!scenario:1