Please enable JavaScript.
Coggle requires JavaScript to display documents.
Ectopic Pregnancy - Coggle Diagram
Ectopic Pregnancy
risk factor
often associated with the risk factor that leads to tubal epithelial damage
previous ectopic pregnancy
previous pelvic surgery
history if PID
black ethnicity
history of infertility
smoking
salpingitis
maternal age over 35 years
multiple sexual partners
intrauterine contraception
sterilisation
differential diagnosis
miscarriage
molar pregnancy
ovarian rupture
pregnancy related degeneration of fibroid
non pregnancy related conditions that can cause bleeding in early pregnancy: urethral bleed, haemorrhoids, trauma to cervix, cervical cancer, vaginitis, cervicitis, cervical ectropion, cervical polyps
non pregnancy related conditions that can cause abdominal pain in early pregnancy: MSK, UTI, constipation, IBS, PID, appendicitis, renal colic, bowel obstruction, adhesions, ovarian cyst, torsion of a fibroid, pelvic vein thombosis
suspected ectopic pregnancy
refer women who are haemodynamically unstable
refer women immediately to an early pregnancy assessment service with positive pregnancy test and any of the following are presented on examination: pain and abdominal tenderness, pelvic tenderness, cervical motion tenderness
refer if they have bleeding or any of the following signs or symptoms: pain, a pregnancy of 6 weeks or more a pregnancy of uncertain gestation
of a pregnancy less than 6 week with no risk factors but are bleeding advise to return if bleed continues or they develop pain, to repeat pregnancy test after 7 to 10 days and return if positive, that a negative pregnancy test means they have miscarried
for all women referred to early pregnancy service explain reasoning why and what to expect on arrival, arrange a follow up and offer appropriate support and information
treatment in secondary care
U/S tool used to diagnosis suspected ectopic pregnancy,
after ectopic pregnancy confirmed treatment choices include, expectant management, medical management, surgery,
complications
maternal death
non tubal ectopic pregnancy
recurrent ectopic pregnancy
adverse effects of treatment: surgery, medications
psychological effects
when to suspect
common symptoms: abdominal pain or pelvic pain, amenorrhoea or missed period, vaginal bleed
less common: breast tenderness, GI symptoms, dizziness, fainting or syncope, shoulder tip pain, UTI symptoms, passage tissue, rectal pressure or pain on defecation
be aware that symptoms generally appear 6-8 weeks after the last period normal menstrual period, clinical presentation can be highly variable ranging from no symptoms to cardiovascular collapse
other signs: cervical motion tenderness, rebound tenderness or peritoneal signs, pallor, abdominal distention, enlarged uterus, tachycardic, hypotension, shock, collapse, orthostatic hypotension
be alert for signs or symptoms of tubal rupture and intra abdominal bleed: vomiting and diarrhoea, shoulder pain, pallor, tachycardic, hypotension, shock, collapse
definition
an ectopic pregnancy is when an fertilised ovum implanting and maturing outside the uterine cavity
most ectopic pregnancies occur in the fallopian tubes and may implant in the ampulla, isthmus or fimbria, intersitium and cornua
other non tubal and may implants in the ovary, abdomen, cervix, caesarean section scar, intersititial part of the fallopian tubes, cornua
a heterotopic pregnancy is the coexistence of both an intrauterine pregnancy and an ectopic pregnancy
assessment
if immediate hospital admission is not indicated confirm pregnancy with urine test, take a medical history and ask about: signs, symptoms', sexual history and use of contraception, date of last menstrual period, if symptoms' started 6-8 weeks after last period,- date of positive pregnancy test
risk factors
perform an abdominal examination: perform a gentle pelvic examination if there is no abdominal pain or tenderness, do not palpate for an adnexal or pelvic mass as this may increase risk of rupture of an ectopic pregnancy
follow up
ensure all arranged antenatal care are cancelled, give the women the opportunity to discuss any questions she has about the ectopic pregnancy
assess the women's psychological wellbeing offer counselling if appropriate
advise women treated with methotrexate to wait at least 3 months before trying to conceive again
give contraception advice
ensure that all rhesus negative women who have had surgical removal of ectopic pregnancy have received anti D immunoglobulin
provide additional information on ectopic pregnancy and ectopic pregnancy support groups
advise the women to inform GP as soon as possible about any future pregnancies