Signs of ectopic pregnancy

Definition of ectopic pregnancy: Implantation of a conceptus outside the uterine cavity.
Occurs approximately 1 in 1000 pregnancy. 95% of which is tubal ectopic.

Risk factors for ectopic pregnancy

• History of infertility of assisted conception
• History of pelvic inflmmatory disease
• Endometriosis
• Prev pelvic surgery
• Previous ectopic pregnancy
• IUCD
• Smoking
• Higher maternal age
  

Symptoms of ectopic prenancy

• Mostly asymptomatic
• Abdominal pain
• Dark PV bleed
• Shoulder tip pain (ruptured ectopic with intra-abdominal blood irritating diaphragm)

Signs of ectopic pregnancy

• Abdominal tenderness
• Adnexum tenderness
• Cervical excitation
  

Investigations of ectopic pregnanacy

• Serum HCG >1500 or 66% rise in 48 hr suggestive of intra-uterine pregnancy
  
• Trans vaginal Ultrasound
• Laproscopy is gold standard

Treatment of ectopic pregnancy

• Expectant: under strict criteria
• Medical: Methotrexate -use contraception for 3 months as teratogenic
• Surgical: Laproscopy vs Laprotomy. Salpingectomy or Salpingostomy
• Anti-D in rhesus negative patients