Ectopic
Implantation of a fertilized ovum outside the uterus results in an ectopic pregnancy
Epidemiology
Risk factors (anything slowing the ovum's passage to the uterus)
Women who are stable are typically investigated and managed in an early pregnancy assessment unit. If a woman is unstable then she should be referred to the emergency department.
β-hCG
The investigation of choice for ectopic pregnancy is a transvaginal ultrasound.
There are 3 ways to manage ectopic pregnancies. And the following criteria can help to guide you on which method your patient will be able to have.
| Expectant management | Medical management | Surgical management |
|---|---|---|
| Size <35mm | Size <35mm | Size >35mm |
| Unruptured | Unruptured | Can be ruptured |
| Asymptomatic | No significant pain | Pain |
| No fetal heartbeat | No fetal heartbeat | Visible fetal heartbeat |
| hCG <1,000IU/L | hCG <1,500IU/L | hCG >5,000IU/L |
| Compatible if another intrauterine pregnancy | Not suitable if intrauterine pregnancy | Compatible with another intrauterine pregnancy |
| Expectant management involves closely monitoring the patient over 48 hours and if B-hCG levels rise again or symptoms manifest intervention is performed. | Medical management involves giving the patient methotrexate and can only be done if the patient is willing to attend follow-up. | Surgical management can involve salpingectomy or salpingotomy |
| Salpingectomy is first-line for women with no other risk factors for infertility | ||
| Salpingotomy should be considered for women with risk factors for infertility such as contralateral tube damage | ||
| • around 1 in 5 women who undergo a salpingotomy require further treatment (methotrexate and/or a salpingectomy) |