ectopic pregnancy approach

what is ectopic pregnancy?

Ectopic pregnancy is a high-risk condition that occurs in 1.9 percent of reported pregnancies. The condition is the leading cause of pregnancy-related death in the first trimester. If a woman of reproductive age presents with abdominal pain, vaginal bleeding, syncope, or hypotension, the physician should perform a pregnancy test. If the patient is pregnant, the physician should perform a work-up to detect possible ectopic or ruptured ectopic pregnancy. Prompt ultrasound evaluation is key in diagnosing ectopic pregnancy. Equivocal ultrasound results should be combined with quantitative beta subunit of human chorionic gonadotropin levels. If a patient has a beta subunit of human chorionic gonadotropin level of 1,500 mIU per mL or greater, but the transvaginal ultrasonography does not show an intrauterine gestational sac, ectopic pregnancy should be suspected.

Diagnostic uterine curettage may be appropriate in patients who are hemodynamically stable and whose beta subunit of human chorionic gonadotropin levels are not increasing as expected. Appropriate treatment for patients with nonruptured ectopic pregnancy may include expectant management, medical management with methotrexate, or surgery. Expectant management is appropriate only when beta subunit of human chorionic gonadotropin levels are low and declining. Initial levels determine the success of medical treatment. Surgical treatment is appropriate if ruptured ectopic pregnancy is suspected and if the patient is hemodynamically unstable.

10 common questions about ectopic pregnancy approach

1How do you monitor an ectopic pregnancy?

Diagnosis. A pelvic exam can help your doctor identify areas of pain, tenderness, or a mass in the fallopian tube or ovary. However, your doctor can't diagnose an ectopic pregnancy by examining you. You'll need blood tests and an ultrasound

2What is the management of ectopic pregnancy?

Surgical management generally is performed using laparoscopic salpingectomy (removal of part or all of the affected fallopian tube) or laparoscopic salpingostomy (removal of the ectopic pregnancy while leaving the affected fallopian tube in situ).

3What happens after methotrexate for ectopic pregnancy?

Methotrexate is given by injection. After treatment, you may have mild abdominal pain or cramping. Some women also have nausea and vomiting, diarrhea, or fatigue. You will have your blood taken several times in the weeks after the methotrexate injection.

4How long can ectopic pregnancy go unnoticed?

The structure containing the fetus typically ruptures after about 6 to 16 weeks, long before the fetus is viable. When an ectopic pregnancy ruptures, bleeding may be severe and even life threatening. The later the structure ruptures, the worse the blood loss, and the higher the risk of death

5What is the complication of ectopic pregnancy?

Complications. The most common complication is rupture with internal bleeding which may lead to hypovolemic shock. In the first trimester, ectopic pregnancy is the most common cause of pregnancy-related deaths and 10% of maternal deaths may be due to ectopic pregnancy

6Does hCG go down with ectopic?

However, about 90% of women with ectopic pregnancy and serum β-hCG levels greater than 2000 IU/L require operative intervention owing to increasing symptoms or tubal rupture. Tubal rupture can also occur when serum β-hCG levels are low or declining, or both

7Is diarrhea a symptom of ectopic pregnancy?

Symptoms of ectopic pregnancy One-sided abdominal pain - you may experience pain, typically on one side of your abdomen (tummy), which can be persistent and severe. ... Diarrhoea and vomiting - an ectopic pregnancy can cause similar symptoms to a gastrointestinal disease and is often associated with diarrhoea and vomiting

8Why is methotrexate used in ectopic pregnancy?

Methotrexate works by stopping the growth of the fertilized egg before a rupture occurs. Sometimes, methotrexate is combined with surgery to treat an ectopic pregnancy. In this case, the medicine removes fetal cells left behind after surgery

9What are the differential diagnosis of ectopic pregnancy?

Diagnostic Considerations Only 50% of patients with an ectopic pregnancy present with the classic triad of pain, amenorrhea, and vaginal bleeding. Numerous conditions may have a presentation similar to an extrauterine pregnancy. The most common of these include the following: Appendicitis

10Do you bleed after methotrexate for ectopic?

After you get methotrexate, you may have: mild to moderate cramps or pain in the abdomen. vaginal bleeding (like a period)

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ectopic pregnancy approach