Lightning Learning: Ectopic Pregnancy

“An ectopic pregnancy is when a fertilised egg implants and begins developing outside the uterus, affecting 1-in-80 pregnancies.”

— advice is based on local guidelines & procedures

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What?

An ectopic pregnancy is when a fertilised egg implants and begins developing outside the uterus:

• 97% fallopian tubes

• 3% interstitial (area between fallopian tubes and uterus)

• Can develop in a number of other areas

Affects 1-in-80 pregnancies. Pregnancy is not viable. Symptoms include lower abdominal pain and vaginal bleeding. Always consider ectopic pregnancy in women (of childbearing age) presenting with abdominal pain.

Why?

If fallopian tube ruptures it can be life-threatening due to bleeding.

Patient may present…

• haemodynamically unstable with symptoms of ectopic pregnancy

• with shoulder tip pain if large amount of bleeding

Mortality rate = 0.2%

Treatment

Surgical: presents with peritonitis, large gestational sac, fallopian tube rupture

Methotrexate: gestational sac <3.5cm, no peritonitis, ability to closely monitor, no contraindications

Further Reading

• Medscape: Emergent Management of Ectopic Pregnancy
• BMJ: Ectopic Pregnancy (summary)
• LITFL: Ectopic Pregnancy
• St.Emlyn's: Problems in Early Pregnancy – Induction
• FOAM EM: Ectopic Pregnancy
• Radiopaedia: Ruptured Ectopic Pregnancy