Ectopic pregnancy: Difference between revisions

Revision as of 21:03, 5 April 2012

Must consider in all women of childbearing age who p/w abd/pelvic pain + hypovolemia
Leading cause of maternal death in first trimester
Pregnancy in patient with prior tubal ligation or IUD in place is ectopic until proven otherwise (25-50% are ectopic)

Major
1. H/O PID
2. History of tubal surgery or IUD in place
3. Previous ectopic
Minor
1. Tobacco
2. Assisted reproduction techniques
3. Age >35
4. Numerous lifetime partners

Helpful in characterizing risk of ectopic, but can NOT be used to rule-out ectopic
- Normal pregnancy: hCG should double every 2d until 10000 mIU/ml
- Ectopic pregnancy: hCG increases more slowly or decreases (esp w/ spont. abortion)

Used to identify presence or absence of IUP
- IUP in setting of fertility tx does not necessarily r/o ectopic (heterotopic pregnancy)
Discriminant zone
- There is no discriminant zone for an ectopic pregnancy:
  - Perform US if ectopic is suspected regardless of the hCG level
- Transvag US for IUP: 1500 mIU/ml
  - If hCG > 1500 and no IUP - assume EP
- Transabd US for IUP: 6000 mIU/ml
Findings
- Gestational sac alone does NOT equal IUP (must also have yolk sac)

Tintinalli

Authors:

@@ Line 2: / Line 2: @@
 *Must consider in all women of childbearing age who p/w abd/pelvic pain + hypovolemia
 *Leading cause of maternal death in first trimester
-*Pregnancy in pt w/ prior tubal sx for sterilization is ectopic until proven otherwise
+*Pregnancy in patient with prior tubal ligation or IUD in place is ectopic until proven otherwise (25-50% are ectopic)
 ===Risk Factors===
-#PID
+#Major
-#History of tubal surgery
+##H/O PID
-#IUD
+##History of tubal surgery or IUD in place
-#Assisted reproduction techniques
+##Previous ectopic
-#Previous ectopic
+#Minor
+##Tobacco
+##Assisted reproduction techniques
+##Age >35
+##Numerous lifetime partners
 ==Diagnosis==