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Ectopic Pregnancy
Αρχειοθετημένη σειρά ("Ανενεργό feed" status)
When? This feed was archived on March 22, 2023 20:11 (). Last successful fetch was on February 16, 2023 22:11 ()
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Manage episode 344374065 series 2811669
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Ectopic Pregnancy
Dr Swapnil Pawar
Ectopic Pregnancy
Written by Dr Ashley Liu
Ectopic Pregnancy
Ectopic pregnancies should always be considered in any patient of reproductive age with vaginal bleeding +/- abdominal pain.
Clinical Manifestation
The most common presentation of ectopic pregnancy is usually first-trimester vaginal bleeding and/or abdominal pain. This may be associated with normal pregnancy discomforts (breast tenderness, frequent urination, nausea).
Vaginal bleeding: varied but usually preceded by a period of amenorrhoea.
Abdominal pain: varied but may be diffuse or localised and usually localised in the pelvis. Sudden onset of pain may be associated with tubal rupture. Shoulder pain may be associated with bleeding irritating the diaphragm.
It is also important to remember ectopic pregnancies may also present asymptomatically.
Risk Factors
- Previous ectopic pregnancy
- Prior tubal pathology
- Previous surgery (e.g. pelvic inflammatory disease, tubal ligation)
- Current use of IUD or IVF
Note>50% of patients do not have an identifiable risk factor for pregnancy.
Diagnostic criteria
B-Hcg + Transvaginal/Transabdominal US
- B-Hcg > 1500 – Should be able to see gestational sac on US
- B-Hcg < 1500 – Continue serial monitoring 48h. If it continues to rise/plateau, it would be concerning for an ectopic pregnancy
Management
Conservative If stable, B-hcg <1500 | Monitor serum B-hcg every 48 hours until it reaches 0 | |
Medical If compliant, B-hcg <5000, mass < 3.5cm, no fetal heart rate | IM Methotrexate (single dose or more)
Contraindicated in renal/hepatic failure, breastfeeding, immunodeficiency, peptic ulcer disease | |
Surgical If medical management is contraindicated, poor compliance, B-hcg >5000, mass >3.5cm present fetal heart rate | Salpingectomy
Salpingotomy
|
Sources:
UpToDate “Ectopic Pregnancy: Clinical manifestations and diagnosis”: https://www.uptodate.com.acs.hcn.com.au/contents/ectopic-pregnancy-clinical-manifestations-and-diagnosis?search=ectopic%20pregnancy&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H2251071846
UpToDate “Ectopic pregnancy: Choosing a treatment”: https://www.uptodate.com.acs.hcn.com.au/contents/ectopic-pregnancy-choosing-a-treatment?search=ectopic%20pregnancy&source=search_result&selectedTitle=3~150&usage_type=default&display_rank=3
The post Ectopic Pregnancy first appeared on Critical Care Education.
32 επεισόδια
Αρχειοθετημένη σειρά ("Ανενεργό feed" status)
When? This feed was archived on March 22, 2023 20:11 (). Last successful fetch was on February 16, 2023 22:11 ()
Why? Ανενεργό feed status. Οι διακομιστές μας δεν ήταν σε θέση να ανακτήσουν ένα έγκυρο podcast feed για μια παρατεταμένη περίοδο.
What now? You might be able to find a more up-to-date version using the search function. This series will no longer be checked for updates. If you believe this to be in error, please check if the publisher's feed link below is valid and contact support to request the feed be restored or if you have any other concerns about this.
Manage episode 344374065 series 2811669
- play_arrow
Ectopic Pregnancy
Dr Swapnil Pawar
Ectopic Pregnancy
Written by Dr Ashley Liu
Ectopic Pregnancy
Ectopic pregnancies should always be considered in any patient of reproductive age with vaginal bleeding +/- abdominal pain.
Clinical Manifestation
The most common presentation of ectopic pregnancy is usually first-trimester vaginal bleeding and/or abdominal pain. This may be associated with normal pregnancy discomforts (breast tenderness, frequent urination, nausea).
Vaginal bleeding: varied but usually preceded by a period of amenorrhoea.
Abdominal pain: varied but may be diffuse or localised and usually localised in the pelvis. Sudden onset of pain may be associated with tubal rupture. Shoulder pain may be associated with bleeding irritating the diaphragm.
It is also important to remember ectopic pregnancies may also present asymptomatically.
Risk Factors
- Previous ectopic pregnancy
- Prior tubal pathology
- Previous surgery (e.g. pelvic inflammatory disease, tubal ligation)
- Current use of IUD or IVF
Note>50% of patients do not have an identifiable risk factor for pregnancy.
Diagnostic criteria
B-Hcg + Transvaginal/Transabdominal US
- B-Hcg > 1500 – Should be able to see gestational sac on US
- B-Hcg < 1500 – Continue serial monitoring 48h. If it continues to rise/plateau, it would be concerning for an ectopic pregnancy
Management
Conservative If stable, B-hcg <1500 | Monitor serum B-hcg every 48 hours until it reaches 0 | |
Medical If compliant, B-hcg <5000, mass < 3.5cm, no fetal heart rate | IM Methotrexate (single dose or more)
Contraindicated in renal/hepatic failure, breastfeeding, immunodeficiency, peptic ulcer disease | |
Surgical If medical management is contraindicated, poor compliance, B-hcg >5000, mass >3.5cm present fetal heart rate | Salpingectomy
Salpingotomy
|
Sources:
UpToDate “Ectopic Pregnancy: Clinical manifestations and diagnosis”: https://www.uptodate.com.acs.hcn.com.au/contents/ectopic-pregnancy-clinical-manifestations-and-diagnosis?search=ectopic%20pregnancy&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H2251071846
UpToDate “Ectopic pregnancy: Choosing a treatment”: https://www.uptodate.com.acs.hcn.com.au/contents/ectopic-pregnancy-choosing-a-treatment?search=ectopic%20pregnancy&source=search_result&selectedTitle=3~150&usage_type=default&display_rank=3
The post Ectopic Pregnancy first appeared on Critical Care Education.
32 επεισόδια
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