ECTOPIC PREGNANCY

Pregnancy outside the uterus, usually in the uterine tubes; could result in an emergency when the tube ruptures

Cause

  • Partial blockage of the tube due to a previous infection
  • Congenital malformation of the fallopian tubes
  • Excessively long tubes

Risk factors

  • History of prior ectopic pregnancy
  • Prior abdominal or tubal surgery
  • History of PID, endometriosis, history of infertility
  • Cigarette smoking
  • Multiple sexual partners

Clinical features

  • There may be a period of amenorrhoea as in normal pregnancy
  • Lower abdominal pain, often acute and followed by slight bleeding from the vagina
  • If the tube ruptures, the patient may suddenly become anaemic and go into shock
  • Abdomen may be very tender with rebound tenderness and guarding on palpation
  • Abdomen may not be moving with normal breathing
  • Tenderness of moving cervix during vaginal examination
  • There may be features of free fluid in the abdomen

Differential diagnosis

  • Other causes of acute abdominal pain and vaginal bleeding, e.g. twisted ovarian cyst
  • Appendicitis, pelvic inflammatory disease
  • Incomplete abortion

Investigations

  • Usually diagnosed clinically
    • If the tube ruptures, there may be little time for investigations but ultrasound could be useful (if the
      patient is not in shock)
  • Pregnancy test (to exclude other causes)
  • Complete blood count, blood grouping and cross-matching

MANAGEMENT

  • Set up IV drip with normal saline and run very slowly just to maintain IV access
  • Refer to hospital for surgery
Note
  • DO NOT RUN A LOT OF FLUIDS BEFORE SURGERY, as this raises blood pressure, which may worsen the
    patient’s bleeding, and worsen state of shock.