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CDHB

Ectopic Pregnancy

• Still a cause of maternal death.
• Should be considered in any women of reproductive age who present with abdominal pain/discomfort and/or vaginal bleeding.
• Other presentations can include non-specific gastrointestinal symptoms (vomiting, diarrhoea, painful defaecation).
• A pregnancy test (urine initially and subsequent quantification with serum beta-HCG) is therefore essential in the early phase of assessment.

Clinical symptoms and signs

• Pelvic pain (can be localized, non-specific, of variable intensity and duration, or absent).
• Vaginal bleeding (spotting, heavy or none).
• Asymptomatic mass found at USS or empty uterus on ultrasound (no pregnancy sac) with a beta-HCG level of >1500 unit/L.
• Occasionally may present with maternal collapse ± other features.
• A history of amenorrhoea may not be obtained.
• Differential diagnoses include ruptured corpus luteum of pregnancy, torsion of ovarian cyst, miscarriage, appendicitis, renal colic, pelvic inflammatory disease or endometriosis.

Management

• If collapse, hypotension or hypovolaemia:
  • Transfer the patient to Resus.
  • Call for the ED Consultant, Gynaecology Registrar or other available senior help.
  • Insert two large bore IV cannulae and infuse warm crystalloid.
  • CBC, beta-HCG.
  • Cross-match 4 units of blood.
  • Catheterize and test urine urgently for pregnancy test.
  • If pregnancy confirmed once the patient is adequately resuscitated, arrange transfer to theatre.
• Non-acute presentation:
  • Urine pregnancy test: if negative, ectopic gestation is virtually excluded and other causes need to be considered.
  • CBC, group and hold, and beta-HCG level.
  • If patient stable arrange for a pelvic ultrasound scan.
  • Discuss with the on-call Gynaecology Registrar.
  • If ultrasound not readily available/out of hours admit to hospital until ultrasound can be performed.
  • Further guidelines are available in the Gynaecology Assessment Unit, or search for "ectopic" on the CDHB intranet.
• Non-sensitized rhesus (Rh) negative women:
  • Non-sensitized rhesus (Rh) negative women should receive anti-D globulin in the situation of a confirmed ectopic pregnancy.
  • Discharge documentation in the form of a standard letter to GP must state whether or not anti-D has been given.

Topic Code: 35907