ECTOPIC PREGNANCY: QUESTIONS AND ANSWERS
LATEST UPDATE (GRADED A+)
What is the relationship between IUCs and ectopic?
Doesn't cause EP but if a pregnancy occurs there's a greater risk that the pregnancy is EP
What type of infertility is of greatest risk for ectopic?
patients with primary infertility due to tubal factors that prohibit or delay ovum transport
What are some surgical risk factors for ectopic?
pelvic or abdominal
What kind of lifestyle factors are risk factors for ectopic?
smoking (dose dependent), multiple partners, early age of 1st intercourse, vaginal douching
What percentage of women with ectopic will have NO identifiable risk factors?
47% according to one study
What is the triad of classic ectopic symptoms?
Pain
Amenorrhea
Spotting or bleeding
What kind of pain is associated with ectopic?
Abdominal usually monitor pelvic, shoulder
What kind of pain suggests rupture?
Sharp, sudden, stabbing
What might exacerbate abdominal pain due to ectopic?
with body motion
What does shoulder pain suggest in ectopic?
Phrenic nerve stimulation -> rupture
How often do women having an ectopic experience shoulder pain?
25%
Why does shoulder pain occur in some ectopic?
intra-peritoneal bleeding with blood collecting below the diaphragm
, What might exacerbate shoulder pain due to ectopic?
Inspiration
Why does inspiration exacerbate shoulder pain in ectopic?
diaphragm is lower, irritated by blood collecting in the belly
What are some non-specific symptoms of ectopic?
- Dizziness &/or fainting (20 - 35%)
- Pregnancy symptoms, e.g. breast tenderness, nausea & vomiting, urinary frequency, fatigue (10 - 25%)
- Urge to defecate (5 - 15%)
- Passage of decidual tissue (5 - 10%)
How are vital signs affected by ectopic?
Usually normal
What percentage of blood loss would result in orthostatic BP changes?
10-15% of blood volume
On abdominal exam, how might a woman with ectopic present if she hasn't ruptured?
Unilateral tenderness in lower abdomen
On abdominal exam, how might a woman with ectopic present if she has ruptured?
Acute abdomen -- rebound, guarding, rigidity
Decreased bowel sounds
Cullen's sign
What is Cullen's sign?
Periumbilical bluish discoloration (blood in the peritoneum)
On pelvic exam, how might a woman with ectopic present?
WNL. May notice a minimal to profuse amount of blood at introitus, vagina or coming from cervical os
On bimanual exam, how might a woman with ectopic present?
- 70% normal size --> IE not pregnant
- 30% enlarged but S<D
- May be displaced to one side
- CMT in 50-75%
- adnexal tenderness, bilateral or unilater
- ill-defined adnexal mass or feeling of fullness in adnexa
- adnexal mass on side opposite the EP in 20% (usually corpus luteum cyst)
- Doughy mass or bulging sensation palpated in posterior vaginal fornix (pouch of Douglas) due to
accumulation of blood
bleeding from fimbriated end of tube into the cul-de-sac
LATEST UPDATE (GRADED A+)
What is the relationship between IUCs and ectopic?
Doesn't cause EP but if a pregnancy occurs there's a greater risk that the pregnancy is EP
What type of infertility is of greatest risk for ectopic?
patients with primary infertility due to tubal factors that prohibit or delay ovum transport
What are some surgical risk factors for ectopic?
pelvic or abdominal
What kind of lifestyle factors are risk factors for ectopic?
smoking (dose dependent), multiple partners, early age of 1st intercourse, vaginal douching
What percentage of women with ectopic will have NO identifiable risk factors?
47% according to one study
What is the triad of classic ectopic symptoms?
Pain
Amenorrhea
Spotting or bleeding
What kind of pain is associated with ectopic?
Abdominal usually monitor pelvic, shoulder
What kind of pain suggests rupture?
Sharp, sudden, stabbing
What might exacerbate abdominal pain due to ectopic?
with body motion
What does shoulder pain suggest in ectopic?
Phrenic nerve stimulation -> rupture
How often do women having an ectopic experience shoulder pain?
25%
Why does shoulder pain occur in some ectopic?
intra-peritoneal bleeding with blood collecting below the diaphragm
, What might exacerbate shoulder pain due to ectopic?
Inspiration
Why does inspiration exacerbate shoulder pain in ectopic?
diaphragm is lower, irritated by blood collecting in the belly
What are some non-specific symptoms of ectopic?
- Dizziness &/or fainting (20 - 35%)
- Pregnancy symptoms, e.g. breast tenderness, nausea & vomiting, urinary frequency, fatigue (10 - 25%)
- Urge to defecate (5 - 15%)
- Passage of decidual tissue (5 - 10%)
How are vital signs affected by ectopic?
Usually normal
What percentage of blood loss would result in orthostatic BP changes?
10-15% of blood volume
On abdominal exam, how might a woman with ectopic present if she hasn't ruptured?
Unilateral tenderness in lower abdomen
On abdominal exam, how might a woman with ectopic present if she has ruptured?
Acute abdomen -- rebound, guarding, rigidity
Decreased bowel sounds
Cullen's sign
What is Cullen's sign?
Periumbilical bluish discoloration (blood in the peritoneum)
On pelvic exam, how might a woman with ectopic present?
WNL. May notice a minimal to profuse amount of blood at introitus, vagina or coming from cervical os
On bimanual exam, how might a woman with ectopic present?
- 70% normal size --> IE not pregnant
- 30% enlarged but S<D
- May be displaced to one side
- CMT in 50-75%
- adnexal tenderness, bilateral or unilater
- ill-defined adnexal mass or feeling of fullness in adnexa
- adnexal mass on side opposite the EP in 20% (usually corpus luteum cyst)
- Doughy mass or bulging sensation palpated in posterior vaginal fornix (pouch of Douglas) due to
accumulation of blood
bleeding from fimbriated end of tube into the cul-de-sac
