ECTOPIC PREGNANCY . . . CONT.
Diagnosis serial ßhCG levels • normal doubling time with intrauterine pregnancy is 1.4-2 days in early pregnancy which increases until 8 weeks, then decreases steadily until 16 weeks • prolonged doubling time, plateau or decreasing levels before 8 weeks, implies non-viable gestation but does not provide information on the location of pregnancy ultrasound • intrauterine sac should be visible when serum ßhCG is • > 1500 mIU/mL (transvaginal) • > 6000 mIU/mL or 6 weeks gestational age (transabdominal) • when ßhCG is greater than the above values and neither a fetal heart beat nor a fetal pole is seen, it is suggestive of ectopic pregnancy culdocentesis (rarely done) laparoscopy (for definitive diagnosis)
Differential Diagnosis (see Common Gynecological Complaints Section)
Treatment goals of treatment • be conservative • try to save the tube surgical (laparoscopy) • linear salpingostomy or salpingectomy • blood loss is replaced if life threatening • if patient is Rh negative give anti-D gamma globulin (Rhogam) • may require laparotomy medical • criteria • < 3 cm unruptured ectopic pregnancies and no fetal heart activity • patient clinically stable • compliance and follow-up ensured • methotrexate (considered standard care) • 1/5 to 1/6 chemotherapy dose, therefore minimal side effects • follow ßhCG levels • plateau or rising levels are evidence of persisting trophoblastic tissue • requires further medical or surgical therapy • failure rate 5% • requires longer follow-up than surgical treatment in order to follow ßhCG levels
Prognosis 5% of maternal deaths 40-60% of patients will become pregnant again after surgery 10-20% will have subsequent ectopic gestation prognosis for future pregnancy improves with more conservative treatment
MCCQE 2000 Review Notes and Lecture Series