An ectopic pregnancy occurs when the fertilized egg attaches itself in a place other than inside the uterus. Almost all ectopic pregnancies occur in the fallopian tube and are thus sometimes called tubal pregnancies
Consider any woman of reproductive age with abdominal pain, amenorrhea or abnormal vaginal
Most commonly in 5th – 8th week after LMP.
May present acutely, or (more commonly), sub-acutely with fluctuating abdominal discomfort with
dark, light PV bleeding & pelvic tenderness.
Beware: Bleeding can occur after pain in most are stable and walk into department, 20% have no
history of amenorrhea!
DO NOT perform vaginal examination.
1. Early liaison with medical officer, esp. if unstable,
2. ABC’s Oxygen,
3. IV fluid resuscitation to maintain SBP >90mmHg,
4. FBC, Group & Hold,
5. Confirm pregnant with urinary,
6. Quantitative if diagnosis suspected, even with negative urinary test,
7. USS as directed by medical officer (Transvaginal if 1500-6500 U/Ml),
8. Rh. (Anti-D) immunoglobulin 250 IU IM (for singleton pregnancy <12/40), 625 IU IM (if
multiple pregnancy or gestational age >12/40 or unkown) to all Rheusu negative patients
who not received it within the last 6 weeks (e.g. for previous threatened miscarriages),
9. May require urgent laparoscopy/ laparotomy,
10. Conservative treatment is an option if:
· No acute systems,
· Falling that are <1000 U/ml initially &
· No blood seen in the Pouch of Douglas on USS.