Ectopic Pregnancy

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Ectopic pregnancy (EP) is defined as a pregnancy in which the implantation of the embryo occurs  outside  the  uterine  cavity,  most  frequently  in  one  of  the  two  fallopian  tubes  or,  rarely,  in  the  abdominal cavity. 

Un-ruptured Ectopic Pregnancy

Clinical presentation 

  • History of amenorrhea
  • PV Sport bleeding in early pregnancy
  • Unilateral Abdominopelvic pain. Unilateral(localized) abdominal tenderness

Management of Un-ruptured ectopic pregnancy 

Referral: Patients should be referred to higher level facilities with equipment and expertise 

  • At higher level facilities un-ruptured EP may be managed surgically or pharmacologically depending GA and available expertise

Pharmacological Treatment 

S: methotrexate (IV) 50mg/M2 single dose 

OR 

S: methotrexate 2.5mg (PO) 24hourly for 5days (in case IV methotrexate is not available) 

Perform weekly pelvic ultrasound to ensure regression of Gestation sac 

Note: Contraindications of methotrexate include a ruptured ectopic, ectopic mass greater than 3.5 cm, fetal  cardiac activity, high level hCG value (10,000 IU), breastfeeding and immunodeficiency 

Ruptured Ectopic Pregnancy

Clinical presentation  

  • History of amenorrhea
  • Acute generalized abdominal-pelvic pain
  • Hypotension
  • Fast and weak pulse
  • Abdominal distension and tenderness with rebound tenderness

Management of ruptured ectopic at the dispensary and Health Center (B-MONC facilities) 

  • Apply ABCD principles of resuscitation
  • Perform abdominal pelvic ultrasound if available
  • Check Hb
  • Start  compound  sodium  lactate  (IV)  OR  0.9%  sodium  chloride  (IV)  infuse  at  a  rate  of 500mls per hour

Referral:  Ectopic  pregnancy  is  an  obstetric  emergency,  resuscitate  and  refer  the  patient  immediately, with an escort by skilled attendant. 

Management of Ectopic pregnancy at the Hospital (C-EMONC facilities) 

  • Perform abdominal pelvic/Transvaginal ultrasonography
  • Hb level
  • Grouping and cross-matching
  • compound sodium lactate (IV) OR 0.9% sodium chloride (IV) depending on amount of blood loss
  • Blood transfusion if indicated depending on the blood loss
  • Perform Emergency laparotomy