1060: Ectopic pregnancy

Abstract

Ectopic pregnancy remains the leading cause of maternal mortality in the first trimester in Australia. It occurs in one in every 500 pregnancies and more frequently in patient’s availing of assisted reproductive technologies (one in 100 pregnancies). Greater awareness of risk factors (previous history of pelvic inflammatory disease, previous ectopic pregnancy, pregnancy by assisted conception), early biochemical testing and improved transvaginal ultrasound allow early diagnosis in over 90% of ectopic pregnancies. These advances have greatly reduced the mortality associated with this life threatening complication of pregnancy. The diagnosis of ectopic pregnancy relies upon: (1) a detailed history; (2) pelvic examination; (3) quantitative β HCG analysis and most importantly; (4) transvaginal ultrasound. More recently, serum progesterone levels have aided the diagnosis of ectopic pregnancy. Uncommonly, laparoscopy and culdocentesis are required to provide additional clues to diagnosis of an ectopic pregnancy. Failure to visualize an intrauterine gestation sac when the HCG reaches 1200 IU/L greatly increases the suspicion of an ectopic pregnancy. Additional supportive biochemical evidence includes failure of the normal 48 hours doubling, plateauing or a decline in HCG levels. The early diagnosis of ectopic pregnancy in the haemodynamically stable pregnancy provides a number of treatment options other than open laparotomy. Indeed, as many as 40% of patients with ectopic pregnancy can be managed expectantly or with medical therapy, most commonly Methotrexate. This talk provides a guideline to the approach to diagnosis and management of this increasingly common complication of pregnancy. Over 200 video clips of tubal and nontubal ectopic pregnancy will be presented. The first section of the talk gives examples of tubal ectopic pregnancies from 8 to 12 weeks. The ultrasound and surgical appearances of unruptured and ruptured pregnancies are described. In the second section of the talk over 100 video clips of the varied appearances of cervical, ovarian, abdominal and other ectopic pregnancies are presented. The final section of the talk will address the ultrasound guided treatment of nontubal ectopic pregnancies. For further information regarding the digital video library in obstetric and gynaecological ultrasound, please refer to the website www.ultrasound.com.au Ectopic pregnancy remains the leading cause of maternal mortality in the first trimester in Australia. It occurs in one in every 500 pregnancies and more frequently in patient’s availing of assisted reproductive technologies (one in 100 pregnancies). Greater awareness of risk factors (previous history of pelvic inflammatory disease, previous ectopic pregnancy, pregnancy by assisted conception), early biochemical testing and improved transvaginal ultrasound allow early diagnosis in over 90% of ectopic pregnancies. These advances have greatly reduced the mortality associated with this life threatening complication of pregnancy. The diagnosis of ectopic pregnancy relies upon: (1) a detailed history; (2) pelvic examination; (3) quantitative β HCG analysis and most importantly; (4) transvaginal ultrasound. More recently, serum progesterone levels have aided the diagnosis of ectopic pregnancy. Uncommonly, laparoscopy and culdocentesis are required to provide additional clues to diagnosis of an ectopic pregnancy. Failure to visualize an intrauterine gestation sac when the HCG reaches 1200 IU/L greatly increases the suspicion of an ectopic pregnancy. Additional supportive biochemical evidence includes failure of the normal 48 hours doubling, plateauing or a decline in HCG levels. The early diagnosis of ectopic pregnancy in the haemodynamically stable pregnancy provides a number of treatment options other than open laparotomy. Indeed, as many as 40% of patients with ectopic pregnancy can be managed expectantly or with medical therapy, most commonly Methotrexate. This talk provides a guideline to the approach to diagnosis and management of this increasingly common complication of pregnancy. Over 200 video clips of tubal and nontubal ectopic pregnancy will be presented. The first section of the talk gives examples of tubal ectopic pregnancies from 8 to 12 weeks. The ultrasound and surgical appearances of unruptured and ruptured pregnancies are described. In the second section of the talk over 100 video clips of the varied appearances of cervical, ovarian, abdominal and other ectopic pregnancies are presented. The final section of the talk will address the ultrasound guided treatment of nontubal ectopic pregnancies. For further information regarding the digital video library in obstetric and gynaecological ultrasound, please refer to the website www.ultrasound.com.au