Ectopic Pregnancy.
Pregnant woman in shock, Amenorrhea, abd. pain, & vaginal bleed. The most common place is in the fallopian tube.

Causes the ectopic pregnancy?
1. Advancing age
2. Pelvic inflammatory disease (# 1 risk factor)
3. Previous ectopic: about 10-20% of those attempting pregnancy after one ectopic will have another.
4. Tubal surgery or defects
5. Previous termination of pregnancy
6. DES exposure
7. IUD
Most patient report missed period, positive pregnancy test, some abdominal pain, and some irregular vaginal bleeding. Some women report fainting or suddenly, without warning a woman is very unwell, collapses and is taken to hospital.


Lab:
CBC, UA, HCG, blood T&C

What tests are used to diagnose ectopics?
1. Obviously first of all a pregnancy test. If the test is negative then ectopic pregnancy is virtually excluded.
2. Transvaginal ultrasound can reliably demonstrate a pregnancy in the uterus from about 5 weeks onward. If TVUS is negative and HCG is < 2000 mIU/ml repeat HCG in 48 hrs, subnormal increases Ectopic probable.

Treatments?
* Start IV fluid, O2, blood transfusion if required
* Medical treatment: with a drug called methotrexate, which is given by injection. This makes the ectopic pregnancy shrink away by stopping the cells dividing, tube pregnacy must be small (less tan 4 cm) and low B-HCG.
* Laparoscopic surgery: open the tube and remove the pregnancy (salpingotomy), or remove the tube (salpingectomy).
* Laparotomy: either salpingotomy or salpingectomy performed.