ECTOPIC PREGNANCY (sản PHỤ KHOA)

ECTOPIC
PREGNANCY


• Intra-uterine pregnancy.
• Extra-uterine pregnancy.
• Pregnancy of unknown location: 7 – 30% (50 – 70% have a spontaneously resolving pregnancy)


SYMPTOMS
• Classic triad symptoms: pain, vaginal bleeding, amenorrhoea.


DIAGNOSIS
• Serial hCG measurements.
• Serum progesterone.
• Ultrasonography.


ULTRASONOGRAPHY
• Intra-uterine sac:
- TAS: hCG > 6500 UI/L
- TVS: hCG # 1000 UI/L.
• EP: TVS
- Sens: 87 – 99%
- Spec: 94 – 99,9%


ULTRASONOGRAPHY
• 95% EP is in Fallopian tube.
• Ultrasonography:

- ectopic mass separate to the ovary.
- Inhomogeneous adnexal mass
- An empty extra-uterine sac with a hyper-echoic ring ± yolk sac ± fetal pole ± cardiac activity.


ULTRASONOGRAPHY
• Non-cystic adnexal mass or inhomogeneous mass:
- Sens: 84,4%
- Spec: 98,9%
- PPV: 96,3%
- NPV: 94,8%


HCG
• hCG: after 48h, the increase of hCG is less than 66%, an EP is more likely (Kadar N, Caldwell BV,
Romero R. A method of screening for ectopic pregnancy and its indications. Obstet Gynecol
1981;58:162–6).


MANAGEMENT


ACOG Clinical Management Guideline, No. 94, June 2008

* 1500 – 2500 UI/L
** does not fall 21%–35% in 2 days
*** hCG decline rapidly


RCOG Green Top Guideline, No. 25, October 2006

TREATMENT
• Laparotomy - laparoscopy
• Medical treatment
• Expectant treatment