Ectopic Pregnancy

DIAGNOSIS
1) Hx: Bleeding Early Pregnancy, UPT +ve, Abd pain, Shoulder tip pain (d/t peritoneal irritation)
2) RF: Hx of Gynae surgery, PID, IUD
3) O/E: Shock, Abd pain, Cervical Excitation
4) TV U/S: No IUGS, Fluid @ POD
5) Ix: Ser Beta hCG (monitor every 48 -72 HRs) - (kat HTAA leh buat mase office hr je)
6) Lap Exploration : suspected Ectopic (cannot rule out)

MANAGEMENT
1) Surgical Mx
- Hemodynamically stable : Lap approach
- Hemodynamically unstable : Laparotomy (Open)
- Tubal Pregnancy: Salpingotomy/ Salpingectomy
- Post-Op Mx:
    Pain Mx (T. Synflex), rpt Post-op Hb, TWBC, send t/s for HPE, WI D2,
    Monitor VSx 4HRly, Encourage orally & ambulate, TCA x 2 week to review HPE

2) Med Mx
- Suitable women: hCG < 3000 iU/L, min symptoms
- IM MTX (75-95 mg) as a single dose
- Ser hCG D4 & D7
- Explain :
     Possibility of need for future Tx &
     SE of Tx (eg: Abd pain, Conjunctivitis, stomatitis, GIT upset)
- Advice:
    Avoid SI dur Tx, drink well,
    Use effective contraception x 3 months after give MTX (Teratogenic)

3) Expectant Mx (for preg unknown location, pt stable)
- b-hCG < 1000 iU, No IUGS
- Monitor conds (sx/syms), b-hCG every 48-72 HR until < 20 iU/L


* Anti-D 250 iU (50 microgram) is given to Rh -ve women