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1. What is the most common site of ectopic pregnancy?
2. what are risk factors for ectopic?
PID, IUD, other tubal damage.
3. what should you look for in the history?
lower abdominal pain, dark vaginal bleeding, syncope and shoulder tip pain (intraperitoneal blood loss)
4. what should you look for on examination?
tachcardia (hypotension and collapse in shock), cervical excitation, abdominal tenderness. Os closed, uterus small for gestation.
5. what investigations do you want?
urine HCG, transvaginal ultrasound looking at uterus and tubes. Quantitative serum b-HCG.
6. how do you manage a suspected ectopic?
nil by mouth, haemoglobin and cross-match blood, pregnancy test, ultrasound, laparoscopy.
7. how do you manage a confirmed non-acute presentation?
either salpingostomy, or tubal removal. Or medicinal: methotrexate. Check b-HCG for descending levels and give anti-D where necessary.
What would you like to do?
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