Obgyn: Ectopic Pregnancy: Free MSRA Podcast

⚕️ FREE MSRA PODCAST – Ectopic Pregnancy🎧 In this episode, we take a high-yield deep dive into ectopic pregnancy, one of the most critical diagnoses in early pregnancy. From risk factors and diagnosis to management and complications – this is your essential revision companion.🧠 Key Learning Points📌 Definition• Ectopic pregnancy = implantation of a fertilised egg outside the uterine cavity• Most commonly in the fallopian tube (97%) – ampulla and isthmus• Non-viable and potentially life-threatening if untreated📌 Causes & Risk Factors🔹 Fallopian tube damage or dysfunction• Previous ectopic pregnancy• Pelvic inflammatory disease (PID)• Tubal surgery🔹 Delayed passage of fertilised ovum• IUCD use – rare failures more likely to be ectopic• Progesterone-only pill• IVF/fertility treatment – up to 3% risk🔹 Other risks: age >35, smoking, endometriosis📌 Pathophysiology• Implantation in non-uterine tissue → no structural support• Risk of rupture, internal haemorrhage, and shock• Tubal pregnancies = most common• Other rare sites: cervix, ovary, abdominal cavity, caesarean scars📌 Differentials• Miscarriage• PID• Ruptured ovarian cyst• Appendicitis• UTI💡 Always suspect ectopic in any woman of reproductive age with pain + bleeding📌 Epidemiology• ~1–2% of pregnancies• UK rate: 11/1000 pregnancies• Mortality: ~0.2 per 100 ectopics• Risk of recurrent ectopic: 10–20%• Heterotopic pregnancy (coexisting IUP + ectopic): 1 in 4,000–30,000📌 Clinical Features• Vaginal bleeding, lower abdominal pain, missed period• Shoulder tip pain = referred diaphragmatic irritation• Signs of rupture: pallor, tachycardia, hypotension, collapse• Pelvic/adnexal tenderness, cervical motion tenderness⚠️ Avoid vigorous bimanual exam if ectopic is suspected📌 Investigations🔹 Pregnancy test – first step🔹 Transvaginal ultrasound – best imaging modality• Absence of intrauterine pregnancy + HCG >1500 = suspect ectopic🔹 Serum β-hCG• Serial values at 48 hrs to assess rise/fall• HCG >1500 without visible IUP = highly suggestive🔹 Additional: FBC, CRP, LFTs, blood group, Rh status📌 Management Options🔹 Expectant – observation• Criteria: small (<35mm), no pain, HCG <1000, no heartbeat🔹 Medical – Methotrexate IM• HCG <1500, no rupture, no IUP, reliable follow-up• Advise contraception for 3 months post-treatment🔹 Surgical – laparoscopy• Indicated if: pain, rupture, HCG >5000, heartbeat present• Salpingectomy vs salpingotomy depending on fertility goals🔹 Give anti-D if Rh-negative and surgical management performed📌 Complications• Rupture → haemorrhage → shock → death• Infertility• Recurrent ectopic• Surgery risks: bleeding, organ injury💡 Early diagnosis saves lives📌 Prognosis• >85% diagnosed before rupture due to better early pregnancy services• Future IUP possible in 64–76% of women• Recurrent ectopic risk: 10–20%• Similar future fertility outcomes whether managed expectantly, medically, or surgically📎 More MSRA Resources for Ectopic Pregnancy📝 Revision Notes: https://www.passthemsra.com/topic/ectopic-pregnancy-revision-notes/🧠 Flashcards: https://www.passthemsra.com/topic/ectopic-pregnancy-flashcards/💬 Accordion Q&A Notes: https://www.passthemsra.com/topic/ectopic-pregnancy-accordion-qa-notes/🚀 Rapid Quiz: https://www.passthemsra.com/topic/ectopic-pregnancy-rapid-quiz/🧪 Quiz Bank: https://www.passthemsra.com/quizzes/ectopic-pregnancy/🎓 Full Course: https://www.passthemsra.com/courses/obstetrics-and-gynaecology-for-the-msra/Hashtags#MSRA #MSRARevision #MSRATextbook #MSRAQuiz #MSRAQuestionBank #MSRAFlashcards #MSRAQANotes #MSRAAccordions #MultiSpecialityRecruitmentAssessment #MSRAOnlineRevision #MSRARevisionWebsite #EctopicPregnancy #ObsAndGynae #ReproductiveHealth