In ectopic pregnancy all are useful for diagnosis except

Ans) d (Flat abdomen) Ref Williams 22nd ed pg 259All except flat abdomen are useful for diagnosing ectopic pregnancy.Ectopic pregnancyCommonest site - AmpullaCommonest cause - PID (Salpingitis)Other causes - IUCD (Progestasert)- Tubal surgery- Adhesion following pelvic surgery- ARTPrevious ectopic -10% chance of recurrent ectopicModes of termination of tubal pregnancy--- Tubal abortion (most common)- Tubal rupture- Tubal mole- Continuation of pregnancyUterus in ectopic - Decidua without Chorionic villusArias- Stella reaction - Typical adenomatous change of endometrial glandsTubal mptureMost common in isthmic regionIsthmic mpture - 6-8wksAmpullary mpture - 8-12 wksInterstitial mpture - 16wksTriad- AmenorrhoeaAbdominal pain - Most constant feature of triadVaginal bleedingOther symptoms - Nausea, vomiting, fainting attacksInvestigation of choice - TVSAbsence of intrauterine pregnancy with a positive pregnancy testFluid in pouch of douglasAdnexial mass clearly separated from ovaryRarely cardiac pulsationOthers - beta HCG, laparoscopy, D & CS. progesterone>25mg/ml- Intra uterine <5mg/ml- AbnormalStudiford criteria - Primary abdominal pregnancySpiegelberg criteria - Ovarian pregnancyPaalman and Me Elin criteria- Cervical pregnancyDmgs used - Methotrexate KC1 Hyperosmolar glucose Ru-486. Indication for Methotrexate in ectopic pregnancy(1) Patient haemodynamically stable(2) Tubal diameter <4cm without cardiac activities(3) Beta-HCG levelSurgery - Linear salpingostomy- Linear salpingotomy- Salpingectomy- Milking of tube