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ECTOPIC PREGNANCY

Abdominal discomfort is very common during pregnancy and can have many causes, especially in the early months.

Lower abdominal pain can have a more serious cause, such as ectopic pregnancy. The vast majority of women with lower abdominal pain in early pregnancy do not have an ectopic pregnancy. Under these circumstances a transvaginal scan or internal scan is the best way to exclude an ectopic pregnancy. In our hands, transvaginal ultrasound can detect more than 90% of ectopic pregnancies. OMNI ensures that any woman who presents with lower abdominal pain in the first trimester has access to the most up to date early pregnancy care.

Ectopic pregnancy

An ectopic pregnancy is the situation where the fertilised egg implants outside the womb, usually in the fallopian tube (95% of the time). As a rule, this is not a normal developing pregnancy and it does not contain a fetus. Ectopic pregnancies are commonly called “tubal pregnancies.” As the ectopic pregnancy grows, the tube may eventually burst (this is because it has not got the same capability as the womb to grow and accommodate a pregnancy). This can cause severe bleeding inside the “tummy” and endanger the mother’s life. The presentation of ectopic pregnancy can be varied from minor non-specific symptoms of bleeding and/or pain to sudden collapse in a woman. The symptoms very often mimic miscarriage and therefore it is important for the clinician to be aware of the possibility of ectopic pregnancy. A urinary pregnancy test is mandatory and if positive, these women need to then have a transvaginal, not transabdominal, ultrasound scan performed. Greater awareness of symptoms and risk factors by General Practitioners and Emergency Physicians can increase the number of women referred for an early scan and in turn potentially decrease maternal morbidity and even mortality. Risk factors for ectopic pregnancy include:
  • Women over the age of 35
  • Previous ectopic pregnancy
  • Previous tubal surgery (including sterilisation)
  • Documented tubal pathology
  • Previous chlamydia or gonorrhoea infection
  • Previous PID (pelvic inflammatory disease)
  • Previous infertility
  • Women who conceive using:
    • Ovulation induction or ovarian stimulation, IVF, ICSI, GIFT and other Assisted Reproductive Techniques (ARTs)
    • Copper and Intra-uterine contraceptive devices (IUCD)
    • Progesterone only contraception
    • Emergency hormonal contraception previously called the “morning after pill”
    • In-utero diethylstilbestrol (DES) exposure
If a woman who conceives has any of the aforementioned risk factors, she should be referred to OMNI for an early scan to confirm the location of the pregnancy.
In selected cases of ectopic pregnancy, OMNI offers non-surgical management strategies which include methotrexate and even expectant management.
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Gynaecology Ultrasound

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Condous performs Advanced Endosurgery procedures for women needing intervention for pelvic masses, adnexal pathology, severe endometriosis or hysterectomy. He also runs ‘Hands on’ Live Sheep Laparoscopic Workshops for gynaecologists at Camden Veterinarian School.
Having completed an undergraduate degree with the University of Adelaide, he left Australia in 1993 and moved to London where he completed his training in Obstetrics and Gynaecology. From 2001 to 2003 Condous worked as a Senior Research Fellow at St George’s Hospital, London. At St George’s he set up the Acute Gynaecology Unit, the first in the United Kingdom. It was also during this time that he developed an interest in Early Pregnancy and especially the management of pregnancies of unknown location (PULs). Condous has developed many mathematical models for the prediction of outcome of PULs which have been featured in numerous peer review journals. In 2005, he returned to Australia where he completed his Laparoscopic Fellowship at the Centre for Advanced Reproductive Endosurgery, Royal North Shore, Sydney.

Condous was appointed as a Consultant Gynaecologist and Senior Lecturer at Nepean Hospital in 2006 and soon was made Associate Professor. In 2010, he was made Departmental Head of Obstetrics and Gynaecology at Nepean Hospital. He obtained the MRCOG in 1999 and was made FRANZCOG in 2005. In 2009, he was awarded his Doctorate in Medicine (MD), University of London, for his thesis entitled: “The management of pregnancies of unknown location and the development of new mathematical models to predict outcome”.

Condous has edited three books including the “Handbook of Early Pregnancy Care”, published over 100 papers in international journals and is internationally renowned for his work in Early Pregnancy. He is the Associate Editor for Gynaecologic Obstetric Investigation, which is a European based journal, as well as the Australasian Journal of Ultrasound in Medicine (AJUM). He is on the organising committee and is an invited speaker at the International Society of Ultrasound in Obstetrics and Gynaecology (ISUOG) Scientific meeting in Sydney 2013. His current research interests relate to the management of ectopic pregnancy, 1st trimester growth, PULs and miscarriage and the use of transvaginal ultrasound (in particular sonovaginography, to predict posterior compartment deep infiltrating rectovaginal endometriosis).Condous is also actively involved with post-graduate education including the annual running of the Early Pregnancy and Gynaecological Ultrasound Interactive Courses for Sonologists, Radiologists, Sonographers and Gynaecologists in Australia.